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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?

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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.

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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.

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The R&I Editorial Team can be reached at [email protected]