The most significant elements of The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA), became effective 2014. Most talked about include the health insurance mandates (now delayed until Jan 2015) and implementation of health exchanges. What can WC benefit providers expect? Possibly some reduction in claims as the general population becomes healthier, or a reduction in the uninsured workforce filing for WC for conditions that may not be work related, or an increase of claims due to employees being made part time without insurance benefits.
There are some factors that we will discuss that may have an impact on Workers Compensation claims. Convenience is a factor and those who have the knowledge base to use their long awaited health insurance coverage may find it an easier path to regular treatments. Let’s face it, WC claims are complicated, workers dislike the lack of control and physicians find the administrative requirements of WC time-consuming. However, the increase use of deductible and co-pays in the health care market could drive users back to WC. There are also shortages of PCPs and treating doctors on both sides of the fence. With the influx of so many new people seeking medical care, the lack of qualified doctors will definitely increase the longevity and cost of a WC claim. Reimbursements is also a key factor. Another significant factor is the ACA will prohibit health insurers from refusing coverage for preexisting conditions. WC has been used by many to obtain healthcare for preexisting conditions. Will we see a shift from WC to health insurance? Only time will tell.
Another influence is the Patient-Centered Outcomes Research Institute (PCORI) created to perform comparative effectiveness research. PCORI is expected to identify the most effective medical treatment and preventative medicine. The hope is this should establish evidence-based guidelines that will improve outcome and in turn decrease medical costs in WC and health insurance.
The hope of the ACA is that the new law would lead to a healthier work force and more affordable and available health insurance. One thing that is certain is CHANGE. The next few years will be ever changing and we can only hope for a shift of significant proportion in the right direction.
  • References: Milliman – An Act of unknown consequences for workers compensation. Centers for Medicare & Medicaid. Rand Institute – Evidenced from MA. Evaluation Medical TX Guidelines Sets for Injured Workers in CA. PCORI. Sathiyakumar- The Future of Workers’ Compensation under PPACA.