Imposing Personal Responsibility Can Help Save Medicaid

WASHINGTON - May 18, 2025 - PRLog -- While many Americans are fearing major cuts under Medicaid, a technique developed and advocated by the National Association of Insurance Commissioners [NAIC], and utilized many times since then - including under Obamacare - could slash the costs of medical care under Medicaid simply by imposing personal responsibility, suggests public interest law professor John Banzhaf.

Instead of broadly slashing Medicaid benefits across the board, imposing personal responsibility upon those who balloon the costs of medical services by continuing to smoke - by making them pay for the huge medical costs they now impose on others - would help solve much of the problem, says Banzhaf, who helped persuade Congress to adopt a 50% surcharge on smokers under Obamacare based upon research he did for the NAIC.

Cigarette smoking cost the U.S. more than $600 billion in 2018,including more than $240 billion in healthcare spending.  A whooping 21.5% of that was imposed upon Medicaid.

So if the majority of smokers were to quit, taxpayers would save over $50 billion a year in Medicaid; more than half of the $88 billion annual cuts in Medicaid spending now being sought.

One way to do this - as recommended by the NAIC - would be to require smokers to pay the excess costs their habit now unnecessarily imposes in order to have health insurance coverage; just as smokers have always been required to pay more than nonsmokers for their life insurance, and in many cases for their home and/or car insurance.

A typical 2-pack-a-day smoker now spends over $7000 a year to smoke, while imposing the huge medical care costs on others though various programs, including Medicaid.

Asking them to accept personal responsibility for their own unhealthy health care choices by paying most of that ito remain on Medicaid would pressure some of them to quit; while those who choose to remain smokers would be paying their fair share of the costs
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It is estimated that, under the Medicaid reform proposed by the House Republicans, more than 8.5 million Americans will become uninsured.

So, while forcing smokers to pay a fair share of the huge health costs they currently impose on others through Medicaid might persuade many of them to leave the plan, this is less unfair since they can avoid this simply by giving up smoking;argues Banzhaf.

Needless to say, imposing the same personal responsibility to pay for the unnecessary costs they impose on Medicaid on those who are obese (or even morbidly obese) would also result in substantial savings to Medicaid; and they too could avoid the consequences by eating a less unhealthy diet.

http://banzhaf.net/   jbanzhaf3ATgmail.com