WCRI – Congressional perspectives

Boston’s always beautiful in March – some days are even more beautiful than others. No better place for the annual gathering of the work comp geeks – myself included aka the WCRI Annual Issues & Research Conference.

The kickoff session featured two former denizens of Capitol Hill opining on the impact of the election on healthcare, labor, and work comp. Former Rep Henry Waxman (D CA) and former Sen Tom Coburn (R OK) took to the podium for a moderated discussion and audience Q&A.

WCRI CEO John Ruser started off asking about the Executive Orders issued by President Trump, specifically the drop 2 regulations for every one adopted. Waxman spoke briefly about the complexities, but focused on the lack of consensus among Republicans on healthcare reform and noted that, due to this lack of consensus, they are looking to the President for leadership.  But the President is not providing leadership on healthcare, so we’ve got a hot potato situation.

Coburn attributed problems to a lazy Congress passing large numbers of bills written by departmental Secretaries; elected officials aren’t developing the legislation but rather using language handed to them. He also believes Congress has abdicated and/or lost much of its rightful place as an equal player among the three branches of government.

ACA

Ruser led off with a hypothetical question about what parts of ACA should be kept if the law is repealed and replaced.  This was the wrong question, as it deals with a – in my view – highly unlikely hypothetical. Instead, the question should have been “what’s going to happen with ACA? Will it be repealed? What will pass if anything?”

Waxman doesn’t believe ACA will be repealed.  In contrast, Coburn thinks that all we have to do is publish prices for health services and outcomes and people will go to those providers with the best prices and outcomes.  I don’t know what planet he lives on, but parents with sick kids, individuals with mental health issues, or children of ailing and incompetent parents are never going to be able to make appropriate “Market based” decisions.  Oh, and insurers are never going to insure people with pre-existing conditions – and they’ll look to cancel policies for those who have the temerity to get sick.

This isn’t an economic decision folks, it’s your daughter or son.

Coburn promoted a bill that is under consideration – Burr Hatch Upton.  He believes this bill will be similar to what comes out of Congress.  Details on this here.

He also said there was no attempt by Democrats to involve the GOP in ACA – a statement that is patently false.

Cost shifting

Waxman responded to Ruser’s question about the potential for healthcare changes on case or cost shifting to work comp.  He talked about Medicaid changes that may well reduce enrollment in Medicaid – didn’t speak to workers comp.  Not surprising as he isn’t a work comp guy.

Coburn is a practicing physician, he discussed unfunded liabilities, asserting $105 trillion in future unfunded liability for medicare medicaid etc, noting that we are hurting Millennials as they will have to pay for this.  This is somewhat interesting as he voted against requiring the feds to negotiate pricing for drugs for Medicare.

Unfortunately these two gentlemen weren’t really equipped to address the question – no fault of their own as this is an esoteric topic.

Federal oversight of work comp

Waxman doesn’t see the new Administration moving to increase federal oversight of workers comp, as there’s been no indication from the nominee or administration about this.  that and there are too many other issues re far more important.  Coburn agreed with Waxman and cited lack of Constitutional support for federal involvement in workers comp.

Coburn discussed the expansion of the definition of disability under SSDI, and the subsequent increase in beneficiaries.  He sees SSDI as a social safety net.  All the data supports his case that SSDI enrollment has increased and there are now 25 million Americans are on ssdi – a number that isn’t right.  The actual figure is 4.8% of the population – or 15 million people.

An audience member asked if the Grand Bargain is being dismantled.  Coburn noted that there’s no requirement that SSDI factor in the cause of the disability; SSDI is responsible for disability regardless of the cause.  He said the real question is should work comp cover the entire cost of the disability?  

That’s an excellent question – I believe the answer has been, and still is, yes.