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The Affordable Care Act and Work Comp – WCRI’s view

WCRI’s Thursday morning begins with a series of presentations and discussions on the impact of PPACA/Obamacare on workers’ comp.

According to WC Executive Director Rick Victor, “Few pieces of legislation have the potential to affect people both financially and personally as the ACA. ”

(Note – my sense is there’s way too much attribution of normal market changes -positive and negative – to ACA, more on that later)

Rick went on to provide a framework for understanding ACA with specific attention to individual states.  Among the key issues

Will expansion of care lead to:

Shortages of providers who treat injured workers, which may lead to longer disability and higher costs – Victor opined that in states where Medicaid expands shortages will be greater than in non-expansion states. Similarly in states with low health status and/or an older population. As an economist, Victor noted that prices might rise and that will reduce shortages – in this case, payers will pay providers above the fee schedule to get access to care.  There’s a precedent for this in Canada, where providers in Ontario treating work comp patients get paid more than when they treat non-occ patients.  This happens in Massachusetts today as well…

That said, WC ALREADY pays more for specialty care than Medicare or Medicaid or group health in almost all states, so additional payments are likely not necessary. Given a multitude of factors, WCRI predicts the states that will have primary care shortages are:

  • California
  • Florida
  • Louisiana
  • Texas
  • New Mexico
  • Nevada
  • Mississippi

I’d note that most of these are states that – at present – aren’t expanding Medicaid.  If – or more likely when – they decide that Medicaid expansion is a good thing, the predicted provider shortage may get worse.

Healthier employees – The data suggests folks with insurance are healthier than those that are not insured.

Victor doesn’t seem to think ACA will reduce unnecessary care for injured workers. Notably, he didn’t give a time frame for that statement; I firmly believe the work done by PCORI WILL have a dramatic effect on the care that’s delivered to, say, patients with back pain.  That’s going to take time – years, not months, but it will have a big impact.

Lots of discussion of the impact of PPACA on cost shifting – and a wealth of data Rick presented that indicated providers find creative ways to upcode, shift procedure mix, or otherwise find ways to increase revenues in the face of price controls or other regulatory attempts to restrain costs.

My research indicates cost-shifting is a complicated issue.

There’s been a good bit of discussion – some on Mark Walls’ LinkedIn group, on the potential for PPACA to influence claiming behavior.  The net is, I just haven’t seen any credible research that indicates PPACA will lead to more claims.  I’ve discussed this in detail here.

Finally, be careful to NOT attribute anything and everything, good and bad to ACA. A lot of things were occurring before ACA, including provider consolidation, more and higher deductibles, rising costs.

Will ACA accelerate, decelerate or change these trends?  It is impossible to separate out ACA’s effect from that of other factors.


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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