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Five Ways ObamaCare and Workers Comp Are Similar


Five Ways ObamaCare Could be ObamaComp(c)

The five ways Obamacare and Workers Comp are similar may come as a shocker.  The Wall Street Journal very recently published an article on how the Affordable Care Act will affect health insurance premiums.   There seemed to be a few items in the Act that sounded very similar to Workers Comp.

Insured Five Ways ObamaCare premium
Wikimedia Commons – Obama

The first similar component is health insurance costs and Workers Comp medical treatment fees both being indexed or based on the Medicare/Medicaid fee schedules.   A large majority of states now use fee schedules to reimburse providers for medical treatment.

The second similarity is in states with no fee schedules, the Usual and Customary charges are indexed on a Zip Code or address.   The Usual and Customary charges seemed to be very similar to the community-based pricing requirements of the Affordable Care Act.

The final three comparisons are best compared by an excerpt from the article.  The following three components reminded me of the same Workers Compensation insurance requirements.

Central to ObamaCare are requirements that health insurers 

  1.  Accept everyone who applies (guaranteed issue)
  2. Cannot charge more based on serious medical conditions (modified community rating)
  3. Include numerous coverage mandates that force insurance to pay for many often uncovered medical conditions.

Workers Comp insurers have almost the same requirements:

  1. Accept everyone that applies indirectly as all employees are covered.  Workers Compensation insurance is a guaranteed issue policy of sorts
  2. Cannot charge more for employees with serious pre-existing conditions.  Workers Comp insurers cover the employees regardless of prior medical condition
  3. Are sometimes forced to cover injuries that may have not been work-related

Also Read: What Is A Guaranteed Cost Program In Workers Compensation?

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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