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May
25

Health insurance status and workers’ comp

The headlines were comforting – not much change in the number of Americans without health insurance.

Before you breathe that sigh of relief, you’d be well-advised to dig a bit deeper, because there’s plenty of bad news just under the headline.

While the national number of uninsured stayed about the same, that’s irrelevant to you – because healthcare is local. Here’s what I’d be worried about.

  • Young adults are almost twice as likely as older adults to be uninsured – about one in six younger adults don’t have coverage.
    Takeaway – no health insurance = more incentive to file work comp claims 
  • Over a quarter of working-age Texans don’t have coverage. Georgia, Florida, and North Carolina are not far behind

    Takeaway – no health insurance = poorer health status, more comorbidities, more charity care for providers thus more incentive to cost- and claim-shift.

  • 44% of working-age adults were covered by high-deductible plans – but more than half of them don’t have health savings accounts needed to fund those high deductibles

Takeaway – “High” deductible healthplans aren’t much different than no insurance at all if the patient can’t afford the deductible – and over half can’t. So, more incentive to cost- and claim-shift.

What does this mean for you?

Workers’ comp will be affected by the Administration’s ongoing behind-the-scene effort to hollow out the ACA and cut funding for Medicare and Medicaid.

 


5 thoughts on “Health insurance status and workers’ comp”

  1. The ACA/Covered CA plans are mostly very high deductible plans in CA. They pay so poorly that few doctors and specialists take them. Nevertheless, payers falsely listed MANY providers on these plans to make it seem as if they had a real network. It was so bad that the payers got fined hundreds of thousands of dollars. That’s why so many are saying that these ACA plans in CA and the insurance cards that come with them are FAKE insurance. People had high deductible, catatrastrophic plans before they were thrown off and forced to buy different plans the ACA deemed appropriate. At least you could keep your doctor with the catastrophic plan. What a SHAM!

    1. Interesting complaint here, IPTCA.

      Why do you think these plans pay “poorly”? Simple- healthcare expenses account for 85% + of individual insurance plan costs, and insurers know that they have to keep healthcare expenses as low as possible to attract any member.

      Your “so many are saying…these plans are…FAKE insurance” comment is reminiscent of another’s claim that “everyone” is saying he should get the Nobel Peace Prize. That does you no credit

      In fact, many pre-ACA plans, and today’s AHPs don’t cover drugs, ER visits, out-of-network providers, mental health, pregnancy, rehab, or any pre-ex condition. ACA plans do – which is one reason they are more costly.

      It comes down to this – providers and the healthcare industry want to make more money than consumers are willing to pay.

      That’s why we’re going to have single payer within the decade.

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Joe Paduda is the principal of Health Strategy Associates

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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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