The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, marks a notable development in the broader effort to reform the U.S. health care system. PPACA arose in the wake of initiatives in several individual states, most notably Massachusetts, to enact comprehensive health care reforms that would expand the availability of coverage, increase quality, and lower costs. Although there is widespread agreement among stakeholders in the workers’ compensation (WC) system that health care reform measures such as those contained in PPACA have the potential to affect the cost and composition of medical care received under...

This chapter provides a brief summary of the major provisions of the Massachusetts reform bill and describes the data sources used to examine the reform’s impact on hospital care. It also provides some basic statistics on WC in Massachusetts that may be helpful in situating this state relative to other parts of the country. The hospital data are used to demonstrate that the reform reduced the share of patients without insurance and changed the mix of payers.

In April 2006, after substantial legislative debate in the latter part of 2005 and early 2006, Massachusetts Governor Mitt Romney signed a statute...

This chapter presents estimates of the effect that health care reform had on the amount and nature of hospital care paid for by WC. I first consider ER billing, and then separately assess billing for hospital inpatients. I next turn to an assessment of charging and treatment volume. Because no single empirical approach is likely to address all potential concerns related to confounding factors, I consider a range of alternative methods for assessing the reform’s impacts. While it may be difficult to conclusively prove that reform had a particular causal effect on WC billing, the fact that I obtained similar...

In considering the implications of this study’s findings for our understanding of the likely impacts of PPACA or other broad-based efforts to reform the U.S. health care system, a number of the study’s limitations are relevant. First, the fact that Massachusetts differs from the rest of the nation in important respects may affect the mapping between reform and WC outcomes. Massachusetts is wealthier, more densely populated, less ethnically and racially diverse, and contains a different occupational mix than the United States as a whole. In addition, reimbursement schedules for WC medical care in Massachusetts are lower than in most other...

This report provides some of the first empirical evidence of the impact of health care reform on medical treatment received by WC patients. Following Massachusetts’s implementation of a health care reform that included provisions similar to many of the key provisions of the PPACA, WC hospital billing volume fell by 5 percent to 10 percent. This decline can be plausibly attributed to the coverage expansions induced by health care reform. Billed charges for patients covered through WC increased in a manner consistent with general medical price inflation and were not obviously affected by the reform. Measures of treatment volume, such...