“Hundreds of millions of dollars” in insurance claims nationally, and possibly far more, could shift from health insurers to workers’ comp carriers due to Obamacare, according to a new study.
In California alone, a 3 percent shift of cases involving so-called “soft tissue conditions,” such as non-specific back pain, from group health insurers to workers’ compensation carriers could result in a $250 million increase in Golden State workers’ comp costs, the report said.
In Pennsylvania, a similarly small shift of back-pain cases would increase workers’ comp costs by nearly $100 million, according to a study released Tuesday by the Cambridge, Mass.-based Workers Compensation Research Institute.
Such “case shifting” from health insurers to workers’ comp carriers could be a “significant under-appreciated effect” of Obamacare, the group said. That’s especially true in states like California, Massachusetts, New York, West Virginia, Wisconsin and Oregon, where 28 percent or more workers are enrolled in HMO plans.
California leads the way with 42 percent, the report said, followed by Massachusetts (34 percent) and New York (31 percent).
The institute describes itself as an independent, non-profit research organization backed by employers, government agencies, insurance regulators, insurance and managed care companies, state labor organizations and other groups in the United States, Canada, Australia and New Zealand.
Members include AIG, the San Francisco-based State Compensation Insurance Fund, Chevron (NYSE: CVX), Costco ( NASDAQ: COST), Macy’s (NYSE: M), Safeway, Stanford University, UPS (NYSE: UPS), Integro Insurance Brokers, the Massachusetts AFL-CIO and the California Division of Workers Compensation, according to the group’s website.
The Affordable Care Act encourages health care providers to form so-called Accountable Care Organizations that shift payment from the traditional fee-for-service model to capitated or pre-paid health insurance — similar to that long provided by Kaiser Permanente in California and elsewhere.
The ACOs, many of which have already blossomed in the Bay Area and elsewhere in California, are intended to provide incentives to deliver care in a more efficient manner while meeting ambitious quality standards.