Oakland, CA – As public policymakers continue to debate the future of healthcare coverage in the U.S., including efforts by the Trump Administration and Congress to repeal and replace the Affordable Care Act and a proposal in California (AB 562) calling for the state to adopt a single-payer, “Medicare-for-All” system, the California Workers’ Compensation Institute (CWCI) has released a white paper that examines the issues, opportunities, and unresolved problems surrounding the integration of workers’ compensation into a 24-hour system. To put current the health care system integration efforts into context, the paper also takes a historical look at proposed or enacted workers’ compensation and health care reforms – including legislation promoting 24-hour coverage or managed care principals – since the Clinton Administration’s efforts to adopt 24-hour coverage in the early 1990s.
The Institute paper, co-authored by Mark Webb, President of Prop 23 Advisors, CWCI President Alex Swedlow, and CWCI Senior Vice-President of Research Rena David, reviews the two basic models of 24-hour coverage: single-payer plans (such as the AB 562 proposal); and pay-or-play plans (employer mandates, such as San Francisco’s “Healthy San Francisco” plan). The authors then discuss how the different structural components and objectives of workers’ compensation medical care would fit within an integrated system, and obstacles to doing so. Beyond the differences in how medical utilization and reimbursement are handled by workers’ comp and group health, the study notes other areas that continue to present significant challenges in designing an integrated system. These include the lack of a shared risk component in workers’ compensation, which has no co-pays, deductibles, or lifetime limits; the different dispute resolution and claim settlement processes; the need to coordinate care and access to treatment for two distinctly different patient populations; the need for medical providers to address issues related to the injured workers’ permanent disability and return to work; and the administrative costs and practical challenges of coordinating the medical and indemnity benefits for occupational injuries.
The Institute has released the white paper as a Spotlight Report, “Revisiting 24-Hour Health Care Coverage and Its Integration With the California Workers’ Compensation System.” The report is available for free in the Research section of the CWCI website, www.cwci.org/research.html.