What we do have is a belief that stuck with me for years before it finally became an organization: the workers’ compensation industry had an education problem, and until we solve it, nothing else we try will work as well as it should.

That’s why we built this. Not to add another training vendor to an already crowded market, but to fill a gap that nobody else seemed to recognize as the gap – the missing foundation beneath all the other problems we keep trying to solve.

Workers’ compensation is one of the most fragmented industries I’ve ever encountered. Fifty-plus different state systems. Thousands of employers with wildly varying approaches. Carriers, TPAs, and self-insured operations all doing things their own way. Medical providers who interact with comp sporadically and often reluctantly. Attorneys on all sides with competing incentives. Regulators trying to oversee a system that looks different in every jurisdiction.

Into this fragmented landscape, we drop new adjusters with minimal preparation and expect them to figure it out. We hire claims professionals and give them a procedure manual instead of an education. We sometimes promote supervisors based on their individual performance without developing their leadership capabilities. We assume that experience alone will somehow transform task processors into skilled professionals.

And then we wonder why outcomes vary so dramatically. Why some adjusters connect with injured workers while others alienate them. Why some organizations build great cultures while others churn through staff. Why the industry struggles to attract and retain talent.

The answer isn’t complicated: we never built the educational infrastructure that a mature profession requires.

Consider virtually any other profession that deals with consequential decisions affecting people’s lives. Medicine has medical schools, residencies, board certifications, and continuing education requirements. Law has law schools, bar exams, and mandatory CLE. Accounting has degree requirements, CPA exams, and professional standards bodies. Engineering has accredited programs, licensing exams, and professional ethics requirements.

These professions invested in education not because they enjoy bureaucracy, but because they recognized that competent practice requires more than on-the-job training. They built systems to ensure that practitioners understand not just the mechanics of their work, but the principles underlying it.

Frankly, with the exception of a few limited licensing requirements, workers’ compensation never built that system.

We have some excellent training programs, to be fair. Many individual carriers and TPAs invest in their people. Industry associations offer valuable conferences and seminars. Specialty certifications exist in various niches. But there’s no coherent educational pathway for someone entering this industry. No common body of knowledge. No shared standards for what a competent claims professional should know and be able to do.

The result is exactly what you’d expect: highly variable quality, reinvention of wheels across organizations, and an industry that has trouble articulating its own professional identity.

When we started thinking about WorkCompCollege, we weren’t thinking about courses and certifications. We were thinking about infrastructure.

What if the industry had a common foundation – a shared understanding of what workers’ compensation is actually trying to accomplish and how competent professionals achieve it? Not just the procedural knowledge of how to process a claim, but the deeper understanding of why we do what we do and how to do it well?

What if adjusters entered the field with a genuine education in the biopsychosocial nature of injury and recovery, rather than learning it – if they learn it at all – years into their careers? What if supervisors were developed as leaders before they were promoted, rather than being left to figure it out through trial and error? What if the industry had clear professional standards that meant something – that signaled to employers, injured workers, and the public that certified professionals had demonstrated real competence?

This isn’t idealistic dreaming. It’s what every other serious profession has done. We’re just late to the realization that we need to do it too.

The Missing Link

Over the past month, I’ve written about restoring the human element to workers’ compensation. About why legislative reform keeps falling short. About how culture and leadership determine outcomes more than policies and procedures.

All of those pieces connect here.

You can’t restore humanity to a system staffed by people who were never taught why humanity matters. You can’t achieve meaningful reform by changing statutes while leaving unchanged the professionals who implement them. You can’t build great cultures without developing the people who comprise them.

Education is the missing link. It’s the intervention that makes all the other interventions work. Without it, we’re trying to build a house without a foundation – and then wondering why the walls keep cracking.

This is what WorkCompCollege exists to provide. Not just training, but education. Not just skills, but understanding. Not just compliance, but competence.

When I say we’re on a mission, I mean it literally. WorkCompCollege isn’t a business strategy dressed up in inspirational language. It’s an actual mission – a commitment to transforming this industry through education because we believe the industry is worth transforming.

That mission asks something of all of us.

It asks adjusters to see themselves as professionals worthy of genuine education, not just task workers who need enough training to follow procedures. It asks them to invest in their own development, to pursue credentials that mean something, to embrace the identity of a skilled professional rather than accepting the limitations of a claims processor.

It asks employers to invest in their people; really invest, not just check the training box. To recognize that education compounds over time, that developing professionals pays dividends for years, that the best adjusters will stay where they’re valued and leave where they’re not.

It asks industry leaders to think beyond their own organizations. To contribute to building the shared infrastructure that benefits everyone. To support the development of professional standards that elevate the entire field rather than just competing for a slice of the existing pie.

It asks all of us to believe that workers’ compensation can be better than it is. That injured workers deserve a system staffed by genuine professionals who understand what they’re doing and why it matters. That this fragmented, inconsistent, often frustrating industry can become something we’re all proud to be part of.

I’ve been in workers’ compensation for a long time. Long enough to have seen fads come and go (big data, anyone?). Long enough to be skeptical of anyone claiming to have all the answers. Long enough to know that real change happens slowly, through sustained effort, one professional at a time.

That’s what we’re building at WorkCompCollege, a community of professionals committed to their own development and to improving this industry. People who believe that education matters. Who invest in becoming better at what they do. Who understand that how we treat injured workers reflects who we are as professionals and as people.

We’re building this community one student at a time. One certification at a time. One organization at a time. It’s not fast. It’s not flashy. But it’s real, and it’s growing.

The Workers’ Recovery Professional certification. The MSP College programs. The AI programs focused on workers’ comp. The partnerships we’re developing with organizations that share our vision. The content we create to push the industry’s thinking forward. All of it serves the same mission: building the educational infrastructure this industry has always needed but never had.

I don’t know what brought you to this article. Maybe you’re an adjuster looking for something more than another compliance training. Maybe you’re a leader trying to figure out how to develop your team. Maybe you’re just curious about what this WorkCompCollege thing is all about. Or you just stumbled in looking for the bathroom (down the hall and to your right). 

Whatever brought you here, I want to extend an invitation.

Join us.

Not because we have all the answers. We don’t. Not because transformation happens overnight – it doesn’t. But because you believe, as we do, that this industry can be better. That injured workers deserve better. That the professionals who serve them deserve better. That education is how we get there.

We built a college for workers’ comp because we believed the industry needed one. What we’re learning is that the industry was ready for one. Professionals across the country are hungry for a better way, not just knowledge, but purpose. Not just credentials, but community. Not just training, but transformation.

That’s the mission. And it has room for you.

If you’re ready to be part of building something different in workers’ compensation, we’d love to have you. Explore what we offer at WorkCompCollege.com, connect with our community, and join the mission of transforming this industry through education – one professional at a time.

And yet, if you pulled ten random claim files from ten different organizations – all following the same state statutes, all subject to the same regulations – you’d find dramatically different experiences for the injured workers involved. Same rules. Same processes. Wildly different outcomes.

The difference isn’t in the handbook. It’s in the culture.

We spend enormous energy in this industry ensuring compliance. Regulators audit files. Quality assurance teams score calls. Supervisors review correspondence. Technology flags deviations from established protocols. From a process perspective, we’ve never been more monitored.

But here’s what I’ve learned after years of observation and discussion: you can comply your way to mediocrity, but you cannot comply your way to excellence.

Trust me. I’ve tried. Sort of.

Compliance tells an adjuster what they must do. Culture tells them what they should do how they go about it. And more importantly, culture shapes what they want to do. Compliance governs the actions that get measured. Culture governs everything else, which turns out to be most of what actually matters.

