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

Risk Management

The Profession

Wawa’s Director of Risk Management knows that harnessing data and analytics will be key to surviving the rapid pace of change that heralds new risk exposures.
By: | July 27, 2017 • 5 min read

R&I: What was your first job?

My first job was at the age of 15 as a cashier at a bakery. My first professional job was at Amtrak in the finance department. I worked there while I was in college.

R&I: How did you come to work in risk management?

A position opened up in risk management at Wawa and I saw it as an opportunity to broaden my skills and have the ability to work across many departments at Wawa to better learn about the business.

R&I: What is the risk management community doing right?


The advancements in analytics are a success for the industry and offer opportunities for the future. I also find value in the industry focus on emerging and specialty risks. There is more alignment with experts in different industries related to emerging and specialty risks to provide support and services to the insurance industry. As a result, the insurance industry can now look at risk mitigation more holistically and not just related to traditional risk transfer.

R&I: What could the risk management community be doing a better job of?

Developing the talent to grow with the industry in specialization and analytics, but to also carry on the personal connections and relationship building that is a large part of this industry.

Nancy Wilson, director, quality assurance, risk management and safety, Wawa Inc.

R&I: What was the best location and year for the RIMS conference and why?

I have had successes at all of the RIMS events I have attended. It is a great opportunity to spend time with our broker, carriers and other colleagues.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

I think the biggest challenge facing most companies today is related to brand or reputational risk. With the ever-changing landscape of technology, globalization and social media, the risk exposure to an organization’s brand or reputation continues to grow.

R&I: What emerging commercial risk most concerns you?


The changing consumer demands and new entrants into an industry are concerning. This is not necessarily something new but the frequency and speed to which it happens today does seem to be different. I think that is only going to continue. Companies need to be prepared to evolve with the times, and for me that means new risk exposures that we need to be prepared to mitigate.

R&I: Are you optimistic about the U.S. economy or pessimistic and why?

I try to be optimistic about most things. I think the economy ebbs and flows for many reasons and it is important to always keep an eye out for signs of change.

R&I: What have you accomplished that you are proudest of?

I am fortunate to have opportunities professionally that make me proud, but I have to answer this one personally. I have two children ages 12 and 9 and I am so proud of the people that they are today. They both are hardworking, fun and kind. Nothing gives me a better feeling than seeing them be successful. I look forward to more of that.

R&I: What is your favorite book or movie?

This is really hard as there are too many favorites. I do prefer books to movies, especially if there is a movie based on a book. I find the movie is never as good. I have multiple books going at once and usually bounce back and forth between fiction and non-fiction.

R&I: What’s the best restaurant you’ve ever eaten at?


I have eaten at a lot of different restaurants in many major cities but I would have to pick Horn O’ Plenty in Bedford, PA. It is a farm to table restaurant in the middle of the state. The food is always fresh and tastes amazing and they make me feel like I am at home when I am there. My family and I eat there often during our trips out that way.

R&I: What is your favorite drink?

I do love a good cup of coffee (working at Wawa helps that). I also enjoy a good glass of wine (red preferably) on occasion.

R&I: What is the most unusual/interesting place you have ever visited?

Vacations aside, I do get an opportunity to travel for work and visit our food suppliers. The opportunities I have had to visit back to the farm level have been a very interesting learning experience. If it wasn’t for my role, I would have never been able to experience that.

R&I: What is the riskiest activity you ever engaged in?

My husband, kids and I recently did a boot-camp-type obstacle course up in the trees 24 feet in the air. Although I had a harness and helmet on, I really put my fear of heights to the test. At the end of the two hours, I did get the hang of it but am not sure I would do it again.

R&I: If the world has a modern hero, who is it and why?

The first people that come to mind are those who are serving our country and willing to sacrifice their own lives for our freedom.

R&I: What about this work do you find the most fulfilling or rewarding?

Every day is different and I have the opportunity to be involved in a lot of different work across the company.

R&I: What do your friends and family think you do?

My husband and children have a pretty good sense of what I do, but the rest of my family has no idea. They just know I work for Wawa and sometimes travel.

Katie Siegel is an associate editor at Risk & Insurance®. She can be reached at [email protected]