Tag Archive: 24-hour care

California single payer could include “24-hour care”

Lara and Atkins said they are working to address concerns that have killed past single-payer proposals. A wide-ranging financial analysis is under way.Atkins has floated an idea to offset steep costs by dissolving workers’ compensation insurance. Under that change, people with work-related illness or injuries could use their regular doctors, eliminating those costs for employers.“In the past I’ve said it wasn’t possible,” Atkins said. “What makes us different now is the experience with the Affordable Care Act…I’m hearing and seeing an appetite to do more.”

Source: Single-payer health care up for debate in California | The Sacramento Bee

This adds a new wrinkle to California’s consideration of single payer medical care that could help overcome opposition due to the entrenched dominance of employer-sponsored group health coverage for the majority of working age people. The apparent idea here is make a payroll tax to finance single payer more politically palatable to business and employer organizations by eliminating the medical treatment component of state mandated workers’ compensation insurance.

This isn’t the first time the idea of providing medical coverage for both vocational and non-vocational injuries and illnesses through an integrated care system has come up in California. In the 1980s and 1990s, the idea was termed “24-hour care.” California Congressman John Garamendi, who served as the state’s first elected insurance commissioner in the 1990s, was a big proponent of the concept, saying it was wasteful to pay for separate forms of insurance for medical care. Garamendi served on Hillary Clinton’s health care reform task force and influenced it to include 24-hour care in the Clinton administration’s health care reform proposal.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Gruber warns of increased tendency toward cost shifting between health and workers’ compensation systems

The trend toward less generous employer-sponsored health coverage and increased employee cost sharing has increased the exposure of the workers’ compensation system to cost shifting, warns Jonathan Gruber. Gruber was the architect of the Massachusetts Health Connector a decade ago that served as the template for the health benefit exchange and individual and small group market reforms of the Patient Protection and Affordable Care Act. Cost shifting between the two systems occurs when, for example, an employee who sustains an injury or illness over the weekend and then files a workers’ compensation claim on Monday, asserting that the injury or illness originates in the workplace.

Heightening the tendency toward cost shifting is the difference in provider access between health and workers’ compensation insurance, Gruber notes, arguing that the two forms of coverage require greater harmonization. “If the workers’ compensation system stays behind, it will have the broadest possible network and the lowest possible cost-sharing, and it’s going to have people migrating into it more and more,” Gruber said in remarks to the Workers Compensation Research Institute (WCRI) in Boston reported by the Insurance Journal.

In 2007, then-California Gov. Arnold Schwarzenegger proposed as part of his health care overhaul (based on Gruber’s Massachusetts’s model) a “24-Hour coverage” pilot program that would have combined the medical treatment component of workers’ compensation with group health coverage. State and local government employees would obtain medical care through the same providers used in a state run managed care program for work and non-work-related health care, with an option for private employers to participate on a limited basis.

According to a report prepared that year by the California Commission on Health and Safety and Workers’ Compensation, at least 10 states adopted legislation permitting 24-hour care pilots but only two — Oregon and California – implemented them. Merging medical treatment coverage for care needs arising out either vocational or non-vocational circumstances can potentially reduce frictional costs and achieve administrative efficiencies, but has proven problematic due to various legal, institutional and cultural impediments.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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