Has the Affordable Care Act had an impact on California workers’ comp?
This is the issue addressed by the California WCIRB in a May 2018 study titled “Impact of the Affordable Care Act on California Workers’ Compensation (see link below). The study is authored by Tim Basuino and Julia Zhang, both Medical Analytics Specialists with the WCIRB.
I applaud the WCIRB for looking into this issue, but see the study as merely a first step in assessing the ACA impacts.
What follows is my reaction to issues explored in the WCIRB report.
Has the ACA affected injured workers’ access to care in the comp system? There has been some speculation that as large numbers of previously uninsured individuals gained coverage under the ACA, it would be harder and harder for injured workers to identify a willing physician to treat a work injury. The study concludes that there is no demonstrable affect of medical treatment access.
“In summary, the study expected a relatively greater decline in overall claim frequency for employers with lower levels of health coverage, small businesses and small restaurants. The actual estimates for the changes in claim frequency were contrary to the study hypothesis in all three comparisons to the extent that if there was any ACA impact on overall claim frequency, other offsetting factors impacting claim frequency were more significant (Figure 2). These offsetting factors could potentially include the impact of the RBRVS, continued greater attention to workplace safety, and the continued migration of experience to less hazardous industries.”
It must be noted, however, that Covered California began coverage only as on January 1, 2014. So it strikes me that it may be early to come to definitive conclusions based on a study that is looking at changes in claims of 12 months maturity between accident years 2013 through 2015.
While the WCIRB stats question whether overall claim frequency is being affected by the ACA, the WCIRB study comes to a different conclusion on the subject of frequency of soft tissue injury claims. Employers in industries that had low levels of health coverage prior to the ACA experienced 12% decrease in the percentage of claims with soft tissue injuries while those in industries with higher levels of health coverage prior to the ACA had a 17.1% increase. These was a similar patter when comparing small to large restaurants.
The WCIRB notes on this point that:
“There was indication of a significant ACA impact on claims with soft tissue injuries following ACA implementation for employers more likely impacted by the ACA. It is important to note that the results of the analysis do not prove that any differences in claim shares were caused by ACA implementation.”
The WCIRB also looked at pre versus post-ACA shares of claims with “co-morbidities” (i.e. conditions such as obesity, high blood pressure and diabetes). Here the WCIRB stats would seem to indicate that the ACA may be having an affect on the numbers of claims with co-morbidities components, though their conclusion lacked confidence due to the limited amount of information available for study.
What’s all this mean? The WCIRB authors seem to point to post ACA changes in certain types of claims, but not in the overall number of claims.
Here is the link to the WCIRB study: