NCCI Report Looks at Affordable Care Act’s Impact on Workers’ Compensation

The Affordable Care Act (ACA), while now on the precipice of being overhauled, has significantly changed the healthcare landscape in our country. The ACA’s individual health insurance mandate, together with the state option for Medicaid expansion, have increased the number of medically insured in America by roughly 20 million people as of early 2016, with the greatest impact occurring at the time both provisions first went into effect in 2014. The ACA, when enacted, was also intended to promote wellness among Americans, including reducing obesity rates in the U.S. Qualifying health insurance plans under the ACA must offer a variety of preventive health care services without copayments or deductibles, including periodic screenings, check-ups, and counseling to prevent illness and other health problems. Moreover, the ACA encourages workplace wellness programs that allow employers to offer incentives to employees who complete a personal health risk assessment, biometric screening, or participate in programs aimed at reducing tobacco use or losing weight, for example.

There has been a great deal of concern about the ACA’s impact, if any, on Workers’ Compensation. Now that there have been two years of ACA implementation, the NCCI recently released research that addresses a couple of questions regarding health care reform and Workers’ Comp:

  • Has the increase in demand for primary care services by newly insured people under the ACA crowded out access to the same services by Workers’ Compensation claimants?
  • If the ACA is successful in reducing population obesity in the United States, what are the potential medical cost savings to Workers’ Compensation?

To address the first question, the NCCI used 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. It found that the ACA has had no discernible impact on crowding out Workers’ Compensation claimants from access to primary care services through 2014. The NCCI also found that 68% of primary care services provided during the first 90 days of a Workers’ Compensation claim occur during the claim’s first 10 days.

Regarding the second issue involving any potential Workers’ Comp savings due to the ACA’s wellness program incentives, the NCCI research shows that a reduction in the U.S. obesity rate from 35% to 25%, in accordance with the goals of the ACA’s wellness initiative, might reduce Workers’ Compensation medical costs by 3% to 4%. The NCCI report states, “It is generally accepted that a healthier workforce is likely to have lower frequency and severity of injuries, as well as a faster return to work, thus reducing the cost of Workers’ Compensation insurance. Population wellness may be associated with certain comorbidities that are relevant to Workers’ Compensation claims. These include obesity, hypertension, diabetes, pulmonary conditions, and drug abuse. Of these, obesity is by far the most studied to date in terms of quantifying its impact on medical costs.”

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