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Other States Have Left Workers' Comp Out of Their Single-Payer Efforts — Why?

September 1, 2016
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Amendment 69, or ColoradoCare, is on November’s ballot and would amend the state constitution to replace Medicaid and private insurance with a single-payer health care system in Colorado.

Under current law, workers’ comp insurance covers the health care needs of injured workers and replaces their lost wages for as long as they are out of work, even if they are permanently disabled. But Amendment 69 will put the medical portion of workers’ comp into the ColoradoCare system, and workers’ comp insurers will be left with only the wage replacement (indemnity) portion.

The difficulty is that medical payments and wage replacement costs are inextricably linked, and divorcing them will cause confusion and destabilize a well-functioning system. Employers will pay the price.

Workers’ comp is complex, which is why the only other states to seriously explore (and ultimately back away from) single-payer health care excluded workers’ comp from their proposals. Here’s what they found.

California has made numerous attempts at implementing a single-payer system. During the last effort, in 2012, even proponents highlighted the difficulty of including workers’ comp. For example, they noted the conflicting legal frameworks between workers’ comp and health care.

They also noted that the California law aimed to make significant changes to how basic health care was financed in the state, and “taking on the additional challenge of revamping workers’ compensation in the same legislation may be too much for one bill.”

In addition to the administrative issues highlighted by the California effort, Vermont predicted increased costs and market disturbance.

Vermont’s Agency of Administration for Health Care Reform, in a report to the Vermont Legislature on “Integration or Alignment of Vermont’s Workers’ Compensation System with Green Mountain Care” (Jan. 15, 2013), indicated that including workers’ comp in its single-payer plan could:

  • Increase overall costs to the employer.
  • Increase administrative burdens.
  • Create regulatory conflicts.
  • Create coverage issues.

That same report included the following assessment of integrating workers’ comp into the single-payer proposal: “To overlay the workers’ compensation medical component into (the initiatives needed to set up Green Mountain Care) could adversely impact the overall medical treatment and recovery period of injured workers and employers could be subject to substantial increases in indemnity costs. The Vermont workers’ compensation (system) is stable at this time and stability during these economic times is critical for business development including the creation of jobs.” It also noted insurers’ concerns that “offering indemnity without any sort of oversight over the health benefits creates a disconnect and subsequent risk that would be potentially difficult for private insurers to manage.”

Previous proposals for single-payer systems in other states have rejected the inclusion of workers’ comp. Let’s not make that mistake in Colorado.

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