The document discusses the potential impacts of the Patient Protection and Affordable Care Act (PPACA) on the workers' compensation system. It notes direct impacts like revisions to the Black Lung program and indirect impacts like more people gaining health insurance putting strain on provider networks. However, it concludes that while the PPACA may have little direct effect initially, the indirect impacts on areas like benefits coordination and administration could be significant but difficult to predict, with some effects potentially increasing costs and others decreasing costs.