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Health Care Reform and Workers Compensation

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Since its passage in 2010, the Affordable Care Act (ACA), commonly referred to as health care reform, has been the subject of intense political debate and a source of anxiety for many employers. Although most employers have focused on the law’s health benefit requirements, the ACA is also expected to impact how they manage their workers compensation costs in the following ways:

Workers’ Health

Proponents of the ACA say that it will lead to a healthier society. Advocates say that because more people will have access to health care, there will be a reduction in comorbidities. There is, however, no significant evidence to support this contention. For example, data from the Centers for Disease Control and Prevention indicate that heart disease remains the leading cause of death in the United States and that the percentage of Americans with a high body mass index has steadily climbed over the last 50 years—two trends that are not confined to the uninsured population.

Cost Shifting

Employers have long been concerned that injuries from non-work-related causes will be shifted to workers compensation. Doing so is tempting because of workers compensation’s combination of higher reimbursement rates for medical providers and lack of deductibles and co-payments for employees.  Some have speculated that the greater access to health insurance promised by the ACA will reduce this shift to workers comp.

It has become clear, however, that the law will not result in all Americans having health insurance coverage. With the ACA requiring that employers offer coverage to all employees working 30 or more hours per week starting in 2015, one-in-10 large companies are planning to cut back on hours for at least a portion of their workforce, according to “Mercer’s National Survey of Employer-Sponsored Health Plans” 2013.

Access to Care

Probably the most predictable outcome of the ACA is that it will increase the number of individuals in the U.S. with health insurance coverage. Despite the potential benefits, this could put additional stress on a health care system that is already short on doctors.

This is particularly troubling as it relates to specialists and the potential for delays in obtaining diagnostic tests and scheduling elective surgeries and other procedures. Longer periods of disability and complications as a result of such delays would ultimately drive workers’ compensation costs up.

With this added pressure on a limited number of medical providers, it becomes more important than ever for employers to develop medical networks that focus on quality of care and outcomes—even if it means paying more on a fee-for-service basis.

Standards of Care

Traditionally, the health care industry’s focus has been on volume; more patient admissions, tests, and procedures translated to higher revenues. Post-reform, however, the industry has shifted its focus to improving standards of care and achieving better patient outcomes.

If this transition results in less emphasis on costly procedures, which often produce questionable results, workers’ compensation costs could be reduced.

Although it remains to be seen whether the standards of care developed under the ACA for group health care would be enforced under workers compensation, this is a promising development for employers.

The 10 Most and Least Expensive Health Insurance Markets in the U.S.

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Health Insurance

Under Obamacare’s new insurance marketplaces, people in Minnesota, northwestern Pennsylvania, and Tucson, Ariz., are getting the best bargains for health care coverage. Premiums in these areas are half the price of policies in the most expensive regions, based on the lowest cost of a “silver” plan – the mid-range plan most consumers are choosing.

“The cheapest cost regions tend to have robust competition between hospitals and doctors, allowing insurers to wrangle lower rates,” according to a report from Kaiser Health News and NPR. “Many doctors work on salary in these regions rather than being paid by procedure, weakening the financial incentive to perform more procedures.”

The 10 regions with the lowest premiums are:

$154: Minneapolis-St. Paul – Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne and Washington counties.

$164: Pittsburgh and Northwestern Pennsylvania – Allegheny, Armstrong, Beaver, Butler, Crawford, Erie, Fayette, Greene, Indiana, Lawrence, McKean, Mercer, Warren, Washington and Westmoreland counties.

$166: Middle Minnesota – Benton, Stearns and Wright counties.

$167: Tucson, Ariz. – Pima County.

$171: Northwestern Minnesota – Clearwater, Kittson, Mahnomen, Marshall, Norman, Pennington, Polk and Red Lake counties.

$173: Salt Lake City – Davis and Salt Lake counties.

$176: Hawaii

$180: Knoxville, Tenn. – Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Knox, Loudon, Monroe, Morgan, Roane, Scott, Sevier & Union.

$180: Western and North Central Minnesota – Aitkin, Becker, Beltrami, Big Stone, Cass, Chippewa, Clay, Crow Wing, Douglas, Grant, Hubbard, Isanti, Kanabec, Kandiyohi, Lac qui Parle, Lyon, McLeod, Meeker, Mille Lacs, Morrison, Otter Tail, Pine, Pope, Renville, Roseau, Sibley, Stevens, Swift, Todd, Traverse, Wadena Wilkin and Yellow Medicine counties. In Chisago County, the lowest premium is $162.

$181: Chattanooga, Tenn. – Bledsoe, Bradley, Franklin, Grundy, Hamilton, Marion, McMinn, Meigs, Polk, Rhea and Sequatchie counties.

 

The 10 most expensive regions are:

$483: Colorado Mountain Resort Region – Eagle, Garfield and Pitkin counties, home of Aspen and Vail ski resorts. Summit County premiums are $462.

$461: Southwest Georgia – Baker, Calhoun, Clay, Crisp, Dougherty, Lee, Mitchell, Randolph, Schley, Sumter, Terrell and Worth counties.

$456: Rural Nevada – Esmeralda, Eureka, Humboldt, Lander, Lincoln, Elko, Mineral, Pershing, White Pine and Churchill counties.

$445: Far western Wisconsin – Pierce, Polk and St. Croix counties, across the border from St. Paul, Minn.

$423: Southern Georgia – A swath of counties adjacent to the even more expensive region. Ben Hill, Berrien, Brooks, Clinch, Colquitt, Cook, Decatur, Early, Echols, Grady, Irwin, Lanier, Lowndes, Miller, Seminole, Thomas, Tift and Turner counties.

$405: Most of Wyoming – All counties except Natrona and Laramie.

$399: Southeast Mississippi – George, Harrison, Jackson & Stone counties. In Hancock County, the lowest price plan is $447.

$395: Vermont*

$383: Fairfield, Conn. – The southwestern-most county, which includes many affluent commuter towns for New York City.

$381: Alaska.

*Unlike other states, Vermont does not let insurers charge more to older people and less to younger ones. Its ranking therefore will differ depending on the ages of the consumers.

Supreme Court Upholds Health Care Law

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In one of the most closely-watched decisions in recent years, the Supreme Court upheld the Affordable Care Act, including the controversial individual mandate requiring most Americans to purchase health insurance or face a financial penalty. SCOTUS Blog posted a succinct one paragraph summary of the decision:

The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

The 5-4 decision was seen as a victory for the Obama Administration and will certainly become a key issue in the upcoming November election as Mitt Romney has already vowed to repeal the law should he win the presidency. In fact, this division was likely anticipated by Chief Justice John Roberts in his majority opinion:

We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.

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Roberts did conclude, however, with regard to the constitutionality of the individual mandate:

The Affordable Care Act is constitutional in part and unconstitutional in part. The individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance.

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Such legislation is within Congress’s power to tax.

Regardless of its ultimate fate, the Affordable Care Act stands, much to the benefit of the some 30 million Americans without health insurance.

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To illustrate where these uninsured are concentrated, the Atlantic offered the following map.