There is a conversation occurring concerning the ability of states to administer specific personal responsibility requirements on Medicaid beneficiaries to receive coverage benefits. This discussion is relevant as it relates to the Medicaid Work Requirements that states are currently proposing. A seemingly simple notion on the surface; recipients must meet specific requirements as a condition of their coverage, but understanding the implications, including the legal ramifications, are important to both sides of the conversation.
At the heart of the matter is the question, “Is healthcare coverage a privilege or a right?” Interestingly, when posed to the general public, 50% fall on each side of the equation. We fund healthcare for those that are eligible, thus it is our given right. If one requires emergency services, regardless of their ability to pay, the Emergency Medical Treatment & Labor Act (EMTALA), prevents Emergency Departments from declining care based on ability to pay. This is also true for the basic rights of inmates, the same rights apply no matter what crime was committed.
When we view something like healthcare as a fundamental right of being, we should also assume there are certain responsibilities required of us. We have an obligation to our fellow community members just as our community is beholden to us.
The dilemma arises when a person does not uphold their responsibilities. But, who defines these requirements and responsibilities? How are they monitored, and more importantly, what are the repercussions for failure to uphold such responsibilities? If I don’t take steps to support my own health, do I lose my inherent right to healthcare? If so, is it indeed a right or merely a privilege in disguise?
We must answer these tough questions if we wish strike a balance between the polarities of right and privilege as well as those of rights and responsibilities when it comes to healthcare. And on a grander scale, we also have an obligation as a community to serve as many as possible within our often-limited resources. Therefore, we must incorporate constraints into our system to provide for more versus providing more to just a few.
The way I see it, if we are to manage these dualities successfully, it is paramount we appreciate all the complexities. Creating absolutes in a setting of ambiguity will only lead to fewer served.
Designing models in test environments are essential. Using trial and error will help us reach a model where equilibrium occurs. Adjustments will likely be required as we move along in our journey. If we identify that a methodology is not working, we need to view that learning as a success rather than a failure. If we do not, innovation will be limited, and progress will not occur. In any design phase, including all stakeholders in the conversation is imperative. Each of those participating in the discussion must understand their own internal biases, and all must agree on a universal principle and work forward from that spot. Often, finding that common ground is the biggest challenge.
Let us not shirk our responsibilities to each other and those we are blessed to serve by avoiding the hard questions or taking a position of not being willing to listen and learn.