Workers Comp Zone


An eagerly awaited 2018 report on the future of health care in California fails to mention workers’ compensation at all.

The report, dated March 12, 2018, is under the aegis of University of California San Francisco and is titled “A Path to Universal Coverage and Unified Health Care Financing in California”. The report, written by UCSF and UC San Diego medical school professors , was commissioned by the California State Assembly. 

The authors note that “This report reflects the authors’ attempts to explain information that emerged from the six Select Committee hearings and to assemble the findings from the hearings into a coherent set of possible recommendations for the California Assembly.”

In a recent blog post I discussed the debate in the California legislature over SB 562, the “Healthy California Act”, a single-payer proposal being pushed by the California Nurses Union and some other advocacy groups.SB 562 stalled in 2017 when Assembly Speaker Rendon refused to advance the bill.

So there were hearings and now this UCSF report.

The report makes the case for an incremental approach to a universal coverage goal.

It is not surprising that workers’ comp isn’t mentioned. Workers’ comp medical care costs are only a small slice of overall California healthcare spending. According to the report, Medi-Cal spending is over $100 billion, Medicare is $75 billion, employer sponsored insurance spending is $100 to $150 billion, individual consumer spending for insurance premiums is $10 billion and out of pocket spending is $25 billion to $35 billion.

Contrast this with figures from the WCIRB 2017 State of the System report. According to the WCIRB, paid physician services in workers’ comp are $1.2 billion, inpatient and outpatient services are $0.6 billion, and pharmaceuticals are $0.3 billion.

So workers’ comp spends a lot on medical but it is a drop on the bucket compared to overall medical spending.

This UCSF report will probably strengthen the hand of policymakers who want to move to universal coverage in measured rather than grand, bold steps.

The UCSF report does make a number of suggestions for alternatives to address remaining coverage gaps and to reduce affordability barriers to healthcare coverage.

One of the big concerns right now is whether California can provide coverage to undocumented residents and how the state would pay for the bill for this. The ACA has made a big difference in the number of Californians without insurance coverage of some kind, but around 3 million still have no coverage. Of the 3 million about 59% are not eligible due to their immigration status according to UC Berkeley studies cited by the UCSF authors.

The UCSF report makes recommendations for interim steps the state could take to position itself for an eventual transition to a universal coverage single payer system,

As noted in my recent blog post, 24-hour care has been a peripheral issue in workers comp for around 25 years, back to an experiment during the Pete Wilson administration. The implications for workers’ comp would be tremendous, but the workers’ comp industry will not be the deciding factor in the long run.

Workers’ comp junkies will want to keep their eye on what happens in the California legislature this year with various health bills. The conventional wisdom is that if more workers have health coverage there may be less problem with treating “co-morbid” conditions and that there may be some lessening of claim frequency if workers can get treatment elsewhere than in the workers’ comp system.

Here is the UCSF report:


And here is the link to my recent post titled “Revisiting Single Payer”:

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Julius Young