Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

Someone Always Pays: Obamacare and Health Insurance Coverage for Injured Workers in Washington State

This is not a political post. The purpose of this article it to share my personal experience as to how the Affordable Care Act (a.k.a. The ACA or Obamacare) affected the lives of some of my clients. Given recent political developments, especially as they relate to healthcare coverage, I felt that I should write about my observations over the years and the current state of health insurance affairs.


The Enactment of the Affordable Care Act (Obamacare)

To be perfectly honest, at first I didn’t know what to think or how to feel about the creation of the Affordable Care Act. On the one hand I was happy for the people who, for the first time in years, finally had access to the very most basic healthcare they so desperately needed. On the other hand, I felt sad for the people who rarely use or need access to healthcare being forced to pay for coverage or whose coverage was becoming significantly more expensive. What was a tremendous blessing to some was a significant burden to others, and it began to rip our society apart. Those who were burdened became resentful to those receiving low or no cost healthcare, feeling that these people were receiving a hand-out or an entitlement that wasn’t earned and that was being paid for on the backs of the hardworking middle class. Those who finally had access to the healthcare they so desperately needed became resentful towards the folks who opposed the plan, feeling that they were valuing the contents of their pocketbooks over the legitimate health needs of another human being.

Gradually I came to appreciate the ACA because I could see the tangible and positive effects of the legislation in my work on a daily basis. In the workers’ compensation setting in Washington State, when an individual is so catastrophically injured that he or she cannot work, the injured worker is provided with time loss compensation equivalent to 60% of the salary the person was making at the time of injury (for a single person with no dependents). Injured workers often received health coverage while working. However, upon becoming unable to work because of their injuries, these injured workers lost their general health coverage. Sure, the medical care they needed for their workplace injuries was covered by industrial insurance, but things like asthma medications, blood pressure medications, diabetes medications, anti-seizure medications, and anti-rejections medications for prior transplanted organs were not covered. Upon losing coverage associated with employment, most of these people could not afford the costs of health coverage like COBRA or private insurance. Even worse, these people could be denied access to new coverage on the basis of pre-existing conditions.


Real-life Example Prior to the Affordable Care Act

First, imagine this pre ACA scenario: As a result of a major illness when you were thirty years old, you had to undergo a kidney transplant. For the remainder of your life you must take medication to prevent your body from rejecting the transplanted organ. The cost of that medication is more than $1000 per month but because you were a blue collar worker, your insurance covered the cost of the medication. You obtained the transplant, got better, and went on with your life. However, when you were 45 years old with two children, you were catastrophically injured at work. As result you lost your job and your access to healthcare and you couldn’t purchase private insurance because no insurance company would accept your pre-existing health condition. You needed the medication or you would die, so you paid for the medication out of pocket but you really couldn’t afford it.

As a result you lost your home to foreclosure, your wife left you and you lost custody of your children because the court didn’t feel you could adequately take care of them. You became depressed but couldn’t afford treatment or medication for the depression. You began to collect food stamps from the Department of Social and Health Services (DSHS), started living in a tent, and turned to street drugs to numb the pain and misery. Eventually your attorney convinced the Department of Labor and Industries (L&I) to accept responsibility for your depression so that industrial insurance would at least cover the cost of seeing a psychiatrist and getting medication. However, your ability to recover from your catastrophic workplace injury was severely, negatively impacted, and you ended up being placed on a pension, receiving that 60% salary for the remainder of your life.


Someone always pays

In this scenario the worker pays, the worker’s family pays, the state aid administration (in WA – DSHS) pays, L&I pays, hospitals and doctors office pay when bills aren’t, and ultimately tax payers pay so that all of the services like the Court system, DSHS and L&I can intervene. It is also highly likely that the individual would have applied and been approved for Social Security Disability benefits, placing a further drain on that system. Society pays through increased taxation to fund the administrations to intervene to provide other services in the absence of health coverage.


The Same Example Under the Affordable Care Act

Now the same scenario post ACA: When you were catastrophically injured and lost your job, you lost the health coverage you had while working. However, under the ACA you were able to shop the marketplace and purchase low or no-cost health coverage for you and your family. You couldn’t be turned away for your pre-existing kidney condition. Your new insurance wouldn’t cover the same anti-rejection medication but would cover a less-expensive medication. It caused side effects and wasn’t your doctor’s top choice but it was covered and it kept you alive.

The money was still tight and you lost your house to foreclosure. Your wife asked for a divorce but you maintained split custody of your kids. Eventually you recovered enough from your injury that you were retrained and you returned to sedentary work in an office setting. However, you never collected food stamps and you never left a hospital or doctor’s office hanging with a bill you couldn’t pay. You never applied for Social Security Disability benefits because you were determined to return to work.


Again – Somebody always pays

In this scenario the worker pays, the worker’s family pays, L&I pays for the work related injuries and retraining, the new insurance pays for the non-industrially related healthcare needs, and all of society pays through mandatory insurance coverage and associated premiums.


Concluding Thoughts and Personal Notes

The bottom line is that in America we value life and we pride ourselves on having the best healthcare options in the world. However, options are not really options if they are not accessible. The ACA fixed the accessibility issue at a very identifiable cost to the middle class. With the dismantling of the ACA, it seems accessibility will become an issue once again and there will still be an extreme cost to society, the difference is that it will not be as identifiable. Administrations like DSHS, L&I and even local government groups like police departments will start expending additional resources to meet the needs of uninsured individuals. Eventually the middle class will feel the monetary impact in increased taxation; it simply will not be as easily identifiable as a new or increased insurance premium was.

Anyone who has ever talked with me for long knows I am ever the optimist. I believe there must be a better solution. I would have to agree that the ACA was clearly not the most ideal solution but I don’t necessarily fault the Obama Administration for that. In the face of what people seemed to universally agree was a health crisis, I believe our elected officials had an opportunity to come together and create a plan that would work. Instead they decided to bicker and hold party lines (both Democrats and Republicans) to such an extreme that it permanently damaged the ACA. In short the ACA was set up to fail. Nothing about the current election cycle changes that. The other thing that hasn’t changed is the simple fact that someone always pays.


  1. Rita

    My granddaughter is on L&I and has been for 2 years this month due to an on the job injury. Her medical insurance expired after a year so she has no insurance for her son. or herself. She tried Washington Apple and they told her she can apply in November. She cant afford to pay for medical insurance. She is severely depressed, her foot doesn’t seem to be getting any better and her son, age 16, hasnt seen a doctor or dentist in over a year. What can she do? What kind of help is out there for her?

    • L&I attorney

      Hi Rita. Please have her call our office and we can schedule a free consultation to try and see what is going on with her claim.

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