When an adjuster picks up the phone to call an injured worker, compliance might dictate the timing of the call. Culture determines the tone of the conversation. Compliance might require that certain information be communicated. Culture determines whether that information is delivered with empathy or indifference.

The adjuster who treats every injured worker with dignity isn’t doing so because it’s in the procedure manual. They’re doing it because that’s who they are in an organization that has made clear that’s who they should be.

This is a factor in every business. I’ve seen offices where the atmosphere is heavy, and effort seems tedious. In insurance offices with a poor culture, you are likely to find adjusters hunched over desks, watching the clock, processing files as fast as possible to meet metrics that reward speed over substance. Supervisors will be circling like hall monitors, looking for violations. Every conversation is tinged with defensiveness.

Of course, there are also claims departments where the energy is entirely different. Adjusters engaged in their work, genuinely trying to help the people on the other end of the phone. Supervisors serving as resources rather than enforcers. A sense that everyone is working toward the same goal rather than just trying to survive another day.

Same industry. Same basic work. Completely different cultures.

The difference, almost without exception, traces back to leadership.

Leaders set the weather in any organization. They clearly set priorities and expectations, as well as determine whether the climate is one of fear or trust, suspicion or support, transaction or purpose. And that climate, more than any policy or procedure, determines how work actually gets done.

When leaders emphasize metrics above all else, adjusters learn to optimize for metrics, even when doing so conflicts with good outcomes. When leaders emphasize human outcomes, adjusters learn to prioritize the injured worker, and the metrics tend to follow.

Care to guess who is getting better outcomes and more satisfied customers?

This isn’t about being soft or ignoring performance standards. The best claims operations are rigorous about results. But they measure the right results, and they create environments where people are empowered to achieve them.

I’ve spoken with many claims professionals and have heard the same themes repeated across organizations and geographies. They want to do good work. They entered this field, most of them, because they wanted to help people. Somewhere along the way, many of them lost that sense of purpose – not because they changed, but because their organizations, and the industry focus demanded it.

What adjusters need from leadership isn’t complicated:

Clarity about what matters. Not fifty competing priorities, but a clear understanding of the outcomes that actually count. If helping injured workers recover is the mission, say so, and then align everything else around that mission.

Permission to be human. Adjusters need to know that taking an extra few minutes on a difficult call isn’t going to get them flagged for productivity issues. They need to know that using judgment is valued, not punished. They need space to be people helping people, not processors processing claims.

Support when things get hard. Claims work is emotionally demanding. Adjusters deal with people in pain, people who are scared, people who are angry. They need leaders who recognize that burden and provide resources to manage it; not leaders who treat burnout as a personal failing.

Development, not just monitoring. The best adjusters want to get better at what they do. They want training that actually helps them serve injured workers more effectively. They want feedback that makes them grow, not just scores that rank them against their peers.

Recognition that matters. Not pizza parties and gift cards, but genuine acknowledgment when they’ve made a difference in someone’s life. The adjuster who helped an injured worker navigate a complex situation and return to work successfully is an adjuster that should know that their effort was seen and valued.

None of this requires a budget increase or a new software system. It requires leadership that understands what actually motivates people to do their best work.

Here’s what happens when culture is right: good adjusters stay. They don’t burn out and leave the industry. They don’t become cynical and disengaged. They grow into mentors who teach the next generation what good claims handling looks like.

And the injured workers they serve? They have better experiences. They recover faster. They return to work sooner. They’re less likely to hire attorneys. They’re more likely to speak positively about their employers. Every interaction ripples outward.

The opposite is equally true. Toxic cultures drive out good people. The adjusters who care the most are often the first to leave, because they can’t reconcile their values with what they’re being asked to do. What remains is a workforce that has learned to keep their heads down and process files. The injured workers they serve experience exactly the kind of impersonal, transactional system that generates friction and extends claims.

There is an oft-heard complaint that says, “What if I train my people and they leave?” To which the only appropriate response should be, “What if you don’t train them, and they stay?” The difference is culture; culture of transparency, culture of priorities, and a culture of concern.

Culture isn’t soft. Culture is strategy. It determines whether you keep your best people or lose them to competitors – or worse, keeping them; a poorly trained, highly stressed, disgruntled workforce. It determines whether injured workers become advocates for your organization or adversaries against it.

Litigation anyone?

Culture doesn’t happen by accident. Left unattended, it drifts, usually in the direction of whatever behaviors are being rewarded, explicitly or implicitly. If you reward speed, you get speed. If you reward closure, you get closure. If you reward humanity, you get humanity.

The leaders who build great claims cultures do so intentionally. They think carefully about what they measure and how they measure it. They hire for values, not just skills. They invest in development that goes beyond compliance training. They create feedback loops that capture the human outcomes, not just the operational ones.

Most importantly, they model the behavior they expect. Adjusters watch their leaders closely. When a supervisor takes the time to genuinely help a struggling employee, that sends a message. When an executive takes a call from an injured worker and treats them with dignity, that sends a message. When leaders admit mistakes and focus on learning rather than blame, that sends a message.

The message is always being sent. The only question is whether it’s the message you intend.

Training your claims team isn’t an expense. It’s an investment – and like all good investments, it compounds over time.

An adjuster who understands the biopsychosocial model of recovery handles claims differently than one who was simply taught the procedure manual. An adjuster who has been trained to communicate with empathy creates different outcomes than one who learned by imitation. An adjuster who understands why the human element matters, not just what the rules require, becomes a fundamentally different professional.

That professional stays longer, performs better, and influences everyone around them. They become the culture you’re trying to build.

This is why we do what we do at WorkCompCollege.com. We’re not just teaching adjusters how to process claims. We’re helping them understand why their work matters and how to do it in a way that serves both the injured worker and the organization. We’re giving them tools that go beyond compliance, tools that help them become the kind of professionals who do right when no one is watching.

Because ultimately, that’s what culture is. It’s what people do when the supervisor isn’t looking, when the call isn’t being recorded, when no one would ever know if they cut a corner. It’s the thousand small decisions that add up to either a claims operation that changes lives or one that just processes files.

Leadership determines which one you build.

Welcome to reform fatigue. It’s the unofficial condition affecting everyone who has survived multiple rounds of legislative overhaul only to discover that the fundamental problems remain stubbornly intact.

I’ve watched this cycle repeat itself across decades and dozens of states. A crisis emerges, costs are too high, benefits are too low, employers are fleeing, workers are suffering. Task forces convene. Stakeholders testify. Legislators negotiate. Eventually, a massive reform bill passes with great fanfare. Everyone declares victory.

And then, a few years later, we do it all again. We reform the reforms of previous reformers.

Let’s not forget the definition of insanity…

There’s a reason the old quote about doing the same thing and expecting different results resonates so deeply in our industry. We have become remarkably skilled at reforming processes while leaving the underlying problems untouched.

We tinker with fee schedules. We adjust benefit formulas. We create new dispute resolution mechanisms. We mandate electronic filing. We restructure medical provider networks. We add layers of utilization review. We implement pharmaceutical formularies. We simplify process with hundreds of pages of new legislation and regulatory code.

These aren’t bad ideas. Many of them produce measurable improvements in specific areas. But they share a common limitation: they’re all designed to optimize a system that was built on assumptions about injured workers that may never have been accurate and certainly aren’t serving us well today.

We keep reforming the machinery while ignoring the people the machinery is supposed to serve.

Here’s what I’ve observed after watching reform efforts in state after state: the legislation that gets passed reflects the interests that show up at the table. Employers want lower costs. Insurers want predictability. Medical providers want fair reimbursement. Attorneys want access to the system. Each group advocates for changes that address their particular pain points.

