CWCI Revisits 24-Hour Coverage and its Integration With California Workers' Comp
As public policymakers 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 proposed legislation in California (SB 562) calling for the state to adopt a single-payer, “Medicare-for-All” system, CWCI has issued 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 integration efforts into context, the paper also takes a historical look at proposed or enacted workers’ comp and health care reforms – including legislation promoting 24-hour coverage or managed care principles – since the Clinton Administration initiated efforts to adopt 24-hour coverage over a quarter century ago.
The white paper, co-authored by Mark Webb, President of Prop 23 Advisors, CWCI President Alex Swedlow, and CWCI Senior Vice-President of Research and Operations Rena David, reviews the two basic 24-hour coverage models: single-payer plans (such as the SB 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’ comp, 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 medical and indemnity benefits in work injury claims.
The white paper has been issued as a Spotlight Report, “Revisiting 24-Hour Health Care Coverage and Its Integration With the California Workers’ Compensation System” which is available for free in the Research section of the CWCI website, www.cwci.org/research.html.
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