Mortocracy: Taking Our Lives For Their Profit

Omega Young lived in Evansville, and she had cancer. When she landed in the hospital, she called the state's help line to say where she was, and the state cut off her Medicaid and her food stamps anyway, with a notice that said she had "failed to cooperate." She died on March 1, 2009. By the time Indiana ended the contract for the computer system that sent her that notice, the state had paid IBM and its partners more than $440 million.

I have spent months following money like that through Indianapolis, from Mayor Steve Goldsmith's sewer contract in 1994 to the Medicaid work requirements that start on January 1, 2027, and what I found needed a name. I call it Mortocracy. It is what happens when the people who decide who pays, who gets help, and who keeps a home make choices that shorten other people's lives, and they never carry that cost themselves.

Seventeen miles, sixteen years

Fishers and the near south side of Indianapolis sit about 17 miles apart. Researchers at the Fairbanks School of Public Health and the Polis Center measured life expectancy ZIP code by ZIP code, and between 2014 and 2018 the gap between Fishers and the shortest-living ZIP code inside the city grew to 16.8 years. A few years earlier the gap had been 13.6 years, so it is getting wider. In the first study, people living just south of Monument Circle could expect to live to about 69, the same as people in Iraq, while people in the northeast suburbs could expect to live past 83, the same as people in Japan.

That gap has a lot of causes, and the researchers say so. What I wanted to know was who collects money from the people on the short end of it.

The bills that never stop

In 2015 Indiana told its poorest adults on Medicaid to pay into a health account every month, which the state called a POWER account, for Personal Wellness and Responsibility. The payments were small, often a few dollars, and churches and nonprofits sometimes covered them. About 60,000 people, nearly a third of everyone charged, lost their coverage or never got it because a payment didn't come in. Mulugeta Wolfe, who went back on the plan, told a reporter the hardest part was remembering to pay. A federal judge threw the requirement out in 2024.

Indiana makes it a felony to lend money at 72 percent interest a year, except for one kind of loan. Since 2002, payday lenders have been allowed to charge up to 391 percent on two-week loans. The typical borrower earns about $19,000 a year, and about 60 percent take out a new loan the same day they pay off the old one. An advocacy group counted more than $300 million in fees over five years, most of it going to companies based outside Indiana. In 2019 the Indiana Senate voted down a 36 percent cap, 22 to 27, and on the same day voted for a bill that kept the 391 percent loans and added new ones.

Marion County landlords filed more than 25,000 evictions in 2024. Fifty owners, many of them out-of-state investment firms, filed more than half the cases in the first half of 2022. A filing goes into the public court system, a data company buys it, and a screening company turns it into a score the next landlord reads, even when the tenant paid up and the case was dismissed. In 2023 federal regulators made TransUnion's screening company pay $15 million for reporting dismissed and sealed evictions. Jessica Savage of Hoosier Action, turned down for housing over a filing that went nowhere, said that in Indiana an eviction record means you might as well give up. Princeton's Eviction Lab found that people who get an eviction filing have about 19 percent higher death rates, and people who lose the case have about 40 percent higher.

Even the sewer bill plays a part. Goldsmith's 1994 contract with a private operator saved the city real money and raised pay for the plant workers who stayed. Over the next thirty years, though, people paying sewer bills, renters included, also paid for police and fire pensions, a $425 million payment to the city in 2011, and $1.5 billion in debt, and none of them ever got a vote.

They have the numbers

The people who make these rules have the numbers. Indiana's own evaluator counted the people the POWER account pushed off coverage in 2016, and the state tried to bring the payments back in 2024 until a judge stopped it. Advocates have handed lawmakers payday loan studies for years, and bills to cap the rate have gone without a hearing, even though 88 percent of Hoosiers told pollsters they wanted a cap. FSSA Secretary Mitch Roob says health care for people like Mulugeta Wolfe is a benefit that has to be earned, and starting in January, members will have to prove 80 hours of work a month or lose it.

The patience goes one way, and the deadlines go the other. When IBM failed, it got ten years of court hearings, appeals, and a fight over the interest on its fees. When the nonprofit landlord JPC let its buildings fall apart while keeping a charitable tax break for more than a decade, it settled, sold its buildings, and left the state. When Omega Young called the state from a hospital bed, she got a letter.

Not everyone in this story got rich. The Medicaid health plans spend about 91 cents of each dollar on care, and some payday stores make thin margins. The money still moves in one direction, from the people with the least to the people who set the rules, and the cost lands on how long people live.

What would change it

Indiana could cap small loans at 36 percent, the same cap the federal government already puts on loans to people in the military. It could stop charging the poorest adults on Medicaid a monthly fee for their own health care. It could slow down eviction filings, give tenants a lawyer, and make data companies delete cases the courts have sealed. It could make contractors pay back what their own employees steal, and it could put the people who pay these bills on the boards that set them.

Omega Young called to tell the state where she was. Somebody should have called her back.

The full research, with every source, is Mortocracy: Who Pays, Who Profits, and Who Dies Early in Indianapolis.