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King v Burwell – implications for workers’ comp


The Supreme Court decision against the plaintiffs in King v Burwell marks the end of the significant legal challenges to the PPACA.

It also makes it much more difficult for a future President to undo key parts of ACA, as the Court opined that the mandate, penalty, subsidies, and other key components are set in statute and therefore cannot be modified or eliminated by administrative or executive action (I’m no attorney, so may have the wording wrong; clarifications welcomed).

Yes, there will be continued attempts by opponents to attack this or that part of PPACA. And the GOP may well pass repeal legislation if the party wins the necessary seats and the White House next year.  But I don’t think they will.

17 percent of our nation’s economy is in the health care sector, a sector that has, for the better part of a decade, totally focused on operating under PPACA.  If PPACA is overturned, the stuff will hit the fan, and the overturners will be blamed.  Politicians don’t like blame, and while the hard core right may rail, their Representatives and Senators will keep focused on the swing voters who decide elections.

Okay, so much for my amateur political punditry.

What does this mean for workers’ compensation?

Not much.  In fact, I can’t discern any meaningful impact other than “business as usual.”

That doesn’t mean ACA hasn’t impacted work comp, however so far the data is rather inconclusive.  I’ll post on that early next week – spoiler alert – the evidence to date indicates there has NOT been a problem for claimant access to care.

7 thoughts on “King v Burwell – implications for workers’ comp”

  1. I think ,if anything, over time the ACA will positively impact WC simply because there should be less cost shifting onto WC by those who have no health insurance. Comp carriers who have to take injured workers as they find them, will likely see fewer and fewer cases where the IW has untreated underlying conditions like diabetes, hypertension, etc.

  2. There is a lot of cost shifting in California since the passage of SB863. When injured workers get a denial of treatment they have been using private insurance ,VA and also Medicare. I have not seen one instance where private insurance is not allowing treatment when a patient has a denial through work comp. I believe this is a change from before the ACA it was more difficult through private insurance to get treatment for a work related injury, depended upon the insurance company. Now access is much easier.

    1. Mary
      Thanks for the comment. Seems that if work comp rejected the treatment request it is viewed as not work comp-related and therefore should be paid by other sources.

      Thus this isn’t “cost shifting” but rather appropriate care reimbursed by the appropriate payer.

      Am I missing something?

  3. Providers should start paying more attention to partnering with Workers’ Comp MCO’s in that their reimbursement structure(s) are quicker and usually higher than Group and especially Medicare and Medicare Advantage. Comp Dollars allow them to differentiate their payer mix to become less dependent on Medicare reimbursements. The door may finally swing open for better partnerships with providers as they seek alternative revenue generating sources.

  4. Hello Joe,

    Thanks for posting this; I link to it in my own micro-round-up of King v. Burwell commentary because you are the rare voice expressing a WC point of view and because I largely agree with the opinions that you have expressed about the affordable care act over time.

    I have been reading your blog for many years but now have the freedom to join in the discussion since the business I represent is my own.

    It is time for more honesty about financing in health care: where the money is coming from, where it is ending up and why. We all know what the answers are, it’s time to fix it.

    Jesse Sharp
    Sharp Statistical Sciences

    1. Jesse
      Thanks for the comment and congratulations on the new venture.

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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