It's still too early to tell whether federal health insurancereforms are having any significant impact on workers' compensationcosts. But it's fair to say that so far, some of the worst-casescenarios raised as the Affordable Care Act (ACA) went into effecthave not yet come to pass.

I've been getting calls lately from people who read my blog ofOct. 2, 2013, "'Obamacare' Might Impact Non-Health Insurer BottomLines," wondering whether any of the possible fallout I cited,either positive or negative, had come to pass. I still believe thethreats and opportunities I posited back then remain plausible, butthey may take more time to manifest themselves.

Supply and demand concerns haven'tmaterialized

My biggest concern was seeing workers' comp patients get stuckwaiting in line for diagnostic tests, visits with specialists, andrehabilitative therapy, behind patients newly insured under theACA. It was simple supply and demand at work, at least in theory.If tens of millions of uninsured people suddenly had healthcoverage, one could reasonably expect many of them to see a doctor,if only because they could now afford it. New ailments wouldprobably be diagnosed, while neglected chronic conditions wouldreceive overdue care.

A stampede into diagnostic and treatment facilities triggered byACA could overload the medical care community and make it moredifficult for those with work-related injuries or illnesses to beexamined, rehabilitated, and returned to their jobs in a timelyfashion. Such a development would be counterproductive for workers'comp insurers, which go out of their way to assure a speedydiagnosis and aggressive treatments to limit the amount of missedworking hours and to lower indemnity payments for claimants.

However, I'm not aware of any empirical studies being completed,nor have I heard of any complaints from workers' comp carriersabout a flood of newly insured patients disrupting their compclaims handling or timeliness of medical treatment.

That's good news, although it's likely not the final word onthis subject.

For one, it's taking time for the ACA to gain traction, givensome technical glitches in implementation early on with the newlyestablished health insurance exchanges that may have discouragedmany from signing up, as well as the fact that there was no penaltylast year for those who didn't have coverage.

(Photo: Shutterstock)

However, the second year of ACA appears to be going a lotsmoother, at least anecdotally, in terms of renewing coverage andsigning up new policyholders. Meanwhile, those without coveragethis year do face a penalty (levied via their federal income taxform) — an amount that will be going up substantially if peopleremain uninsured as the ACA takes full effect. That could promptmillions more to buy into the system, potentially triggering adelayed reaction in utilization that spills over and disruptsworkers' comp cases.

It's also too early to judge whether having millions morecovered by health insurance will ease the temptation by formerlyuninsured patients to try to have their medical problem classifiedas job-related so they could receive coverage under workers' comp.That proposition seems to be logical in theory, but in realitythose with standard health insurance still have to pay (oftenpricey) out-of-pocket expenses such as office visits, co-payments,and deductibles. Workers' comp patients face none of these chargeswith their first-dollar coverage, which means that fraud mightstill remain an attractive option for some.

Concerns about cost-shifting

In addition, new concerns have been raised about the ACA perhapscreating incentives for cost-shifting from health insurance toworkers' comp, due to the former's move from fee-for-service tocapitated systems. More health plans may become accountable careorganizations under ACA, financed by a set fee per member. Thisshould theoretically discourage providers from ordering unnecessarytests or treatments.

Under such a scenario, however, if classifying a case asjob-related moves a claim out of a capitated health plan and into afee-for-service workers' comp program, it might encourage someproviders to favor a comp claim so they could boost their incomepotential. Once again, however, this is all speculative, so we'llneed more time to see how the situation develops.

It also remains to be seen if gradually lowering the uninsuredpopulation improves the overall health of the workforce and therebylimits the frequency and severity of work-related injuries andillnesses, an outcome conventional wisdom seems to favor.

Developments to watch

The only thing for certain is that such questions should keepinsurance researchers like myself busy for quite some time as wewatch these trends play out.

Of course, all of these questions may become moot if the ACA iseffectively crippled later this spring by a U.S. Supreme Courtdecision nullifying federal subsidies for those buying coverage instates without their own health insurance exchange. And if theRepublicans end up winning the White House in 2016 and hold ontocontrol of both houses of Congress, ACA could conceivably berepealed altogether.

What happens then? If the many millions who have received (orbeen prompted to buy) health insurance under ACA end up losingtheir health coverage, what impact might that have on workers' compcarriers? My guess is that the results wouldn't be pretty foreither side of the insurance business.

Sam Friedman ([email protected]) isinsurance research leader with Deloitte's Center for FinancialServices in New York. For many years, he was Editor in Chief ofNational Underwriter. Follow Sam on Twitter at @SamOnInsurance, as well as on LinkedIn. These opinions are his own.