At the 2017 WCRI Annual Issues and Research Conference, former US Representative Henry Waxman and former US Senator Tom Colburn discussed how the 2016 election is impacting a variety of issues. The discussion was moderated by WCRI CEO John Ruser.
The Affordable Care Act was complex legislation and changing it is changing it. By design, ACA attracted high-risk individuals into the insurance marketplace by prohibiting carriers from excluding pre-existing conditions. The costs of these high-risk individuals were supposed to be offset by the mandate requiring everyone in the US to have health insurance so the risk was spread across a larger pool of policyholders. However, experience has shown that the costs created by ACA have been much higher than the premiums received which is why carriers are pulling out of the ACA marketplace.
One of the big problems with healthcare in the US is that there is no transparent marketplace. People do not fully understand what their healthcare will cost and what the potential outcomes will be. There is no way for people to shop the marketplace and compare prices and outcomes. Until you require the publishing of healthcare pricing and outcomes, there will continue to be problems in this marketplace. The government cannot resolve these issues in the healthcare system.
Although both parties acknowledge flaws with the ACA, from a political standpoint, the parties are not aligned on how to resolve these problems. Healthcare carriers that have pulled out of the ACA marketplace want to see a new plan that will preserve their profits as many were losing money providing coverage under the ACA exchanges. Higher deductibles have become the norm in order to control employer costs along with preserving the viability of the carrier marketplace. Unfortunately, these high deductibles make healthcare unaffordable for many people.
There are concerns that a replacement to ACA will lead to additional cost shifting to workers’ compensation and Medicaid. The speakers felt this was a realistic concern. One speaker felt strongly that less federal interference was the best approach to this. State administered Medicaid programs have the flexibility to add in case management and other protocols that can lower costs and improve outcomes. States are better situated to deal with the needs of their residents than the federal government.
Federal Intervention in Workers’ Compensation
Back in October 2016 the Department of Labor issued a report criticizing state workers’ compensation systems and calling for increased federal oversight including minimum standards. Both panelists think this issue is dead for now. Reforming state workers’ compensation is low on the list of priorities for the politicians and there are also concerns that the federal government lacks the authority to pursue this issue.
Shifting from WC to SSDI
There is bipartisan concern that workers’ compensation systems are shifting costs to SSDI. If workers’ compensation benefits are inadequate individuals will seek alternative benefits. However, there is also concern that SSDI has become too lax on their standards of who gets approved for these benefits. Too many are on the SSDI roles that could be working.