Workers’ Injury Law & Advocacy Group 15th Annual Conference, Aventura, Florida, November 4, 2010.


The relationship between national health care reform and workers’ compensation is not a new issue. Whenever there is a serious discussion about some form of national involvement in the delivery or financing of general health care, the question arises: how does workers’ compensation fit in to this plan? The question is a logical one for state workers’ compensation and federal health care reform share a number of common concerns. Both strive to provide meaningful access to care; both aim to stem the tide of rising costs; and each is concerned about how to coordinate with the other. But, the devil is in the details.

The 1972 Report of the National Commission on State Workmen’s Compensation Laws briefly spoke to this issue. That Report took the position that it would be unwise and unnecessary for any national health insurance program to assume workers’ compensation medical costs. In the view of the Commission, folding workers’ compensation medical costs into a national health insurance program “would be inconsistent with a central tenet [of workers’ compensation]...that the costs of work-related injuries and diseases should be allocated to the responsible source, and will be unnecessary if our recommendations for medical care under workmen’s compensation are adopted.

The Clinton Administration tackled national health insurance again in the 1990's. The administration’s initial proposals favored merging the medical component of workers’ compensation into a federal health care system. Proponents of “full integration” or “merger” believed that the unification would reduce administrative costs which would produce savings that would offset costs to employers in supplying health insurance. This, in turn, might help generate political support for expanding the federal role in health care. This proposal failed to garner any significant support outside of the White House. In fact, it prompted considerable opposition. Business owners apparently concluded that shifting medical costs from workers’ compensation to general health insurance would not produce any real savings. The Clinton administration backed off of this “full integration” approach and instead advanced other proposals that had less encompassing treatments of workers’ compensation. One of the proposed bills would have retained the employer’s obligation to provide medical benefits under workers’ compensation laws, but would have pre-empted state “choice of provider” laws and empower employees to select providers from any federally approved health plan. Other proposals simply required workers’ compensation medical providers to comply with various federal laws. Of course, none of these bills were enacted into law.

The reforms proposed first by candidate and then President Obama, took slightly different forms at different times. Candidate Obama forcefully advocated for a form of a “national health insurance” which President Obama later toned down into a “public option.” At no time did the Obama proposals call for the full integration of workers’ compensation into a national health care system. Rather, they called for the creation of a federal insurance provider that would be, in essence, an additional available payer, much like Medicare. As we know, the public option did not survive the political battle.

The law that was ultimately passed is known as the Patient Protection and Affordable Care Act (PPACA) (H.R. 3590) and the modified, as enacted, Reconciliation Act of 2010 (H.R. 4872). Just how will this federal law affect state workers’ compensation systems? As discussed in more detail below, the federal legislation will have little direct impact on workers’ compensation and as far as indirect effects are concerned, preliminary commentary is admittedly speculative.