You know who rarely has a seat at that table? Injured workers.

Oh, their interests are discussed. Their benefits are debated. Their experiences are referenced in testimony. But the actual human beings who wake up one morning as productive employees and go to bed that night as claimants navigating a system they never expected to encounter, their voices are largely absent from the rooms where reform gets written.

Is it any wonder that reform after reform fails to address what actually frustrates them?

When I talk with injured workers – and I’ve talked with many over the years – they rarely complain about the specific provisions of their state’s workers’ comp statute. They don’t express opinions on medical fee schedule conversion factors or the appropriate threshold for permanent partial disability ratings.

What they talk about is feeling lost. Feeling ignored. Feeling like a number in a system that nobody ever explained to them. Feeling suspected of fraud when they’re actually in pain. Feeling like getting better is somehow in conflict with getting compensated.

No reform bill I’ve ever seen has included a provision requiring the system to treat people like human beings. Apparently, that’s not something you can legislate.

I’m not suggesting that legislative reform is pointless. There are genuine structural problems in workers’ compensation that require statutory fixes. Benefit adequacy, cost containment, dispute resolution, these are legitimate areas where law and regulation play essential roles.

But we’ve reached a point of diminishing returns on process reform. We’ve optimized the system to within an inch of its life. We’ve added technology, removed friction, streamlined procedures, and automated decisions. By almost any operational measure, workers’ compensation has never been more efficient.

And yet.

Injured workers still report feeling dehumanized by the process. Employers still view comp as a necessary evil rather than a safety net that protects both them and their workforce. Adjusters still burn out under impossible caseloads. Medical providers still complain about administrative burden. Attorneys still find plenty of dissatisfied clients to represent.

Efficiency isn’t the same as effectiveness. Processing claims faster doesn’t mean we’re processing them better.

This is where I think the conversation needs to shift. The next wave of meaningful change in workers’ compensation isn’t going to come from a 500-page reform bill. It’s going to come from a fundamental reconsideration of what we’re actually trying to accomplish.

Are we trying to minimize costs? Process claims? Adjudicate disputes? Or are we trying to help injured workers recover and return to productive lives?

The answer should be obvious, but our systems don’t reflect it. We’ve built an industry around managing claims rather than helping people. And until we address that foundational disconnect, no amount of legislative tinkering is going to solve what ails us.

Real advocacy in workers’ compensation means advocating for a different set of priorities. It means pushing for outcomes that matter to human beings, timely medical care, clear communication, dignity throughout the process, support for return to work; rather than outcomes that matter to spreadsheets.

It means training adjusters to be advocates for recovery rather than processors of paperwork. It means educating employers about their role in supporting injured workers rather than just their obligations under the statute. It means building cultures within organizations that value the human outcomes as much as the financial ones.

None of this requires new legislation. It requires new thinking.

I’ll be honest: I’m skeptical that the next round of reform will be any different from the last dozen. The same interests will show up at the same tables and advocate for the same incremental adjustments. Some costs will shift. Some processes will change. And the fundamental experience of being an injured worker in America will remain largely the same.

But I’m not without hope.

What gives me hope is the growing recognition, among adjusters, employers, carriers, and even some regulators, that we’ve been optimizing for the wrong things. The conversations I’m having today are different from the ones I was having a decade ago. More people are asking the right questions. More organizations are willing to experiment with approaches that prioritize the human element.

The change won’t come from a state capitol. It will come from claims departments that decide to answer phones differently. From employers who support injured workers rather than suspecting them. From adjusters who see their role as helping people rather than managing files. From an industry that finally recognizes that injured workers aren’t the problem to be managed, they’re the reason we exist.

That’s the reform that matters. And unlike legislation, it doesn’t require a single vote.

The workers’ compensation industry doesn’t need another reform bill. It needs a reformation, a fundamental shift in how we think about the people we serve. If you’re ready to be part of that conversation, I invite you to connect with us at WorkCompCollege.com and explore the community we’re building around a different vision for this industry.

I’ve spent decades in this industry, and we’ve seen this transformation happen many times. It’s not malicious. It’s not even intentional. It’s simply what happens when we build systems designed to process volume rather than serve people.

The workers’ compensation system has become remarkably efficient at processing claims. We’ve developed sophisticated algorithms for reserving, automated systems for bill review, and streamlined processes for everything from initial intake to settlement negotiations. From a purely operational standpoint, we’ve never been better at moving paper.

The problem is that injured workers aren’t paper.

When I wrote Thank You For Holding: Your Injury Is Important To Us, I wasn’t trying to indict the entire industry. I was trying to hold up a mirror. The title itself came from countless hours spent listening to injured workers describe their experiences with the system, the endless hold times, the form letters, the feeling of being processed rather than helped. That automated message we’ve all heard a thousand times; “Your call is important to us,” has become the unintentional motto of an industry that has forgotten how to demonstrate that importance through action.

Here’s what the data consistently shows us, and what common sense should have told us all along: when injured workers feel like they’re being treated as human beings rather than claim numbers, outcomes improve. Across the board.

Workers who feel heard and respected return to work faster. They’re less likely to hire attorneys. They report higher satisfaction with medical care. They’re more likely to comply with treatment protocols. Their claims close sooner and cost less.

This isn’t soft science or wishful thinking. This is what happens when you treat people like people.

The inverse is equally true. When injured workers feel ignored, dismissed, or processed, they dig in. They become adversarial. They seek legal representation not because they need it, but because they feel they need protection. What could have been a straightforward claim becomes a contested battleground, with costs multiplying at every turn.

We’ve created a system that often generates the very friction it then struggles to overcome.

For years now, we’ve been talking about the biopsychosocial model of injury and recovery. The concept is simple: a person’s recovery from a workplace injury isn’t determined solely by the physical nature of the injury itself. Psychological and social factors play enormous roles, stress, fear, financial anxiety, relationships with supervisors, perceptions of fairness.

An injured worker who believes their employer cares about them, who trusts that the system will treat them fairly, who feels supported rather than surveilled, that worker heals differently than one who feels abandoned, suspected, or processed.

We know this. The research is overwhelming. And yet our systems continue to be designed as though injuries happen to bodies rather than to people.

The good news is that restoring humanity to workers’ compensation doesn’t require burning down the existing system and starting over. Often, it requires remarkably small changes that yield disproportionate results.

A phone call instead of a form letter. Using someone’s name instead of their claim number. Asking “How are you doing?” before asking for documentation. Explaining the next steps rather than just processing them. Following up to ensure someone understood their benefits rather than assuming they did.

These aren’t revolutionary concepts. They’re basic human courtesies that have somehow become casualties of our drive for efficiency.

I’ve talked with adjusters who tell me they want to provide this kind of personal attention but feel crushed by caseload expectations. I’ve heard from managers who say they’d love to emphasize humanity but are measured solely on cycle times and closure rates. I’ve sat with executives who genuinely care about injured workers but have built organizations that inadvertently do the opposite. I’ve chatted with regulators that recognize the issue, but are saddled with legislative guidelines that were created with process in mind rather than outcomes.

The system didn’t become impersonal because bad people designed it. It became impersonal because we optimized for the wrong things.

This is why, for more than a decade now, I’ve been advocating for a shift in how we think about what we do. We don’t just compensate workers for their injuries. We help them recover; physically, financially, and psychologically – from events that have disrupted their lives.

The difference isn’t semantic. It’s foundational.

When our goal is compensation, we focus on processing the claim correctly and closing the file. When our goal is recovery, we focus on helping a human being return to wholeness. The processes may look similar on the surface, but the outcomes differ dramatically.

