Affordable Care Act Does Not Crowd Out Workers’ Compensation Claimants: NCCI Research

By | November 15, 2016

New industry research has found that while the Patient Protection and Affordable Care Act (ACA) has dramatically increased the number of people who are medically insured, it has not hurt access to medical care for workers’ compensation claimants, which had been a concern before the law first went into effect in 2014.

The new research also suggests that if the ACA is successful in its goal of reducing obesity through its wellness programs, it promises to lower workers’ compensation costs.

While the ACA does not directly address workers’ compensation, its larger effects on healthcare delivery may still be expected to impact workers’ compensation as well, according to the National Council on Compensation Insurance (NCCI), which provides rate making services for insurers in 36 states and conducted the research titled Impacts of the Affordable Care Act on Workers Compensation.

The ACA, also known as Obamacare, with its individual mandate, Medicaid expansion and other features, has increased the number of medically insured in America by roughly 20 million people as of early 2016. NCCI researchers sought to determine if the resulting increase in demand for primary care services crowded out access to the same services for workers’ compensation claimants. They looked at medical data from workers’ compensation claims to compare primary care utilization per claim during different time windows from the accident date for accident years 2012 through 2014, which includes the first year of expanded medical insurance under the ACA.

According to Leonard Herk, Ph.D., senior economist for NCCI and author of the report, the possibility that the ACA would crowd out access to primary care for workers’ compensation claimants has been a concern since at least 2013.

Herk said that to his knowledge this research is the first to address the crowding out question with workers’ compensation data pertaining to 2014, the first year of significantly expanded medical coverage under the ACA.

In this section of its research, NCCI found that the ACA has had “no discernible impact on crowding out workers’ compensation claimants from access to primary care services through 2014,” the first full year of expanded medical insurance coverage under the ACA.

The research also revealed that 68 percent of primary care services provided during the first 90 days of a workers’ compensation claim occur during the claim’s first 10 days.

Obesity Costs

NCCI also noted that the ACA has improving wellness as an objective, particularly in terms of obesity, hypertension, diabetes and substance abuse. According to NCCI, while these conditions alone do not typically form the basis of a workers’ compensation claim, their presence may increase injury severity by complicating recovery and return to work, and may also increase injury frequency.

NCCI reviewed recently published studies on the medical costs associated with obesity to estimate the potential savings to workers’ compensation from obesity reduction in the general population.

“Obesity was selected as an aspect of population wellness because it impacts medical costs in the general population, and because it has been the most studied to date among various health conditions associated with wellness,” Herk told Insurance Journal.

In the obesity section of this research, NCCI concluded that a reduction in the U.S. obesity rate from 35 percent to 25 percent, in accordance with the goals of the ACA’s wellness initiative, might reduce workers’ compensation medical costs by 3 percent to 4 percent.

Additional Research

In earlier research, NCCI looked at setting a baseline for the time from injury to treatment in workers’ compensation cases before the ACA went into effect in January, 2014.

This separate research, Time from Injury to Treatment in Workers Compensation: Setting a Baseline to Monitor the Affordable Care Act, released in January, found that the “healthcare system currently has sufficient capacity reserve so that provider availability plays a secondary role to claimant behavior in driving the time to treatment.”

That study stressed that in a changing healthcare environment, educating workers about accessing the workers’ compensation system becomes increasingly important.

The study also showed that the use of provider networks can influence the timing of care, especially toward making use of physical and occupational therapy sooner, and that there was no relationship between higher reimbursement levels and a shorter time to begin treatment.

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