Paper written for elective course on Affordable Care Act

1. Running Head: PPACA: The End of Workers’ Compensation? 1
PPACA: The End of Workers’ Compensation?
Richard Krasner
Florida Atlantic University
HSA 6930
The 2010 Patient Protection and Affordable Care Act
Dr. Mahle
August 1, 2011

2. Running Head: PPACA: The End of Workers’ Compensation? 2
Table of Contents
Introduction ..................................................................................................................................................3
Impact of PPACA on Workers’ Compensation..............................................................................................4
Conclusion...................................................................................................................................................10
References ..................................................................................................................................................11

3. Running Head: PPACA: The End of Workers’ Compensation? 3
Introduction
On March, 25, 2011, a memorial service was held on a New York City street corner near
Washington Square Park, now the site of one of NYU’s main campus buildings. The memorial
service was held by family members and thousands of people who had marched to the site
through Greenwich Village. They were commemorating the famous fire that occurred there one
hundred years earlier and took the lives of 146 young women, mostly Italian and Jewish
immigrants, (Wikipedia, 2011). The acquittal of the owners of the Triangle Shirtwaist Company
and the tremendous loss of life began a reform movement both in New York State and
nationwide to improve working conditions, fire safety and access to medical and other benefits
for workers injured on the job through state workers’ compensation laws.
The workers’ compensation industry began that day one hundred years ago, and the
question as to whether or not workers’ compensation will continue to be a remedy for those
killed or injured while working, under the PPACA, is the topic of this paper. While the law is
only a year old, and was signed within days of the ninety-ninth anniversary of the Triangle fire,
how it will impact workers’ compensation remains unknown, but we can look at some possible
areas of concern to those in the workers’ compensation industry.
Historical Background
In 1972, the National Commission on State Workmen’s Compensation Laws issued a
report that took the position that it would be unwise and unnecessary for any national health

4. Running Head: PPACA: The End of Workers’ Compensation? 4
insurance program to assume medical costs of workers’ compensation. The Commission stated
that to fold workers’ compensation medical costs into a national health insuranceprogram would
be inconsistent with the central tenet of workers’ compensation and that the costs of work-related
injuries and diseases should be allocated to the responsible source. In the 1990’s, the Clinton
Administration’s health reform proposals favored the merging of the medical component of
workers’ compensation into a federal health care system. The Administration backed off of this
proposal after strong opposition from business owners who said it would not produce any real
savings, would have pre-empted state “choice of provider” laws and empower employees to
select providers from any federally approved health plan, (Eaton, 2010).
Impact of PPACA on Workers’ Compensation
My perusal of the available research, post enactment, on the impact PPACA will have on
workers’ compensation led me to five online articles or commentaries from individuals and
organizations heavily connected to or involved with the workers’ compensation industry. While
each of them said it was too early to know the full effect of the law on workers’ compensation,
all of the authors stated that there were twoimpacts that PPACA might have on workers’
compensation: direct and indirect.One author even said there might also be speculative impacts
as well, (Krohm, 2011).However, there was no consensus on which aspects of the law were
direct impacts and which were indirect impacts, as will become apparent.

5. Running Head: PPACA: The End of Workers’ Compensation? 5
Direct Impacts
Much of the research showed that there are very few direct impacts on workers’
compensation, (Eaton, 2010). The obvious reason for this is that workers’ compensation was not
a minor focus of the legislation, (Eaton, 2010; Krohm, 2011). Krohmstated that, “there is no
language in the law that would directly and explicitly affect workers’ compensation.From the
beginning of bill-drafting in both the House and Senate, it was clear that workers’ compensation
was not an area that should get mixed into the reform process”.
Three direct impacts cited by two other authors included revisions to the Black Lung
program that will make it easier for coal miners and their survivors to obtain black lung benefits,
(Harrison, 2010; National Council on Compensation Insurance [NCCI], 2010), new taxes on
pharmaceutical and medical device manufacturers that might be passed on to policyholders,
causing higher workers’ compensation premiums, (Harrison, 2010), and changes in Medicare
reimbursement levels that may have a cost impact for those states that utilize Medicare as a basis
for reimbursements in their workers’ compensation fee schedules for physicians and hospitals
(inpatient, outpatient and ambulatory surgical centers), (NCCI, 2010).
Indirect Impacts
The authors compiled an extensive list of indirect impacts of the PPACA on workers’
compensation, and there is considerable overlap between them. Black Lung claims was cited by
Eaton as an indirect impact, contradicting what Harrison and NCCI had stated. Another indirect
impact cited by Eaton had to do with the requirement of theSecretary of Health and Human
Services to determine whether the reporting of health services delivered through workers’