Workers’ Recovery isn’t a new program or a branded initiative. It’s a philosophy, a reminder that behind every claim number is a person with fears and hopes, a family depending on them, a life that has been disrupted by something they didn’t choose.

I’m not naive. I understand the pressures facing adjusters, employers, and carriers. I know that caseloads are high, margins are thin, and everyone is being asked to do more with less. Telling people to “just be more human” isn’t a strategy.

But I also know that the current approach isn’t working as well as it should. We’re spending enormous resources on litigation that wouldn’t exist if people felt heard. We’re extending claim durations through adversarial relationships that could have been prevented with early communication. We’re paying for problems we created.

Restoring the human element isn’t just the right thing to do, it’s the smart thing to do. It’s how we reduce friction, improve outcomes, and build a system that actually serves its intended purpose.

It starts with recognizing that every claim number has a name. Every file has a face. Every injured worker is someone who woke up that morning expecting to come home at the end of their shift the same way they left.

They deserve better than “Thank you for holding.”

Shameless plug: If this message resonates with you, I invite you to explore WorkersRecovery.com and join the conversation around workers’ compensation 2.0. We’re building something different – and we’d love to have you be part of it.

Thank You For Holding: Your Injury Is Important To Us blends humor and hard truth to make the case that America’s century-old workplace injury system must stop managing claims and start restoring lives.

LAKEWOOD RANCH, FL — Bob Wilson, President and co-founder of WorkCompCollege.com and one of the most recognized voices in the workers’ compensation industry, today announced the publication of his first book, Thank You For Holding: Your Injury Is Important To Us — A Lightheartedly Serious Look at Workers’ Compensation Reform. The book is available April 1, 2026 at WorkersRecovery.com, WorkCompCollege.com, and through major print and digital retailers.

More than a decade in the making, Thank You For Holding is both an unflinching examination of a system that processes more than 7,000 newly injured American workers every day and a detailed proposal for transforming it. Wilson argues that the workers’ compensation system—born from the “Grand Bargain” over a century ago—has evolved into an overly complex bureaucratic apparatus that competently manages claims but too often fails at its original purpose: helping injured people get better and get back to living.

At the heart of the book is a deceptively simple proposition: rename and reframe the system as “Workers’ Recovery.” Wilson contends that words shape how systems behave, and that a name change would signal a fundamental shift in priorities—from processing paperwork to restoring lives, from counting costs to counting recoveries, and from managing claims to supporting the human beings at the center of them.

The book’s ironic title and lighthearted tone are deliberate. Wilson, whose blog From Bob’s Cluttered Desk has been recognized as a top workers’ compensation publication by LexisNexis, deploys humor as a rhetorical strategy—not decoration. “Sometimes the most effective way to expose a problem is to make people laugh at the absurdity of it,” Wilson writes. “But behind the jokes, there’s a serious argument.”

Across thirteen chapters, the book follows an injured worker from the moment of injury through the paperwork avalanche, the employer shuffle, the insurance labyrinth, the medical merry-go-round, and the often-clumsy return to work. It then pivots to solutions—outlining how improved communication, better expectations, streamlined procedures, and a philosophical commitment to recovery over process can produce better outcomes for every stakeholder.

The foreword is written by Abbie Hudgens, the former Administrator of the Tennessee Bureau of Workers’ Compensation, past president of the International Association of Industrial Accident Boards and Commissions (IAIABC), and a nationally recognized leader in workers’ compensation reform. Under Hudgens’ leadership, Tennessee implemented what has been widely regarded as one of the most effective state-level reform efforts in the history of the program.

The intellectual foundation for the book traces to a 2015 point-counterpoint exercise published in the IAIABC Journal, in which Wilson authored “The Case for Workers’ Recovery” opposite Dr. John F. Burton Jr., one of the nation’s foremost scholars on workers’ compensation. That exercise forced Wilson to coalesce what had been a loosely defined concept into a structured, detailed proposal—one that has since been refined through over 200 conference presentations and more than a decade of industry engagement.

“Workers’ Recovery is not a call for revolution,” Wilson says. “It is a proposal for evolution. Same foundational principles. Same Grand Bargain. But upgraded for the 21st century, with the focus placed squarely where it belongs: on helping injured workers get better and get back to living.”

A companion website at WorkersRecovery.com provides an overview of the book’s framework and serves as a resource for industry professionals, employers, legislators, and anyone interested in the future of workers’ compensation.

Thank You For Holding: Your Injury Is Important To Us — A Lightheartedly Serious Look at Workers’ Compensation Reform is the first publication to be released by the WorkCompCollege.com Press. It will be available in print and digital formats beginning April 1, 2026 at WorkersRecovery.com, WorkCompCollege.com, and through major retailers including Amazon, Barnes & Noble, and other booksellers.

# # #

About the Author

Bob Wilson is the President and co-founder of WorkCompCollege.com and the author of the widely read industry blog From Bob’s Cluttered Desk (bobscluttereddesk.com). Named one of the “50 Most Influential People in the Workers’ Compensation Industry” by the SEAK Occupational Medicine Conference, Wilson brings decades of experience spanning restaurant and hospitality management, human resources, technical recruiting, and technology development to his advocacy for system reform. He has presented the Workers’ Recovery concept at more than 200 industry conferences. He is a graduate of Fort Lewis College in Durango, Colorado, and resides with his wife in Bradenton, Florida.

And, of course, how that reality affects workers’ compensation. 

Let’s approach it this way. If you think you are a stupid person, would you please raise your hand?

I am willing to bet that no one reading this actually responded affirmatively to that request, so, for the purposes of this discussion we will say that there are no stupid people reading this article. There is a possibility, of course, that someone who is stupid may not have the intellectual capacity to recognize the condition, but for now we will maintain the “no stupid reader” premise. 

Next, I would ask, “Who can think of at least one stupid thing that they have done in the course of their lifetime? Please raise your hand.”

Virtually everyone reading this article should have raised their hand, or at least envisioned themselves raising their hand, to that one. Some may not have raised their hand because doing so in their cubicle, home office, or sitting in their jammies in bed, might have made them feel, well, stupid. If you simply failed to respond because you don’t think you’ve ever done at least one stupid thing, I would refer you to the first question. You got the answer to that one wrong, and our “all readers are not stupid” theory is shot to hell.

Finally, I would ask, “Have you done something stupid today? Please raise your hand.” 

Before you respond to that one, I would remind you that you have taken several minutes out of your preciously short day to read this article, so answer carefully.

The bottom line is that most of the people reading this article are of normal intelligence. Yet the fact remains that we all have at one or more points in our lives done something stupid. People with average intelligence can do stupid things. Highly intelligent people can do stupid things. And stupid people truly excel in the category. It is the one area where they can absolutely claim dominance. Stupidity can at times be ubiquitous, in that no one can permanently escape its clutches. 

For instance, Captain Smith of Titanic fame may have said, “THAT Iceberg? I thought you were talking about lettuce.” 

Or we might have had Napoleon Bonaparte, on his march to Moscow: “Russia in winter? How bad could it be? I didn’t even pack a coat — we’ll be home by Tuesday.”

General Custer at Little Bighorn: “Outnumbered? Pfft. I counted, and there’s like… twelve of them. Tops.”

Thomas Edison’s accountant: “You’re spending HOW MUCH on a light bulb? Just buy candles, Tom.”

The engineer on the Hindenburg: “Hydrogen, helium — they both start with ‘H.’ What’s the difference?”

King George III, circa 1775: “Let them have their little tea party. They’ll calm down by spring.”

