Risk Insider: Noah Skillin

Do I Have a Right to Be Uninsured?

By: | May 2, 2017 • 3 min read
Noah Skillin is the COO and a founder of Risk Cooperative. His focus is on leading the marketing, compliance, systems and IT for a global risk and insurance advisory firm based in Washington, DC. He is an experienced risk management practitioner holding PMP and CRM designations.

With the ongoing attempts to repeal the Affordable Care Act, one key argument against the ACA is that the mandate for all individuals to have health insurance coverage strips Americans of their right to make a personal decision. But is it only personal? Should individuals have the right to refuse coverage and go uninsured?


On paper in a zero-sum world, the answer to this question is easy. If you want to take the risk of not having health insurance, who is to stop you? Presumably individuals can weigh the cost of having coverage against the chance of needing medical attention and determine if they wish to forego coverage.

However, it’s not that simple. When others go without insurance, it not only comes at a cost to society, but also to the individuals who have elected to pay for insurance, as well as the businesses that provide it to employees.

When the number of individuals experiencing serious medical conditions is higher, it can also lead to full hospital and emergency room beds and increased waiting times for ambulances and treatment, impacting both insured and uninsured individuals alike.

Many argue that the lower-cost options under the ACA come with high deductibles that require patients to pay significant fees out of pocket. While it is true that there are high-deductible plans, it is important to note that a primary feature of the ACA was to ensure that preventative care is available to all Americans without being subject to any deductible.

In other words, any insured person can seek treatment for preventative or wellness benefits, such as annual physicals. These visits often uncover issues early on, when they are more easily and affordably treated. However, when an individual is uninsured, they are unlikely to seek treatment for seemingly minor issues. Often, these issues are exacerbated if they are not treated early.

The end result may be much more serious and costly emergency medical visits. In addition, with the rise of vector-borne diseases, such as Zika and others, when the uninsured do not seek treatment early it can lead to more rapid spread of the disease throughout society.

When the number of individuals experiencing serious medical conditions is higher, it can also lead to full hospital and emergency room beds and increased waiting times for ambulances and treatment, impacting both insured and uninsured individuals alike.

A healthier community is important for the economy. If workers are sick, they either miss work or work while impaired, decreasing their productivity. The healthier they are, the more productive and thus the stronger the economy.

There are also real costs that may be passed on to insured individuals. Since the passing of the Emergency Medical Treatment and Labor Act in 1986, emergency departments are federally mandated to treat patients regardless of insurance or ability to pay for treatment. When an uninsured patient comes to an emergency room, he or she receives the same treatment as an insured patient — and these are often the costliest as they are, by their nature, serious events.


When the patient is unable to pay after the fact, there is little recourse for the hospitals to recuperate funds for the treatment provided. This in turn can lead to higher fees and increased insurance costs for those who are insured, in addition to taxpayers funding this through Medicare and Medicaid programs.

Patients without insurance cost the health care system billions each year. The American Hospital Association estimated that hospitals in 2015 provided more than $35 billion worth of uncompensated care.

While it may seem like a personal decision to buy insurance or not, the reality is the choice has serious consequences on others, including those who cannot afford insurance and others who are insured. The impacts can range from worse care, to increased spread of diseases, to a less productive workforce.

More from Risk & Insurance

More from Risk & Insurance

2017 Teddy Awards

The Era of Engagement

The very best workers’ compensation programs are the ones where workers aren’t just the subject of the program, they’re a part of it.
By: | November 1, 2017 • 5 min read

Employee engagement, employee advocacy, employee participation — these are common threads running through the programs we honor this year in the 2017 Theodore Roosevelt Workers’ Compensation and Disability Management Awards, sponsored by PMA Companies.

A panel of judges — including workers’ comp executives who actively engage their own employees — selected this year’s winners on the basis of performance, sustainability, innovation and teamwork. The winners hail from different industries and regions, but all make people part of the solution to unique challenges.


Valley Health System is all-too keenly aware of the risk of violence in health care settings, running the gamut from disruptive patients to grieving, overwrought family members to mentally unstable active shooters.

Valley Health employs a proactive and comprehensive plan to respond to violent scenarios, involving its Code Atlas Team — 50 members of the clinical staff and security departments who undergo specialized training. Valley Health drills regularly, including intense annual active shooter drills that involve participation from local law enforcement.

The drills are unnerving for many, but the program is making a difference — the health system cut its workplace violence injuries in half in the course of just one year.

“We’re looking at patient safety and employee safety like never before,” said Barbara Schultz, director of employee health and wellness.

At Rochester Regional Health’s five hospitals and six long-term care facilities, a key loss driver was slips and falls. The system’s mandatory safety shoe program saw only moderate take-up, but the reason wasn’t clear.

Rather than force managers to write up non-compliant employees, senior manager of workers’ compensation and employee safety Monica Manske got proactive, using a survey as well as one-on-one communication to suss out the obstacles. After making changes based on the feedback, shoe compliance shot up from 35 percent to 85 percent, contributing to a 42 percent reduction in lost-time claims and a 46 percent reduction in injuries.

For the shoe program, as well as every RRH safety initiative, Manske’s team takes the same approach: engaging employees to teach and encourage safe behaviors rather than punishing them for lapses.

For some of this year’s Teddy winners, success was born of the company’s willingness to make dramatic program changes.


Delta Air Lines made two ambitious program changes since 2013. First it adopted an employee advocacy model for its disability and leave of absence programs. After tasting success, the company transitioned all lines including workers’ compensation to an integrated absence management program bundled under a single TPA.

While skeptics assume “employee advocacy” means more claims and higher costs, Delta answers with a reality that’s quite the opposite. A year after the transition, Delta reduced open claims from 3,479 to 1,367, with its total incurred amount decreased by $50.1 million — head and shoulders above its projected goals.

For the Massachusetts Port Authority, change meant ending the era of having a self-administered program and partnering with a TPA. It also meant switching from a guaranteed cost program to a self-insured program for a significant segment of its workforce.

Massport’s results make a great argument for embracing change: The organization saved $21 million over the past six years. Freeing up resources allowed Massport to increase focus on safety as well as medical management and chopped its medical costs per claim in half — even while allowing employees to choose their own health care providers.

Risk & Insurance® congratulates the 2017 Teddy Award winners and holds them in high esteem for their tireless commitment to a safe workforce that’s fully engaged in its own care. &


More coverage of the 2017 Teddy Award Winners and Honorable Mentions:

Advocacy Takes Off: At Delta Air Lines, putting employees first is the right thing to do, for employees and employer alike.


Proactive Approach to Employee SafetyThe Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.


Getting It Right: Better coordination of workers’ compensation risk management spelled success for the Massachusetts Port Authority.


Carrots: Not SticksAt Rochester Regional Health, the workers’ comp and safety team champion employee engagement and positive reinforcement.


Fit for Duty: Recognizing parallels between athletes and public safety officials, the city of Denver made tailored fitness training part of its safety plan.


Triage, Transparency and TeamworkWhen the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.

A Lesson in Leadership: Shared responsibility, data analysis and a commitment to employees are the hallmarks of Benco Dental’s workers’ comp program.


Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]