PHILADELPHIA—There is little question that the Patient Protection and Affordable Care Act (PPACA) will impact every American, but its ramifications on Workers' Compensation remains a subject of conjecture and speculation among legal experts and risk managers.
“It is so fluid a situation that we have to say to our clients that we don't have the answer; no one does,” says Catherine J. Flynn, an attorney at Weber, Gallagher, Simpson, Stapleton, Fires & Newby at an educational session April 11 during the Philly I-Day conference.
Holding up the 1,000-plus pages of the PPACA, Flynn says only eight pages directly relate to Workers Comp, but the rest of the law could have much greater implications for that line of coverage.
The focus on wellness and preventive care could have long-term impact on costs as workers become healthier and get in front of chronic diseases. This would not only drive down healthcare costs, but could have positive results for Workers' Comp costs.
Christian Davis, also an attorney with Weber Gallagher, says a downside to the preventive and wellness programs is that since people are exercising more, they may come to work and say they were injured on the job to put in a claim. However, the law might have the opposite effect—since if they have insurance they would be more willing to see a doctor for an examination.
That would also affect the number of fraud and abuse cases in the Workers' Comp program because they would have a healthcare provider to go to and not need to rely on Workers' Comp to cover an accident or illness, Davis suggests.
One impact costs is the more than 2 percent tax on medical devices that took effect this year, says Davis. The tax aims to raise $20 billion over 10 years to help pay for parts of PPACA program. Insurers could see those costs passed on to them, she says.
With more people coming into the healthcare system because they have insurance, there is a fear there will be a shortage of doctors. Ben Evans, executive director of risk management for the University of Pennsylvania, says, as a self-insured program, it is already difficult to contract with physicians to cover Workers' Comp cases. A physician shortage would not only make the situation more tenuous, but also drive up costs.
The physician shortage would make it more difficult for patients to get treatment, meaning individuals may be out of work longer, says Evans. However, Anita Devan, senior vice president and regional executive for Zenith Insurance, points out that PPACA does provide funds to medical schools for developing family practice physicians, aimed at increasing the pool of doctors.
On the positive side, says Evans, a wellness program would help reduce accidents and improve overall health, which would decrease costs, he hopes.
From the standpoint of a risk manager, self-insured programs like to control what they can. He says he worries that PPACA will make it more difficult to have that control.
“We do not know what this [PPACA] means,” says Evans. “We work hard at the University of Pennsylvania to drive costs and do the best we can to get people back to work.”
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