Bariatric Surgery Often Bypassed in Affordable Care Act Coverage

Bariatric Surgery Often Bypassed in Affordable Care Act Coverage

According to the findings of a recent study presented during the Obesity Week 2015, most U.S. states do not provide coverage for bariatric surgery under the Affordable Care Act (ACA) despite the urgent need for efficient obesity treatments and the minimal impact such surgery has on monthly premiums.

In the study, a team of scientists from the University of South Carolina in Greenville and the Vanderbilt University Medical Center in Nashville, Tennessee, looked at ACA health insurance plans in Virginia, Oregon and Oklahoma — states where some insurance plans provide coverage for bariatric surgery.

The results revealed that insurance premiums generally were higher with a surgery benefit, but not by much. In Oklahoma and Oregon, the variance in premiums was $29.33 and $24.67, respectively. However, in Virginia, the results revealed that monthly insurance premiums were lower by $14. At the moment, only 23 out of 51 State Health Exchanges cover obesity treatment using 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, in a news release. “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 study data was collected from Avalere PlanScape, which conducted an analysis of the 2015 State Exchange Plan features using data from the Benefits and Cost Sharing Public Use Files (PUF) and the Centers for Medicare & Medicaid Services (CMS) Plan Attributes. Only Virginia, Oregon and Oklahoma have one or more regions within each state a portion of the insurance plans includes coverage for bariatric surgery.

While obesity is a nationwide endemic, each state makes its own decisions in the treatment of obesity under the ACA, according to John M. Morton, MD, MPH, president of the ASMBS, and chief of the Bariatric and Minimally Invasive Surgery  at the Stanford University School of Medicine.

“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.”

According to the most recent data, rates of obesity in the United States now exceed 35 percent of the population in three states (Arkansas, West Virginia and Mississippi), 22 states have rates above 30 percent, 45 states are above 25 percent, and every state is above 20 percent. Arkansas has the highest adult obesity rate at 35.9 percent, while Colorado has the lowest at 21.3 percent. The data also show that 23 of 25 states with the highest rates of obesity are in the South and Midwest.

Obesity Week is the largest global conference with a focus on basic science, prevention, clinical application and treatment of obesity, and is hosted by The Obesity Society (TOS) and the American Society for Metabolic and Bariatric Surgery (ASMBS).

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