The idea of a single-payer health insurance system has been discussed at both federal and state levels for years. To date, no state has fully adopted such an approach; however, several jurisdictions are studying the issue.

Of particular interest are bills that include a reference to workers compensation. According to the report by NCCI, in most states that reference workers compensation, the legislation generally contains similar language that directs the board of new state single-payer healthcare programs to develop a proposal for coverage of healthcare items and services covered under the workers compensation system, including whether and how to:

– – Continue funding for the healthcare services under the workers compensation system
– – Incorporate an element of experience rating

In 2022, four states considered or are considering single-payer health insurance proposals with a workers compensation component:

– – Kansas introduced HB 2459, which would have created a universal single-payer healthcare program. The bill required the new program’s board to develop proposals addressing workers compensation and experience rating by July 1, 2024. The bill did not advance this session.
– – Rhode Island introduced H 8119 and S 2769, which would create a universal single-payer healthcare program. The bills require the new program’s director to develop procedures for accommodating coverage of healthcare services covered under the workers compensation system.
– – California AB 1400 would have created a universal single-payer healthcare program and required the new board to develop proposals addressing workers compensation and experience rating. But the bill was not called for a vote on the Assembly floor and is considered failed for this legislative session.
– – New York A 6058, introduced in 2021, would establish a single-payer healthcare program in the state. The bill was recently voted out of the Assembly Committee on Codes and is now in the Assembly Ways and Means Committee. It requires the board of the new healthcare program to develop a proposal for healthcare services covered under the workers compensation law. This includes whether and how to continue funding those services under that law and incorporate an element of experience rating. (The Senate companion bill, S 5474, is currently in the Senate Health Committee.)

In addition, Oregon enacted legislation in 2021 that extended a previously created state Task Force on Universal Healthcare until 2023 and extended the deadline for the task force to submit recommendations to the legislature until September 30, 2022. The recommendations may address whether the single-payer healthcare program should replace the medical portion of workers compensation. Washington enacted legislation in 2021 that established a new commission on universal healthcare. The commission must submit a report with recommendations to the state legislature and the governor by November 1, 2022. However, the legislation did not include a workers compensation component.

Single-payer health insurance is an important topic and all proposals, whether federal or state, raise numerous questions for workers compensation stakeholders, including:

– – What happens to the state workers compensation system if a state enacts single-payer health insurance legislation and the state decides to incorporate the medical portion of workers compensation into the new single-payer program?
– – Would the private workers compensation market continue to write workers compensation policies to cover the indemnity portion of workers compensation?
– – If so, how would the split in public/private coverage impact the delivery system for injured workers, including benefits, quality of care, etc.?
– – How would workers compensation regulators fit into the new system? Would they continue to have any oversight?
– – For employees, their primary concerns are how will this affect benefit delivery and overall medical care for a workplace injury or illness. Would it streamline it or slow it down?
– – Would an employee have to pay into the new system to receive medical care for a workplace injury, unlike workers compensation where the employee does not have to pay for medical care?