And Dr. Frankenstein, at his IME: “The claimant says he can’t return to work, but I literally WATCHED him get off the table and walk.”

Yes, stupid can at times touch each and every one of us. And thank God for that little fact.

People toiling in workers’ compensation should learn to appreciate and celebrate the existence of stupidity. Quite frankly, if it wasn’t for stupidity, many of us might not have a job. 

Again, we are not saying injured workers are stupid. Instead, some of them may be people of extraordinary intellect who for the briefest of moments made a stupid decision. The forklift driver who was texting while driving and literally cut a coworker in half. The truck driver watching porn on his iPad and drove off the road. Or the employee repairing a broken viewer on a camera, and when testing the not yet dry repair found he had glued the camera to his eye. The guy in Montana who got high and then tried to feed bears in an enclosure. Yeah, that ended well. That last one might just have been a dumbass.

Not all accidents are the result of stupidity. Some are just freak happenstance, or the result of unavoidable events such as equipment failure or the momentary distraction. Yet other accidents may be the direct result of stupidity, but not of the injured worker. Sometimes stupid decisions or actions made by supervisors, coworkers, or customers are the cause behind a workplace injury to an innocent person otherwise intelligently toiling along. 

It doesn’t really matter what the source is. The important point is that stupidity is a major force driving our little corner of the economy. We should embrace and applaud it for what it is. To not do so would be, quite frankly, well, stupid. 

I am reminded in closing of the words of Governor William J. Le Petomane, in the movie Blazing Saddles, which in itself was a brilliant tribute to bigotry and stupidity. He said, “Gentlemen, we have to protect our phony baloney jobs.”

Do you have a workplace injury story that can be directly attributed to stupidity? Share it in the comment section below! Please, no personally identifiable information, and keep it clean. But sharing these stories may help in the development of an entirely new type of conference presentation. And how stupid is that?

For the past several months, I’ve been working on something I’ve wanted to write for quite some time—a book about an idea I’ve been championing since the early-2010s.

On April 1st, that book will be released.

It’s called Thank You For Holding: Your Injury Is Important To Us — A Lightheartedly Serious Look at Workers’ Compensation Reform.

And yes, I’m aware of the date. No, it’s not a joke.

An Idea Nearly Twenty Years in the Making

In the early-2010s, I started advocating for something that seemed simple but felt revolutionary: we should stop calling our industry “workers’ compensation” and start calling it “Workers’ Recovery.”

The reasoning was straightforward. Language shapes how systems behave. A system called “compensation” focuses on paying claims. A system called “Workers’ Recovery” would focus on restoring people’s lives.

It wasn’t just wordplay. It was a fundamental reframe of what we’re actually trying to accomplish when someone gets hurt at work.

Nearly two decades later, that idea has gained real traction. We’re seeing more focus on biopsychosocial approaches to injury management. More discussion of claim advocacy and social determinants of health. More recognition that injured workers are whole people with lives, not just claim files with injury codes.

We’ve even built certification programs at WorkCompCollege.com around Workers’ Recovery principles, with hundreds of people now trained in this approach.

Progress is happening. But we haven’t finished the job.

This book is my attempt to take the Workers’ Recovery concept from advocacy to action—to show not just why we should make this change, but how we can actually do it.

What Workers’ Recovery Means

At its core, Workers’ Recovery is about a simple shift in priorities.

Instead of asking “How much does this injury cost?” we ask “How do we help this person get better?”

Instead of treating injured workers as problems to be managed, we treat them as people to be supported.

Instead of building systems around efficiency and cost containment, we build them around healing and restoration.

The remarkable thing is: when you make that shift, the outcomes improve. Not just for injured workers—for everyone. Better recovery rates. Faster return to work. Lower long-term costs. Healthier workplace cultures. More engaged employees.

Doing the right thing turns out to also be the smart thing.

We don’t need to choose between compassion and practicality. We don’t need to sacrifice injured workers’ wellbeing for the sake of system efficiency. We can have both—but only if we’re willing to rethink what success actually looks like.

What the Book Covers

Thank You For Holding walks through what Workers’ Recovery looks like in practice.

It follows the injured worker’s journey—from the moment of injury through the reporting process, medical treatment, employer response, insurance management, and eventual return to work. At each stage, it asks: what would this look like in a system built around recovery rather than compensation?

Some of the answers are obvious. Some are surprising. All of them are achievable.

The book also addresses the practical questions: How do we measure success differently? How do we train people to think recovery-first? How do we align incentives so that everyone benefits from better outcomes? How do we get from where we are to where we should be?

These aren’t hypothetical questions. They’re the questions I’ve been working through for nearly twenty years of advocating for this change.

Why Now

The timing feels right for several reasons.

First, the workers’ compensation industry is more open to reform than it’s been in decades. The pandemic forced everyone to rethink how we work, how we support employees, and what really matters. Mental health has moved from taboo to priority. Remote work has challenged assumptions about what’s possible. We’re in a moment where fundamental change doesn’t seem radical—it seems necessary.

Second, we’re seeing the next generation of claims professionals, medical providers, and workplace safety specialists entering the field. They’re not invested in defending the status quo. They want to build something better. This book is for them.

Third, the data is increasingly clear: the old approach isn’t working as well as we need it to. We can do better. More importantly, we know how to do better. We just need to commit to actually doing it.

And finally, after nearly two decades of talking about Workers’ Recovery in blog posts, presentations, and conversations, it felt like time to put it all in one place—to make the complete case for why this matters and how we make it happen.

Who Should Read It

I wrote this book for several audiences:

For people new to workers’ compensation: An introduction to what the system could be, rather than just what it is. A vision of possibility rather than resignation.

For experienced professionals in the field: A challenge to think differently about work we’ve been doing the same way for years. Not because we’re doing it wrong, but because we can do it better.

For injured workers and their families: An explanation of what recovery-focused care looks like and why you should expect it—not as a luxury, but as a baseline standard.

For employers: A roadmap for building workplace injury programs that actually support recovery while also protecting the bottom line. These goals aren’t in conflict.

For anyone interested in how systems can be redesigned around human wellbeing: Workers’ compensation is just one system, but the principles apply broadly. How do we build systems that serve people instead of just processing them?

The Lighthearted Part

The subtitle promises “A Lightheartedly Serious Look” at reform, and that’s deliberate.

I could have written a dense policy analysis. I could have made it academic and austere. But I’m not that smart. And that’s not how you create change. That’s how you write books that gather dust.

Instead, I wrote it the way I write this blog—accessible, occasionally funny, genuinely optimistic about what’s possible when we decide to do things differently.

Because Workers’ Recovery isn’t a grim duty or a painful sacrifice. It’s actually the more hopeful path. It’s the version of this work where we get to help people heal instead of just managing their claims. Where we build systems that work with human nature instead of against it. Where we can look at what we do and feel good about it.

That’s worth being optimistic about.

What Happens Next

Thank You For Holding: Your Injury Is Important To Us releases on April 1st. It will be available through a companion site set up to promote the Recovery concept, https://WorkersRecovery.com. It will also be available through WorkCompCollege.com, as well as major booksellers in both print and digital formats.

I’ll share ordering information as we get closer to the release date. In the meantime, I wanted you to know where I’ve been and what I’ve been working on.

I also wanted to say thank you—to everyone who’s been reading this blog over the years, everyone who’s engaged with the Workers’ Recovery concept, everyone who’s told me “this makes sense” or “we should try this” or even “I’m not sure this will work but I’m willing to listen.”

I also want to thank Former Tennessee Administrator Abbie Hudgens, both for her editing input and agreeing to write the Foreword for the book.

