Will the Affordable Care Act Fuel Higher or Lower Workers Compensation Costs?

As health care costs continues to grow as a hot topic in board rooms and bars alike, there are many debates on how workers’ compensation will be impacted.  While none in the insurance industry have historically integrated occupational and non-occupational health care, It just makes too much sense for small and large employers alike.

Common logic would suggest that if employees are not covered for health insurance off the job, there is a potential for fraudulent claims to be filed in the workers’ compensation arena as it is the only healthcare policy available to be triggered.    The following RAND Study from a few years ago supports that thought process.

The share of patients accessing the ER who had no insurance fell from approximately 15 per- cent prior to the reform to about 9 percent after the reform, a 40 percent decrease. The increase in coverage can be explained by new enrollments in Medicaid rather than by uptake of private health insurance.”

Click to access RAND_TR1216.pdf

As a counterpoint, here is a more recent article that looks at a potential cost increase on the workers’ compensation side due to benefit levels of healthcare versus workers’ compensation.


“By Victor’s projection, that shift could result in as much as $90 million in claims moved from group health to workers’ comp in Illinois, and $55 million in Pennsylvania. These, of course, are preliminary estimations that could change pending how well ACOs perform and whether the reimbursement format changes. WCRI also plans to reexamine the issue with a focus on how fee schedules affect workers’ comp outcomes and rates.”

The author looks forward to all of these twists and turns brought by our new health care reform and sorting out the impact to the overall cost of providing the best quality health care to American workers on or off the job.


Paul Hughes

Author: Paul Hughes

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