How Health Care Reform Could Change Workers’ Compensation

Ever since the Patient Protection and Affordable Care Act passed in 2010, there has been much speculation about how the new laws will change the face of health care in the United States. Much of the attention has focused on the new requirements for individuals to carry health insurance coverage and the impact that will have on employers. 

However, health insurance isn’t the only type of insurance coverage that will be impacted by the new laws. The expanded health care coverage regulations are also expected to affect workers’ compensation insurance. How those effects will play out remain to be seen, but there is speculation that there will be significant decreases — and potential increases — to workers’ compensation costs.

Better Health Care, Fewer Injuries, Lower Costs

Each year, there are millions of workers’ compensation claims filed, costing employers — and hospitals — billions. However, according to researchers, not all of those claims are actually due to work-related injuries. In many cases, employees without adequate insurance coverage would use their workers’ compensation coverage to pay for treatment for pre-existing conditions or injuries. Under the new health care law, the individual mandate requires that everyone carry at least basic health insurance coverage. This means that people may be more likely to seek treatment for illness and chronic conditions via their regular insurance coverage, and not file a workers’ comp claim — thereby lowering the cost for workers’ compensation.

However, and perhaps more importantly, experts predict that the actual number of on-the-job illnesses and injuries will actually decrease thanks to the PPACA. Because employees will have better access to health care, particularly preventive care and chronic condition management, they will be healthier overall. While conditions like obesity and diabetes or behaviors like smoking are not generally the specific cause of a workplace injury, they often contribute to the severity of the injury or illness, thereby increasing costs. Ideally, the PPACA will improve overall health, and reduce overall costs.

Cost Shifting

While many people believe that the PPACA will lower the costs of caring for sick or injured employees, others predict that the new laws will only shift the costs to different payers. When employees have adequate health coverage, they may be more likely to simply use that insurance to cover their expenses, rather than make a workers’ comp claim and endure the scrutiny and red tape that often ensues. So while specific workers’ comp claims will decrease, the overall costs for health care will remain flat, or even increase, as those who would not have sought treatment previously, now do so.

Changes to Medicare reimbursement rates could also impact workers’ compensation once the law goes into effect. On the surface, because hospitals will no longer have to bear the significant burden of covering free or reduced care for low-income patients without health coverage, they won’t have to bill workers’ compensation insurance as aggressively as they do now. However, because workers’ compensation rates are tied to Medicare reimbursement rates — which are perpetually on the chopping block — there may be little difference in how hospitals bill workers’ comp, and they may actually increase the charges to workers’ compensation insurance to make up for shortfalls.

Claim Process Changes

Because cost containment is one of the primary goals of the PPACA (watch an informative video about the act here), certain changes to how claims are processed and managed are predicted to help manage costs. Because the new laws call for better care coordination and standardized reporting, the overhead costs of managing and processing claims should decrease. In addition, many states are enacting new laws calling for mediation, rather than litigation, in workers’ compensation dispute cases. Mediation will reduce the length of time it takes to process claims — and potentially get employees back to work sooner — and also potentially help reduce claim payments.

Again, there is much speculation about how the PPACA will affect workers’ compensation coverage and claims, and only one thing is certain: There will be changes. Employers who are navigating the new landscape of health care reform should seek more information to understand how the changes will impact them and how they can best position themselves to make a seamless and affordable transition to the new health care landscape.

About the Author: Eleanor Harpswell is the benefits and compensation manager for a New England–based manufacturing firm. A former insurance professional, she contributes to several industry publications, offering insight and analysis into issues related to managing employee insurance coverage.