This book exists because enough people believed the idea was worth pursuing. Now we get to see if we can turn that idea into real, lasting change.

I hope you’ll read it. I hope you’ll share it with someone who might benefit from thinking about workplace injury differently. And I hope you’ll join me in building something better than what we have now.

Because Workers’ Recovery isn’t just a rebrand. It’s a commitment to putting injured workers’ healing at the center of everything we do.

That’s the system we should have built from the beginning.

It’s not too late to build it now.

Bogdan Savych, Senior Policy Analyst at WCRI, presented the institute’s forthcoming study on the impact of hospital closures on the workers’ compensation system at the 2026 WCRI Issues and Research Conference last week. The study, co-authored with Olesya Fomenko, examined multiple dimensions of the closure question — travel distances, service utilization patterns, care settings, medical costs, and disability duration — across both urban and rural areas nationwide.

The headline finding was a split verdict. Hospital closures unquestionably increase the burden on injured workers in rural areas, who must travel significantly farther to receive care. But that added distance does not appear to translate, on average, into higher medical costs or longer periods of temporary disability — a result that surprised even the researcher presenting it.

Savych opened by grounding the research in a concrete scenario: a worker in a rural community suffers a fracture. The nearest hospital has closed. Instead of driving 10 miles to an emergency room, the worker now drives 15. The surgeon isn’t at that facility either, so the worker travels another 30 miles for surgery, then returns home for recovery and drives 15 miles for physical therapy. Multiply that story across the country, and the scope of the problem becomes clear. Nearly every state has communities affected by hospital closures, and roughly half of all closures occur in rural areas.

The study’s methodology compared workers whose nearest hospital closed against a control group whose three closest hospitals all remained open, controlling for worker characteristics, injury types, and location factors to isolate the effect of the closure itself.

In urban areas, closures had minimal impact on travel distances. When you live in a city like Boston, Savych noted, losing one hospital still leaves several others within a short drive. But in rural areas, the effect was substantial — an average increase of about five miles to the nearest emergency room. That may sound modest, but it compounds on top of already longer rural baselines. Workers needing specialty care such as surgery, neurological testing, or pain management injections were already traveling more than 30 miles on average, and for the 10 percent with the longest trips, more than 60 miles. Hospital closures add to distances that are already significant.

Regional variation matters too. In the Northeast and Midwest, the baseline distance to emergency services runs about eight miles. In the West, it’s nearly 15. Closures add four to six miles across all regions, but the practical impact hits hardest where distances are already longest.

The more interesting story, and the one most relevant to workers’ comp stakeholders, is what happens to the pattern of care after a closure. Savych presented evidence that rural workers don’t simply go without treatment. Instead, care shifts out of hospital settings and into alternatives — physician offices, urgent care centers, ambulatory surgical centers, and outpatient facilities.

Before any closures, roughly one in three rural workers received emergency room services on the day of injury, compared to one in five in urban areas. That baseline gap exists partly because rural areas have fewer specialists and emergency rooms often serve as the provider of last resort. After a closure, emergency room utilization in rural areas dropped from about 30 percent to 27 percent. In areas where the hospital closed entirely — with no services retained at the location — the rate fell further, to about 24 percent. And where the nearest remaining hospital was more than 20 additional miles away, only 17 percent of workers received hospital-based emergency care on the day of injury.

But that care didn’t simply vanish. The study found increases in evaluation and management office visits, physical medicine services, and even major surgeries performed outside hospital settings. Workers who would have gone to a hospital emergency department were instead showing up at physician offices and outpatient facilities. Physical therapy, previously delivered in hospital-based settings, shifted to community-based providers, and workers actually received slightly more PT visits in those non-hospital settings.

This is where the findings defied expectations. Savych acknowledged that he had personally expected to find cost increases — and polled the audience, most of whom raised their hands predicting the same. But the data told a different story.

Across the full range of measures — total medical costs, indemnity benefits, and duration of temporary disability — the study found no statistically significant effects from hospital closures. The changes were small and inconsistent, offering no strong evidence that closures drive up costs or extend time away from work.

The likely explanation is what Savych described as a “setting effect.” When care migrates out of hospitals and into outpatient and office-based settings, the per-service cost tends to be lower. Hospital-based care carries higher facility fees, and when workers receive equivalent services in less expensive settings, the cost differential can offset the friction created by longer travel distances and the slightly increased utilization of services like physical therapy. The net result, at least on average, is roughly a wash.

Similarly, return-to-work timelines showed no meaningful change. Savych said this finding surprised him, but attributed it to the fact that workers were still accessing the care they needed — just in different places and sometimes with longer drives to get there. The care itself wasn’t being foregone; it was being rerouted.

For injured workers, the clearest takeaway is that hospital closures make accessing care harder and less convenient, particularly in rural communities where distances are already long. The burden falls on the worker to find alternatives, navigate unfamiliar facilities, and absorb the time and cost of additional travel. But the evidence suggests that workers are, by and large, still getting treated.

For employers in rural areas, the findings reinforce what many already know: finding providers for injured workers is a challenge that hospital closures only intensify. Savych shared an anecdote about his wife’s first job out of college, which involved personally driving an injured worker 40 miles to physical therapy appointments because that was the only available provider. Employers are already problem-solving around access gaps, and closures will push more of them toward solutions like telemedicine, partnerships with urgent care clinics, or outreach to ambulatory surgical centers.

For the workers’ compensation system more broadly, the cost neutrality finding is notable but comes with caveats. These are average effects. Individual cases in areas with severe access constraints — where the nearest hospital is now 20 or more additional miles away — may look very different. And the study examined closures that have already occurred; the pipeline of potential future closures, particularly if Medicaid coverage contracts as Dr. Benjamin Sommers warned in his keynote address earlier in the day, could produce closures in communities with even fewer fallback options.

During the Q&A, audience members raised questions about regional variation, telehealth adoption, and whether new providers are entering markets left vacant by closures. Savych noted that regional differences in the core findings were modest — workers in the West are accustomed to longer drives, and an extra four to six miles doesn’t change behavior as much as one might expect. On telehealth, he acknowledged the study hadn’t examined it directly but flagged it as a priority for future research. And on new market entrants, he pointed to a broader trend of nurse practitioners and physician assistants filling gaps previously staffed by physicians, though he cautioned that whether a given rural area can financially sustain a new provider depends heavily on the insurance coverage of its population — a factor now under considerable pressure.

The research arrives at a moment when the conversation about rural healthcare access is intensifying. With Medicaid work requirements set to take effect later this year and enhanced marketplace subsidies already expired, the financial foundation supporting rural hospitals and the communities they serve is shifting. WCRI’s findings suggest the workers’ comp system has, so far, absorbed hospital closures without dramatic cost consequences — but the next wave of closures, driven by coverage losses rather than the market dynamics of the past decade, may test that resilience in ways the data hasn’t yet captured.

Following his opening keynote at the 2026 Workers’ Compensation Research Institute Issues and Research Conference, Harvard health economist Dr. Benjamin Sommers sat down with WCRI CEO Ramona Tanabe for an extended Q&A session that drew pointed questions from the audience. If his keynote laid out the landscape of what’s changing in American health coverage, the discussion that followed explored the practical consequences — for states, for hospitals, for workers’ comp carriers, and for the patients caught in between.

A Stealth Partial Repeal, Not an Outright One

Tanabe opened by asking Sommers where he sees the coverage landscape heading over the next several years. His answer was measured but direct. Sommers noted that when Republicans controlled Congress in 2017, full repeal of the Affordable Care Act came within a single Senate vote — the famous thumbs-down from the late Senator John McCain. This time around, nobody has seriously proposed full repeal. The ACA, he observed, has grown more popular over the past decade, making outright elimination politically untenable.