6. Running Head: PPACA: The End of Workers’ Compensation? 6
compensation medical services should be a part of the new national reporting standards, which
will result in changes to state record keeping and reporting practices.
Standards for the coordination and subrogation of benefits would have been established if
the language in an earlier version of the legislation had been passed, but this portion wasremoved
during reconciliation, (Eaton, 2010; NCCI, 2010). Revision of Medicare reimbursement levels
was also cited by Eaton as an indirect impact on workers’ compensation. Expansion of Medicaid
coverage, which will add between 15 and 20 million people to Medicaid, will place a stress on
state budgets that pay most of the Medicaid benefits. This will make it difficult for workers’
compensation systems to get additional revenue to increase benefits or improve administrative
services, (Eaton, 2010; Krohm, 2011).
On the other hand, new excise taxes on pharmaceuticals and medical devices were cited
by Eaton and NCCI as an indirect impact that would result in rising costs for devices used in
workers’ compensation cases. Related to that was the indirect impact of an expanded Medicare
Part D that would cause pharmacy costs to rise due to extra demand, and the absence of price
controls or re-importation options, (Krohm, 2011).Pilot projects that will explore ways to reduce
or contain costs may involve evidence-based protocols to be used in workers’ compensation,
(Eaton, 2010).
Access to providers, especially with the increase in the number of Americans having
health insurance, will impact workers’ compensation because with the decline in the number of
physicians choosing primary care as their specialty, those that do choose to work as primary care

7. Running Head: PPACA: The End of Workers’ Compensation? 7
physicians will do so if reimbursement rates are higher under private plans than under workers’
compensation, (Eaton, 2010). Lastly, the elimination of the donut hole through the legislation
may lead to increases in prices, especially those drugs prescribed for workers’ compensation
claimants, (Eaton, 2010).
Additionally, the short supply and patient backlog of primary care providers in rural and
poverty stricken areas may get worse after 2014 due to penalties for those who remain uninsured,
and when tax credits to subsidize purchase of insurance kick in, which may impact injured
workers as well, (Krohm, 2011). Other indirect impacts mentioned as being far-reaching was that
the frequency and importance of “medical use” review will increase because health insurers and
workers’ compensation insurers battle over responsibility for medical expenses; there is also a
question as to whether or not health reform will increase or decrease the number of workers’
comp claims, (Krohm, 2011).
This is due to a provision in the law that allows health insurers to charge smokers 50%
more for coverage and another provision provides that if employees are enrolled in a company
wellness program or meet certain health standards, they can get a 30% reduction in
premiums,(Harrison, 2010). This in turn would lead to improved national health, which would
help to reduce workers’ compensation claims, (Eaton, 2010; Harrison, 2010; NCCI, 2010).
Still others believe that because more employees will have health insurance, they will be
less likely to file questionable or hard-to-prove claims, if they can get health insurance to pay for
it. On the other hand, there are some who believe that PPACA will result in increased workers’
compensation claims because if they have health insurance they will take advantage of medical

8. Running Head: PPACA: The End of Workers’ Compensation? 8
services such as surgeries. More treatment and surgeries means they will miss time from work,
which will increase workers’ compensation claims to receive indemnity (wages and other
income) benefits while not working, (Harrison, 2010).
On the heels of improving the overall national health, debate exists among those in the
industry and the nation at large as to whether the legislation will improve or damage the national
economy, with those in favor of the legislation believing it will make a positive impact, and
those against who focus on the immediate costs and believe it will stifle job creation and drag the
recovery, (Eaton, 2010). One final indirect impact is that health reform would be seen as a
stepping stone to the federalization of workers’ compensation. A bill introduced to the House of
Representatives in 2009 would create a National Commission on State Workers’ Compensation
Laws to examine state workers’ compensation programs. It was believe that this would be a
precursor to federalization, but Harrison does not agree with this idea because the bill has been
stalled in committee.
Speculative Impacts
Another area of overlap between the authors is in what Krohm considered speculative
impacts on workers’ compensation. He suggested that there would be a slight reduction in claims
frequency rates because more workers will have access to health insurance. This is highly
speculative because the connection between general health coverage and the propensity to file
workers’ compensation claims is scant. He believes that more workers will be healthier because
they have greater access to care, especially if they can lessen or reduce the impact on their health
from such problems as obesity, smoking, depression and substance abuse.

