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Workers Compensation Impact from Affordable Care Act Focus of Study

Disability Insurance
November 29, 2016

The National Council on Compensation Insurance (NCCI) has published a research project report that should be of interest to captive insurers that provide workers compensation coverage. The research report, Impacts of the Affordable Care Act on Workers Compensation, answers two questions, as explained in the research brief overview.

  • The first is whether workers compensation claimants have been "crowded out" of access to the same primary care services now in increased demand by patients newly insured under the ACA.

  • The second is what the potential workers compensation medical cost savings are if the ACA is successful in reducing US population obesity.

The three key findings in the NCCI research report, as noted in the overview, are as follows.

  • There has been "no discernible impact" on workers compensation claimants being crowded out from access to primary care services through 2014, which was the first full year of expanded medical insurance coverage under the ACA.

  • Of primary care services provided during the first 90 days of a workers compensation claim, 68 percent occur during the first 10 days of the claim.

  • If the ACA's wellness initiative goal of reducing the US obesity rate from 35 percent to 25 percent is achieved, there might be a corresponding reduction in workers compensation medical costs by 3 percent to 4 percent.    

The data and methodology section of the research brief explains that the research used 2014 accident year data that consisted of claims whose accident date fell between October 3, 2013, and October 2, 2014, inclusive. Primary care services in the study included all medical services whose procedure codes are associated with office visits, emergency room visits, diagnostic imaging (e.g., X-rays and MRIs), and diagnostic testing. The primary care services did not include medical services whose procedure codes indicate surgery, physical medicine, drugs, and supplies.

The author of the research report, Leonard F. Herk, Ph.D., is senior economist in NCCI's Actuarial and Economic Services Division.

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