New England Insurance Agent Blog

Affordable Care Act and Workers Comp:  For Better or for Worse?
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Affordable Care Act and Workers Comp: For Better or for Worse?

NCCI recently published its 2014 Issues Report on Workers Compensation. To no one's surprise, part of their attention is on the Affordable Care Act  - the ACA, better known as Obamacare.  Even though workers comp represents a very small portion of the medical dollars spent in the U.S., it's an important dollar for those of us trying to help employers contain costs.

With over 7 million people accessing health insurance through the ACA's networks, and the prospect that millions more will soon join the ranks of the insured, it's a good time to ask what impact, if any, accessible health insurance will have on workers comp. To begin with, the demand for services, especially at the primary care level, is going to increase dramatically. But as newly insured people begin to use their insurance, we can expect that emergency rooms -- the first choice for treatment for those without choices -- will see a decline in walk-ins suffering acutely from untreated illnesses. Conversely, emergency rooms will remain the primary point of entry for most workers comp claims, as these usually involve injuries in the workplace.  The net effect? Similar if not improved access for injured workers through the ER. In addition, workers with health insurance are less likely to view workers comp as their preferred option for covering injury and illness; a small reduction in the relatively minor incidences of fraud may occur. Finally, if health insurance results in healthier people -- and we certainly hope it does -- these healthier people will be in better shape to do their jobs; when injured, they will recover faster.

It's at the specialty levels that the biggest problems are likely to occur. With millions added to the rolls of the insured, people are going to be diagnosed and treated for myriad illnesses. Primary care physicians -- already in short supply -- will be referring their new patients to specialty care. Certain kinds of these specialties are frequently involved in workers comp, with orthopedics at the top of the list. Increased demand for services may result in injured workers being delayed in accessing specialty care, with any such delays translating into longer time away from work. As every agent knows, time away from work means higher costs for comp. To further complicate the matter, stringent comp fee schedules such as those in Massachusetts already put injured workers at the back of the line for treatment, further aggravating access to timely care; in states such as Connecticut and New Hampshire, however, the generous fee schedule of one (CT) and the absence of a schedule in the other (NH), ensure that injured workers are given priority for treatment.

While there is much public good in expanding health insurance to those who currently lack it, the ACA in its current form raises many concerns.  In the coming months, we will focus our attention on the ACA's impact on workers comp: it's a lonely job, perhaps an insignificant one in the overall scheme of things, but we are happy to do it.

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