9. Running Head: PPACA: The End of Workers’ Compensation? 9
Another speculative impact he mentions is that the pilot programs and experimentation
called for in PPACA to create better models for managing the coordination and delivery of
medical care, and as Eaton indicated would lead to more evidence-based protocols on how to
treat certain high-cost occupational injuries and diseases. Finally, he speculates that the impact of
PPACA on the national economy and on workers’ compensation in particular, will be one of
“wait, see and respond accordingly”.
One speculative impact that none of the authors mentioned has to do with something that
has already happening even before the creation and enactment of PPACA. Some four years ago,
I learned about a company in Connecticut that was engaged in the health care claims subrogation
arena. This company had created a software system to participate in a pilot project the New York
State Workers’ Compensation Board was conducting in connection with the Health Information
Matching Program (HIMP) laws for the purpose of subrogating health care claims that are later
determined to be workers’ compensation claims, but that when the injured worker was treated,
presented his employer’s health insurance card, and therefore the health care carrier was billed
for the services provided, instead of the workers’ compensation carrier.
“New York law provides that a health insurer who makes payments for medical services on behalf
of an employee who has suffered a work-related injury is entitled to be reimbursed by the
employee’s employer or its workers’ compensation carrier, if the claim is found compensable.”
WCL §13(d)(1)
In my research of the subrogation arena, I discovered that there are many companies out
there doing the same or similar types of work. It is purely speculative on my part, but it is
possible that as more people get covered under PPACA with health insurance, the probability

10. Running Head: PPACA: The End of Workers’ Compensation? 10
that more workers will present their health insurance card instead of telling the provider that they
suffered an on the job injury and should be covered under the workers’ compensation
insuranceof their employers.What impact this will have on the number of workers’ compensation
claims filed in the future is anyone’s guess. But the potential exists for a substantial increase in
workers’ compensation claims not only in New York, but nationwide if the situations in which
this occurs happens elsewhere. Again, we will have to wait, see and respond accordingly.
Conclusion
The consensus of opinion regarding the impact of PPACA on workers’ compensation can be
summed up by Eaton as follows: “the PPACA will have little director immediate effect on state workers’
compensation systems. However, there is potential for considerable indirect affects, especially with
regard to record keeping, coordination of benefits, and other details of administration. The actual impact
of the recent federal legislation is difficult to predict. Some of the potential indirect effects may increase
costs while others may moderate or even decrease costs.” So to answer the question as to whether PPACA
is the end of workers’ compensation, we will have to wait, see and respond accordingly when the time
comes.

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References
Eaton, T.A., The Impact of the Patient Protection and Affordable Care Act of 2010 On State
Workers’ Compensation Systems. Presentations and Speeches.Paper 28. Retrieved from
http://digitalcommons.law.uga.edu/fac_presp/28
Harrison, D.M., (2010). Health Care Reform and Workers’ Compensation, Alabama Employment
Law Letter.Retrieved from http://www.hrhero.com/hl/articles/2010/04/22/health-care-
reform-and-workers-compensation
Krohm, G., (2011). What Will Federal Health Care Reform Mean For Workers’ Compensation
in the U.S.? Retrieved from
http://www.iaiabc.org/i4a/headlines/headlinedetails.cfm?id=156
National Council on Compensation Insurance, Inc., (2010).National Health Care Law:
Implications for Workers’ Compensation Insurance. Retrieved from
https://www.ncci.com/documents/NationalHealthandWC.pdf
New York State Workers’ Compensation Law, Article 2, Section 13 (d) (1).
Wikipedia, Retrieved from http://en.wikipedia.org/wiki/Triangle_Shirtwaist_Factory_fire