Abby Anderson: Incarceration should not be a debt sentence

By Abby Anderson

The Washington State Legislature recently passed HB1412, which will expand judicial discretion of a person’s ability to pay legal financial obligations and their associated 12% interest rates. However, the unjust expenses of the criminal justice system do not end there. The inmate exclusion policy in the Social Security Act severely limits people who are incarcerated from accessing affordable health care and should be removed from federal statute.

I believe our current carceral system does not work for anyone – not victims, perpetrators, nor people awaiting trial. Instead, the current system provides a false sense of security to the general public, while limiting well-being and inflicting further debt on people who are incarcerated.

In Washington state, people who are incarcerated can make a maximum of $55 per month through work programs. They also have a $4 copay for all medical services not considered “medically necessary preventative care” (such as tuberculosis screenings and medically appropriate vaccinations). At these rates, it would take someone who is incarcerated 11.11 hours of work to afford one $4 copay. To illustrate further, if you make $15 per hour, a $4 copay is the equivalent of $166.65 each time you visit the doctor. If someone cannot afford the $4 copay, they will fall into copayment debt and for many who are incarcerated, this debt will be added to the mountains they have already accumulated from criminal legal fines and fees.

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

While federal law inhibits complete policy change, Washington has taken small steps to improve Medicaid coverage. In 2017, the Washington Department of Health changed its policy to allow individuals who are incarcerated to suspend, rather than terminate, their Medicaid coverage. This allows individuals to reinstate their coverage upon re-entry, but it limits the scope of their coverage during incarceration to covering only 24-hour or longer stays in an inpatient facility, charging copays for all other medical visits. To further support reentry, in May 2021, Gov. Jay Inslee approved the formation of a work group to investigate ways Washington can allow individuals to reinstate their Medicaid coverage 30 days prior to re-entry, eliminating the gap in coverage upon release. These policies, however, do not sufficiently break down barriers to health and well-being for people while they are incarcerated.

The Department of Corrections has an obligation to care for those living within their facilities. In the case of Estelle v. Gamble (1976), the Supreme Court ruled that denying access to medical care constitutes cruel and unusual punishment. Financial barriers deter people from seeking care and therefore should be considered along these same lines. People who are incarcerated experience substance use disorders and mental health challenges at a higher rate than the general population. As COVID-19 revealed, people in carceral facilities are extremely susceptible to communicable diseases. People who are incarcerated deserve equitable and affordable access to care for all health and well-being 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 needs to continue to recognize the expensive and unjust charges of the criminal legal system and support the well-being of people who are incarcerated by eliminating copays.

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.