What the One Big Beautiful Bill Act represents instead, Sommers argued, is a quieter undermining of the law’s coverage gains. Work requirements don’t repeal the Medicaid expansion, but they erode it. The subsidy expiration doesn’t eliminate the marketplaces, but it prices millions of people out. As he described in his keynote, roughly 40 million Americans gained coverage through ACA-related programs at the peak. Sommers now expects the country to “backslide” by 5 to 6 million on the Medicaid side through work requirements and another 3 to 4 million through the marketplace subsidy loss — landing somewhere between the pre-ACA world and the historic coverage highs of 2023.

“Some would call this a stealth partial repeal,” Sommers said. “I think that’s a fair reading of it.”

Arkansas Was Supposed to Be the Cautionary Tale — It May Be the Best-Case Scenario

When Tanabe pressed on the evidence base behind work requirements, Sommers expanded considerably on the Arkansas data he had presented in his keynote. Arkansas remains the only state that fully implemented a Medicaid work requirement, and the results were sobering: 18,000 people disenrolled, uninsured rates climbed, and employment didn’t budge. But Sommers revealed that two other states offer corroborating evidence, even though their programs never fully launched.

New Hampshire, he explained, had received federal approval and built out its verification infrastructure. State officials were confident they could avoid Arkansas’s mistakes. But when they examined their own numbers just before beginning to remove noncompliant enrollees, they discovered they were performing just as poorly — large numbers of likely-eligible people hadn’t completed the paperwork. New Hampshire hit pause rather than proceed.

Georgia took a different approach, pairing a partial Medicaid expansion with work requirements as a front-door condition. The state initially projected 100,000 enrollees in the first year, later revised that down to 30,000, and ultimately enrolled fewer than 5,000 — a fraction of the estimated 300,000 to 400,000 people who could have qualified under a standard expansion. Interviews on the ground told the same story: people didn’t understand the rules and couldn’t navigate the system.

Perhaps most striking was Sommers’ reassessment of what the Arkansas experience actually tells us. He had long described it as a cautionary tale, but the more he examined it, the more he came to believe Arkansas may represent something closer to a best-case scenario. Arkansas had relatively strong data systems — it could cross-reference Medicaid rolls with SNAP enrollment and medical frailty designations to automatically exempt many beneficiaries. Many other states lack those capabilities. The people who lost coverage in Arkansas were disproportionately those the state couldn’t automatically verify, and even then, more than half of them were removed. States with weaker data infrastructure, Sommers warned, could see significantly worse outcomes.

The Two Big Misunderstandings

Asked what the public most misunderstands about work requirements, Sommers identified two things. The first is the assumption that Medicaid is full of able-bodied adults choosing not to work. The data show otherwise: roughly 40 percent of the affected population is already employed, another large share has health-related limitations, and only about 3 to 5 percent are neither working nor exempt for an obvious reason. The policy targets that narrow sliver while imposing paperwork burdens on everyone else.

The second misunderstanding is more subtle. Many of the legislators who voted for the One Big Beautiful Bill Act, Sommers said, told him they supported the concept but wanted to make sure vulnerable populations — people with disabilities, those in treatment for substance use disorders, pregnant women — would be protected through exemptions. The problem is that writing exemptions into law doesn’t mean they function in practice. The pandemic unwinding and the Arkansas experience both demonstrated that eligible people lose coverage in large numbers when they can’t navigate administrative processes, regardless of what the statute says should happen.

He predicted that by 2027, media coverage of real people losing Medicaid despite qualifying for exemptions will force policymakers to revisit the issue. Public support for work requirements drops sharply, he noted, when people learn that eligible individuals are losing coverage as a side effect.

Workers’ Comp as a “Soft Target”

The most direct workers’ compensation connection came from an audience member — Joe Paduda of Health Strategy Associates — who framed the issue bluntly. With workers’ comp representing just 0.74 percent of total U.S. medical spending, roughly $31 billion, and with hospitals deploying increasingly sophisticated revenue cycle management tools, Paduda argued that workers’ comp is “uniquely incapable of fighting back” and represents a soft target for providers seeking to maximize reimbursement as other coverage sources shrink.

Sommers agreed, drawing an important distinction. The traditional cost-shifting hypothesis — that hospitals simply raise prices on private insurers when public coverage shrinks — doesn’t hold up well in the economics literature. Hospitals generally negotiate the highest rates they can regardless of their payer mix. But claim shifting to workers’ comp is a different matter entirely. When a worker loses Medicaid and faces a gray-area injury that could plausibly be filed under either program, the incentive to route it through comp becomes much stronger. That dynamic, as Sommers documented in his keynote, has been consistently observed in the research: coverage expansions reduce comp claims, and coverage contractions increase them.

The Cost of Running Work Requirements

Paduda also raised the question of implementation costs — how much states actually spend to administer work requirement programs versus what they save by covering fewer people. Sommers acknowledged that covering fewer people does reduce spending, but described the administrative overhead as substantial and largely unrelated to healthcare delivery. Georgia, he noted, spent hundreds of millions of dollars building eligibility verification infrastructure that enrolled only a few thousand people. The federal government has set aside implementation funds for states under the new law, but Sommers said preliminary estimates suggest it falls well short of what will be needed. States will face a painful choice: implement the program poorly and watch eligible people lose coverage, or divert already-strained budgets toward administrative compliance.

Rural Hospitals, the Data Gap, and International Context

Several other questions rounded out the session. On rural hospitals, Sommers noted that while the Rural Hospital Transformation Program created under the new legislation will provide some financial relief, its formula distributes funds relatively evenly across states rather than targeting the expansion states where coverage losses will be most concentrated. Preliminary analyses suggest the program won’t offset the revenue losses hospitals will face from newly uninsured patients. He pointed out that rural hospital closures over the past decade have already been disproportionately concentrated in non-expansion states, and expansion states may now begin experiencing similar financial stress.

On data collection, Sommers made an impassioned case for robust federal monitoring of work requirement implementation. During the pandemic unwinding, the Centers for Medicare and Medicaid Services required states to report detailed data on who was losing coverage and why — information that enabled the kind of research he presented in his keynote. Whether the current administration will impose similar reporting requirements remains unclear, and Sommers described the research funding environment as increasingly difficult.

An audience member asked about GLP-1 medications and whether insurers are too hasty in curtailing coverage. Sommers, pivoting to his clinical perspective, called the drug class genuinely impressive — the evidence keeps getting stronger with each new study, covering cardiovascular disease, sleep apnea, liver disease, and addiction in addition to obesity. But he cautioned that most effective healthcare interventions still cost more than doing nothing, because you treat many people to prevent adverse outcomes in a few. The real challenge, he said, is that insurers making coverage decisions today rarely capture the long-term savings, because patients switch plans and employers every few years. That misaligned incentive structure, he noted, leads to chronic underinvestment in prevention across American healthcare.

Asked what the U.S. could learn from other countries, Sommers offered a wry observation: plenty, but American policymakers are “really uninterested in hearing about other countries.” The U.S. remains an outlier in both its uninsured population and its prices, paying more than any peer nation with outcomes that are no better.

The Physician’s Perspective

Tanabe closed by asking Sommers to speak as a doctor rather than an economist. He described a patient — a veteran who had experienced homelessness and was enrolled in Medicaid with nominal copayments of a dollar or two per prescription. The man had 15 medications and asked Sommers to rank them in priority order because he couldn’t afford them all each month. Sommers told the audience he got the patient to at least number six on the list, but that clinically, the patient needed 12 or 13 of those prescriptions.

