Medical Debt In Prisons

Hospitals, prisons and other community service agencies, in addition to being landing pads for those with mental illness, also contribute to the problem of homelessness through mounting debt and inadequate discharge planning. Medical debt is the leading cause of bankruptcy and contributes to housing instability in 27% of people struggling with medical bills (Pollitz et al. n.p.). Even among individuals with private health insurance, those with “out-of-pocket medical expenses that exceed five percent of their income are about twice as likely to have difficulties paying their rent and utilities, [and] affording food…” (Pollitz et al. n.p.). Likewise, the prison system burdens its “guests” with crippling debt. The costs imposed on criminal defendants – which include court fees, restitution, fines, booking fees, probation supervision fees, treatment fees for any ailments or substance abuse, per diem
fees for the cost of incarceration, and the legal extortion that constitutes the prison commissary system – leave ex-cons with the harsh lesson, that although their formal sentence has ended, the punishment continues (Swartztol & Shafroth). “These convictions often spark a cascade of economic consequences that persist for years after the formal sentence is over and threaten a person’s ability to successfully and self-sufficiently re-enter society” (Swartztol & Shafroth).
This transition can also be made harder by the complete lack of discharge assistance. The Department of Corrections essentially opens the door and pushes them outside, with nothing but the clothes and belongings they entered with. Increasingly, it seems hospitals do the same. Forster et al. found that nearly 20% of patients experience an adverse event within three weeks of discharge. Patients and their families assume the burden of care upon release from the hospital, including the costs and reconciliation of resources. For those with housing instability, this process can contribute to the loss of their housing. Another population vulnerable to transition issues is young adults aging out of the foster care system. Research conducted at the University of Chicago reported one in three youths released from the foster care system experienced at least one episode of homelessness (Predictors). Each of these transitional failures and subsequent risk of homelessness could have been prevented with adequate planning and discharge assistance through case managers or social
workers.
For many vulnerable populations, family and domestic violence are the impetus to homelessness. For women, this is one of the leading causes. “Lack of affordable housing and long waiting lists for assisted housing mean that many women and their children are forced to choose between abuse at home and life on the streets” (Domestic). Many youth run away from home to escape family problems, physical and sexual abuse, substance abuse or mental health problems of a family member, and parental neglect (Finzel). Lesbian, Gay, Bisexual, and Transgender (LGBT) youth can face homelessness after being rejected by their families or forced out of their homes after coming out. One study found that 40% of homeless youth served by various agencies identified as LGBT (LGBT). While there are social services that try to help women and families fleeing domestic violence, “there are currently no federal programs specifically designed to meet the needs of gay and transgender homeless youth, and there are no protections in place to keep gay and transgender youth from being discriminated against while accessing federally funded homeless services” (LGBT). However, social services fail both populations, as evidenced by the number of women and both hetero- and homosexual youth on the streets.
Economic factors contributing to homelessness include income disparity, foreclosures, and unemployment. The gap between rich and poor continues to grow, as the poor grow poorer and the rich grow richer. Research on income disparities show that they “…have increased sharply over the past few decades, with the average real income of households in the bottom decile down 18 percent in 1980– 2014 (from $7,700 to $6,300) and that of households in the top decile up 66 percent (from $154,000 to $256,000)” (The State 15). Workers struggle to make ends meet on their low wages. “Despite five years of growth American real wages are still 1.2% below what they were at the beginning of 2009 (Economist). In 2014, median pay was 10% lower than it was in 2008 at the beginning of the recession (Economist). As the Economist reports, wages should increase at roughly the same rate as production. They state, “the two moved in tandem following the second world war (between 1947 and 1960 both rose by 51% in America) but have been drifting apart since the 1960s: since 1960 productivity in America has risen by almost 220%, but real wages by less than 100%.” And while many people struggle to survive on low wages, others cannot even find work. Unemployment rates, while decreasing since the sharp spike caused by the recession, hover around 5% currently (Bureau of Labor Statistics). But some regions are affected more than others. Rural areas and America’s Rust Belt, which traditional relied on manufacturing jobs, are suffering from the deindustrialization of the U.S. economy. “Many regard deindustrialization with alarm and suspect it has contributed to widening income inequality in the United States and high unemployment in Europe” (Rowthorn & Ramaswamy 1). Manufacturing employment peaked at 28% in 1965 and has fallen steadily to 16% in 1994, at which point the enactment of the North American Free Trade Agreement (NAFTA) increased the rate (Rowthorn & Ramaswamy 2, Long n.p.). However, this began to decline again in 2000; the U.S. currently has an 8% manufacturing employment rate (Long). These industrial jobs typically pay significantly more than minimum wage, which means workers who once made a comfortable living are now struggling with low wages in new jobs, if they can find employment at all.
The result of this shift, combined with the economic recession and subsequent housing market collapse, has been unprecedented numbers of foreclosures, which has forced numerous families onto the streets. Fortunately, the foreclosure rate is declining as we move further in time from the recession. According to CoreLogic, the total number of foreclosure completions averaged 55,900 per month in 2015. However, those numbers fell to 38,000 in January of 2016 and continue to decline. Despite improvements, these economic factors continue to contribute to the problem of homelessness in America.