Salvage Medicaid by Imposing Personal Responsibility

WASHINGTON - June 17, 2025 - PRLog -- As this headline notes, Medicaid Keeps Getting More Popular as Republicans Aim to Cut it by $800 Billion (https://www.npr.org/sections/shots-health-news/2025/06/17/nx-s1-5435312/medicaid-cuts-big-beautiful-bill-trump-kff-poll), but the proposed cuts are estimated (https://www.nbcnews.com/health/health-care/proposed-medicaid-cuts-lead-thousands-deaths-study-finds-rcna213265) to cause some 7.6 million Americans to lose health insurance, and trigger thousands of avoidable deaths.

But more than half of that total cost is caused by the tiny minority of U.S. adults [11%] who insist upon smoking cigarettes despite the huge costs their smoking imposes on our economy; more than 6 trillion over 10 years, 2.4 trillion in overall health care expenses, and over $500 billion in Medicaid health care costs.

So one way to slash the proposed (and arguably necessary) costs of Medicaid by more than 50% would be to do what many Republicans as well as Democrats have long preached; finally begin imposing personal responsibility for unhealthy lifestyle choices.

Require those who currently enjoy Medicaid insurance at taxpayer expense to either quit smoking, or to pay the huge costs which their smoking now imposes on the great majority of American taxpayers, suggests public interest law professor John Banzhaf, "The Man Behind The Ban on Cigarette Commercials," the "Ralph Nader of the Tobacco Industry," and "a Driving Force Behind the Lawsuits That Have Cost Tobacco Companies Billions of Dollars."

Imposing this simple requirement, for the same reason a 50% smoker surcharge was included under Obamacare, would save those who cannot make this fundamental change  from having their health insurance snatched from them.

This simple alternative, which has been approved and advocated by the states' insurance commissioners, tested by many private companies, and incorporated under Obamacare, would save many lives, says the law professor.

Instead of broadly slashing Medicaid benefits across the board, imposing personal responsibility upon those who balloon the costs of medical services by asking them to quit smoking or pay for the huge medical costs they now impose on others would help solve the problem, says Banzhaf, who helped persuade Congress to adopt the 50% surcharge on smokers under Obamacare based upon research he did for the National Association of Insurance Commissioners [NAIC].

Asking them to accept personal responsibility for their own unhealthy and often deadly lifestyle choices by paying all or most of that in order to remain on Medicaid would help persuade many of them to quit; while those who refuse would be paying their fair share of the costs rather than imposing them on others, Banzhaf adds.

http://banzhaf.net/   jbanzhaf3ATgmail.com  @profbanzhaf