Abby Anderson: Incarceration shouldn’t be a debt sentence

By Abby Anderson

The Washington State Legislature recently passed HB1412, which will expand the judicial discretion of a person’s ability to pay statutory financial obligations and their associated interest rates by 12%. However, the unfair spending of the criminal justice system does not stop there. The Social Security Act’s inmate exclusion policy severely limits incarcerated people’s access to affordable health care and should be removed from federal law.

I believe that our current prison system does not work for anyone – neither the victims, nor the perpetrators, nor those awaiting trial. Instead, the current system gives a false sense of security to the general public, while limiting welfare and further indebting those incarcerated.

In Washington state, incarcerated people can earn a maximum of $55 a month through work programs. They also have a $4 co-pay for all medical services not considered “medically necessary preventive care” (such as tuberculosis screenings and medically appropriate vaccinations). At these rates, it would take an incarcerated person 11.11 hours of work to pay a copayment of $4. To illustrate further, if you earn $15 per hour, a $4 co-pay equals $166.65 on each doctor visit. If someone can’t afford the $4 copayment, they will fall into copayment debt and for many incarcerated people, that debt will add to the mountains they’ve already piled up from fines. and legal fees.

The Social Security Act’s inmate exclusion policy prohibits “public institution inmates” from receiving Medicaid coverage. This exclusion applies to all incarcerated persons except the few who may be able to maintain private insurance. This leaves the vast majority of those incarcerated without medical coverage and subject to $4 copays.

While federal law prevents a comprehensive policy change, Washington has taken small steps to improve Medicaid coverage. In 2017, the Washington Department of Health changed its policy to allow incarcerated people to suspend, rather than terminate, their Medicaid coverage. This allows individuals to reinstate their coverage upon reintegration, but it limits the scope of their coverage during incarceration to coverage of stays of 24 hours or more in a hospital facility, charging co-payments for all others medical visits. To further support re-entry, in May 2021 Governor Jay Inslee approved the formation of a task force to investigate ways in which Washington can allow individuals to reinstate their Medicaid coverage 30 days before re-entry, eliminating the coverage gap at release. However, these policies do not sufficiently remove barriers to people’s health and well-being while incarcerated.

The Department of Corrections has an obligation to care for those who live in its facilities. In Estelle v. Gamble (1976), the Supreme Court held that denial of access to medical care constituted cruel and unusual punishment. Financial barriers deter people from seeking care and should therefore be considered along the same lines. Prisoners suffer from substance use disorders and mental health problems at a higher rate than the general population. As revealed by COVID-19, people in prisons are extremely susceptible to communicable diseases. Prisoners deserve equitable and affordable access to care for all their health and wellness needs.

The federal government should abolish the inmate exclusion policy and allow all individuals to have health insurance coverage while incarcerated.

Until then, Washington State must continue to recognize the costly and unjust charges of the criminal justice system and support the well-being of those incarcerated by eliminating copayments.

Abby Anderson grew up in Mead, earned her undergraduate degree at Gonzaga University, and is pursuing master’s degrees in public administration and social work at the University of Washington.


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John A. Bogar