More insured via Exchanges is good news for Work Comp

People who obtained private health insurance coverage thru the Exchanges in 2014 were less healthy than those previously insured. A just-published article in HealthAffairs provides details on their medical issues and conditions, more on this below. [sub req]

That’s not surprising; prior to ACA, many individuals and families weren’t able to obtain coverage at a reasonable price, and some couldn’t get any coverage at any price, due to insurers underwriting practices.

Now that medical underwriting and pre-existing exclusions are outlawed, folks with health problems can get insurance.  Before we jump into the implications discussion, here’s the specifics.

among those with individual private coverage, the likelihood of reporting fair or poor health and the likelihood of being obese increased by 1.5 and 4.2 percentage points, respectively (Exhibit 1). We also found that the likelihood of having at least one of ten specific chronic conditions5 increased by 6.7 percentage points for this group—a change that was driven by increases in the likelihood of having hypertension (a 4.0-percentage-point increase) and diabetes (a 2.9-percentage-point increase)

The good news is many of these chronic conditions respond well to relatively inexpensive treatment, and the cost of caring for these individuals is much lower if they have access to good primary care.

For work comp payers, the good news is a bit less obvious – but it is good news – for two reasons.

First, in general the working population will be slightly healthier – because more workers will have insurance, and the least-healthy are more likely to be improving their health status. Thus if they do get injured, they will likely heal faster as their overall health status is better.

Second, work comp insurers won’t have to pay to treat their non-occ medical conditions, as the patients are more likely to have health insurance.

 

3 thoughts on “More insured via Exchanges is good news for Work Comp

  1. Joe –

    While I understand the theory that a higher percent of the population having insurance may decrease severity and drop the comp rolls, the numbers will tell. I believe it is far too early to declare victory.

    Also, I question some of your assumptions. If the population does become healthier, logically your first concluding point makes sense. Access and compliance, however, are two different things. Many fully insured employees with \”Cadillac\” health plans don\’t use them; I suspect the newly insured population will ultimately adopt the same behaviors.

    Also, the fact that more workers have health insurance must be balanced against the continued cost shifting we see nationally. I don\’t know for sure, but I assume the ACA and Exchanges don\’t covering 100% of the cost of care. This translates to the fact that the average traditionally insured employee, through high deductible plans and HSAs, faces rising out-of-pocket expenses. Work comp, on the other hand, is \”free\” to the employee.

  2. Joe –

    While I understand the theory that a higher percent of the population having insurance may decrease severity and drop the comp rolls, the numbers will tell. I believe it is far too early to declare victory.

    Also, I question some of your assumptions. If the population does become healthier, logically your first concluding point makes sense. Access and compliance, however, are two different things. Many fully insured employees with “Cadillac” health plans don’t use them; I suspect the newly insured population will ultimately adopt the same behaviors.

    Also, the fact that more workers have health insurance must be balanced against the continued cost shifting we see nationally. I don’t know for sure, but I assume the ACA and Exchanges don’t covering 100% of the cost of care. This translates to the fact that the average traditionally insured employee, through high deductible plans and HSAs, faces rising out-of-pocket expenses. Work comp, on the other hand, is “free” to the employee.

Leave a Reply

Your email address will not be published. Required fields are marked *