He also highlighted a finding from his recent research that carries particular relevance for the workers’ comp world: confusion itself is a health risk. During the pandemic, his team found that many Medicaid enrollees who were still covered believed they had lost their insurance because they hadn’t heard from their state in over a year. Those people behaved like uninsured patients — they delayed care and avoided doctors’ offices — even though their coverage was intact. As work requirements and more frequent eligibility checks layer additional complexity onto an already difficult-to-navigate system, Sommers warned that misinformation and confusion will drive coverage losses beyond what the policy itself intends.

For an industry that sits at the intersection of employment, healthcare access, and injury, the message from this session was hard to miss: the changes coming to American health coverage won’t just affect Medicaid rolls and marketplace enrollment numbers. They’ll ripple directly into workers’ compensation — through claim shifting, through sicker workers with less access to preventive care, and through a healthcare system under increasing financial strain looking for every available dollar.

Dr. Sommers, the Huntley Quelch Professor of Health Care Economics at the Harvard T.H. Chan School of Public Health and a practicing primary care physician, drew on his extensive research portfolio and experience as a former Deputy Assistant Secretary at the U.S. Department of Health and Human Services to outline what he described as a partial unraveling of the coverage gains achieved under the Affordable Care Act — and what that could mean for employers, injured workers, and the workers’ compensation system.

His message was clear: when millions of Americans lose health insurance or shift to plans with significantly higher out-of-pocket costs, workers’ compensation becomes an increasingly attractive avenue for medical care. The industry needs to be paying attention.

Sommers opened by walking the audience through a decade of health coverage expansion. The Affordable Care Act, he explained, achieved its coverage gains through two primary mechanisms: expanding Medicaid eligibility to adults earning up to 138 percent of the federal poverty level, and creating health insurance marketplaces with premium tax credits that made private coverage affordable for millions who didn’t have access through their employers. By late 2022 and into 2023, the national uninsured rate had reached its lowest point in American history — roughly 8 percent of the population, or about 26 million people. Some 40 million Americans had coverage directly attributable to ACA-related programs.

“We are really the only high-income country that has tens of millions of people without health insurance,” Sommers noted, providing international context. “But this was the lowest it had ever been.”

That progress, he argued, is now at risk. Sommers identified several converging policy changes — some legislative, some administrative — that are poised to reverse a significant share of those coverage gains.

The most immediate impact came from the expiration of enhanced premium tax credits at the end of 2025. Originally passed during the pandemic in 2021 and extended through the end of that year, these subsidies had made marketplace coverage dramatically more affordable for many people. Under the enhanced credits, roughly 60 percent of uninsured Americans who qualified could find a plan for zero dollars per month. Notably, Sommers did not discuss the amount of money being paid to insurance companies on the behalf of those people.

Congress, however, failed to extend the credits, despite a prolonged government shutdown in which the issue was central to negotiations. Sommers estimated that 3 to 4 million people could lose their insurance and become uninsured as a result of the premium increases that have already begun taking effect in 2026.

Beyond the subsidy expiration, the second Trump administration has taken several administrative actions that don’t require congressional approval. Federal spending on marketplace outreach and advertising has been cut dramatically — navigator programs that helped people understand their options and enroll saw a 90 percent funding reduction. The open enrollment period has been shortened. And a proposed rule would expand access to high-deductible catastrophic plans, previously available only to young adults, to people of all ages. Some of these plans could carry deductibles in the tens of thousands of dollars, offering little practical coverage unless a person becomes catastrophically ill.

Sommers also presented findings from his ongoing research with MIT economist Jonathan Gruber showing that the same law, without any change from Congress, can be significantly more or less effective at covering people depending on who controls the executive branch and how aggressively states pursue enrollment. He noted that marketplace subsidies were roughly twice as effective at reducing uninsured rates in states that established their own marketplaces compared to those relying on the federal healthcare.gov platform.

On the Medicaid side, Sommers outlined the major provisions of the One Big Beautiful Bill Act, passed last year, which introduces the first federal work requirement for Medicaid beneficiaries in the program’s history. Under the new law, adults enrolled through Medicaid expansion in 40 states will need to demonstrate 80 hours per month of work, community service, education, or other qualifying activity to maintain their coverage. The requirement is set to take effect at the end of 2026, though some states have discussed earlier implementation.

While acknowledging that work requirements poll well with the general public across party lines, Sommers presented evidence suggesting the policy is unlikely to achieve its stated goals of increasing employment and self-sufficiency. He pointed to a natural experiment in Arkansas, which implemented a similar work requirement in 2018 with federal permission. Within months, 18,000 people were removed from the program for noncompliance. The result was a substantial increase in uninsured rates with no measurable change in employment. A third of those subject to the policy reported they had never even heard of it.

The underlying math, Sommers explained, tells the story. In Arkansas, roughly 40 percent of the affected Medicaid population was already working. Another large segment had health-related limitations preventing employment. Only about 3 to 4 percent were neither working nor had an obvious qualifying exemption. The policy, in effect, required 97 percent of beneficiaries to navigate paperwork proving they already met the criteria, and many couldn’t get through the process. Based on this and similar evidence, analysts have estimated that 5 to 6 million people could lose Medicaid coverage due to the administrative burden of work requirements, while the Congressional Budget Office has projected essentially no impact on actual employment.

Sommers bolstered this concern by showing data from the post-pandemic Medicaid “unwinding,” when states had to redetermine eligibility for everyone who had been continuously enrolled during the public health emergency. Some 24 million people lost coverage during that process, and the variation across states was staggering. In states like Maine and Oregon, fewer than 10 percent of enrollees were removed. In Utah and Oklahoma, the figure approached 40 to 50 percent — and the vast majority of those losses were not because people were found ineligible, but because they couldn’t understand the overly complex process or complete the paperwork.

The legislation also introduces twice-yearly eligibility redeterminations for expansion enrollees starting in early 2027, increased cost-sharing for those above the poverty level, and new restrictions on how states can use provider taxes to finance their share of Medicaid spending — a change that will put particular financial pressure on the 40 expansion states.

So what does all of this mean for workers’ compensation? Sommers connected the dots directly. Research has consistently shown that when people gain health insurance from other sources, workers’ comp claims shift. A study from Massachusetts found that coverage expansion produced a 5 to 10 percent reduction in workers’ compensation paid claims for emergency department and inpatient services. Conversely, when young adults age off their parents’ insurance at 26, workers’ comp claims increase in that age group. And when coverage doesn’t disappear but simply becomes less generous — through higher deductibles and cost-sharing — workers gravitate toward using their comp benefits for treatment they might otherwise have sought through their health plan. Studies cited by Sommers found that the growth of high-deductible plans in the employer market has already contributed to 1 to 3 percent increases in workers’ comp spending.

The implications are straightforward: as millions of Americans face higher premiums, lose subsidies, get dropped from Medicaid through work requirements or complex red tape, or shift to catastrophic plans that cover very little, the workers’ compensation system should expect to absorb some of that displaced demand.

Sommers closed by emphasizing that state-level decisions will matter enormously in determining how these changes play out. States that invest in automated data matching and behind-the-scenes eligibility verification will retain far more of their eligible Medicaid populations than those that place the reporting burden on enrollees. The variation during the pandemic unwinding proved that administrative capacity — not just policy design — drives real-world outcomes.

The presentation set a serious tone for the two-day conference, underscoring that the workers’ compensation industry does not operate in a vacuum. Changes to the broader health insurance landscape will inevitably ripple into comp, and the magnitude of those ripples will depend on decisions being made right now in Washington and in state capitals across the country.