Newswise — Most states do not cover bariatric surgery under the Affordable Care Act (ACA) despite the need for effective treatments for obesity and the minimal impact it has on monthly premiums, according to new research presented here at ObesityWeek 2015, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The weeklong conference is hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).
Researchers from Vanderbilt University Medical Center in Nashville, TN and the University of South Carolina in Greenville examined plans in three states – Oklahoma, Oregon and Virginia – where a portion of the plans cover bariatric surgery. Insurance premiums were generally higher with a surgery benefit, but not by much. In Oregon and Oklahoma, the difference in premiums was about $24.67 and $29.33, respectively. But, in Virginia, monthly premiums were actually lower, by $14. Currently, only 23 out of 51 State Health Exchanges include coverage for bariatric surgery.
"This study shows it’s not really a cost issue as to why bariatric surgery isn’t covered," said study co-author Wayne English, MD, associate professor of surgery, Vanderbilt University Medical Center. “It may be an issue of false notions about the true costs of bariatric surgery or it may be discrimination. Either way, poor policy is affecting millions of people every day, in many states. It shouldn’t matter where you live as to whether or not you have access to bariatric surgery. There is great inequality throughout state health exchanges operating under the Affordable Care Act."
The data in the study was obtained from Avalere PlanScape, which performed an analysis of the 2015 State Exchange Plan features using information from the Centers for Medicare & Medicaid Services (CMS) Plan Attributes and Benefits and Cost Sharing Public Use Files (PUF). Only Oklahoma, Oregon and Virginia have one or more regions within their states in which a portion of the plans cover bariatric surgery.
John M. Morton, MD, MPH, president of the ASMBS and chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine says though obesity is a national epidemic that knows no boundaries, obesity treatment under ACA is left to each individual state to decide.
“There is a real geographic disparity," said Dr. Morton, who was not involved in the study. “And it's sad to say that many of the states expected to exclude obesity treatments can be found in the South, where the highest rates of obesity can also be found. We are working very hard to change the equation so that all people with obesity, no matter where your home happens to be, can have access to evidence-based prevention and treatment programs including bariatric surgery."
In addition to Dr. English, study authors of the abstract entitled, “Covering Bariatric Surgery has Minimal Effect on Insurance Premium Costs within the Affordable Care Act," include, Brandon Williams, MD, Vanderbilt University Medical Center and John Scott, MD, University of South Carolina.
About Obesity and Metabolic and Bariatric Surgery
According to the Centers of Disease Control and Prevention (CDC), more than 78 million adults were obese in 2011–2012.i The ASMBS estimates about 24 million people have severe or morbid obesity. Individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including type 2 diabetes, heart disease and cancer.ii,iii
Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques.iv The risk of death is about 0.1 percentv and the overall likelihood of major complications is about 4 percent.vi
About the ASMBS
The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in obesity, while maintaining a steady exchange of experiences and ideas that may lead to improved outcomes for morbidly obese patients. For more information, visit www.asmbs.org.
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*COVERING BARIATRIC SURGERY HAS MINIMAL EFFECT ON INSURANCE PREMIUM COSTS WITHIN THE AFFORDABLE CARE ACT -- Wayne English, MD; Brandon Williams, MD; John Scott, MD; Presented November 4, 2015
iPrevalence of Obesity Among Adults: United States, 2011–2012. Center for Disease Control and Prevention. (October 2013). Access October 2013 from http://www.cdc.gov/nchs/data/databriefs/db131.htm
iiOffice of the Surgeon General – U.S. Department of Health and Human Services. Overweight and obesity: health consequences. Accessed March 2012 from http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.html
iiiKaplan, L. M. (2003). Body weight regulation and obesity. Journal of Gastrointestinal Surgery. 7(4) pp. 443-51. Doi:10.1016/S1091-255X(03)00047-7.
ivPoirier, P., Cornier, M. A., Mazzone, T., et al. (2011). Bariatric surgery and cardiovascular risk factors. Circulation: Journal of the American Heart Association. 123 pp. 1-19. Accessed March 2012 from http://circ.ahajournals.org/content/123/15/1683.full.pdf
vAgency for Healthcare Research and Quality (AHRQ). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Jan 2007
viFlum, D. R. et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed June 2012 from http://content.nejm.org/cgi/content/full/361/5/445
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