Healthcare Reform and Obesity

In case you missed the news last week, and frankly I’m not sure how you could have with the wall-to-wall coverage, the Supreme Court upheld the vast majority of the constitutionality of healthcare reform often called “Obamacare” by its opponents. With the law standing for now (further legislative challenges are expected), I thought it would be a good time to review both the major positive and negative aspects of the law when it comes to obesity issues. Note that my comments are reserved to the major obesity-related aspects of reform and not a comment on reform as a whole.

The Positives

Significant Investment in Prevention – The law includes upwards of $15 billion in funds to support The Prevention and Public Health Fund to promote wellness, prevent disease and prevent against public health emergencies. Obviously, obesity falls into all of these areas, but keep in mind that we will have to fight for these funds as they have been targets of budget cuts and every disease state wants a share of the monies.

Menu Labeling – The law also roles out national menu labeling (something some of you are likely very familiar with, seeing calorie counts of foods, when you go to large restaurant chains, as several states and cities already implemented such rules). Look for calorie counts on chain restaurant menus starting nationally in January 2014.

United States Preventative Services Task Force (USPSTF) – According to the law, services given an A or B rating from the USPSTF are required to be covered with no cost-sharing (no copays). Obesity screening and intensive counseling has a B for adults and obesity screening and moderate to intensive counseling has a B for kids. Assuming no changes, this may mean that every American has the ability to have a conversation with their doctor about their weight and it be a covered service.

Pre-existing Conditions – Healthcare reform also prohibits insurers from denying enrollment or charging higher rates based on pre-existing conditions starting in January 2014. This should eliminate people being denied health insurance because of having obesity or because they have had a procedure to address their obesity (both very common in today’s insurance marketplace).

The Negatives

Employer Wellness Incentives and Penalties – under the so-called “Safeway” Amendment to healthcare reform, employers will now be able to financially penalize employees who don’t meet certain health goals including meeting specific BMI targets. The penalty can be up to 30% of the total cost of an employee’s health insurance (rising up to 50% with permission from the Government). This is somewhat counterintuitive to many of us for several reasons.

First, we recognize that many of the plans, which will want to penalize their employees, don’t offer coverage of services to help them in the first place. This means a person will now even have less money to pay for the services they need to address their weight and in my opinion, make it even more unlikely they will be able to afford the help they need. In addition, this provision assumes a one-size-fits-all approach. No matter how successful some people are with their obesity intervention, they may never have a body mass index less than 30 and we shouldn’t penalize them for factors outside of their control. OAC will be closely monitoring this provision and the regulation coming forward regarding it.

Too Soon to Tell

Healthcare Exchanges and the Essential Benefit Package – the centerpiece of healthcare reform are the healthcare exchanges. The state (or regional based) exchanges are designed to allow individuals and/or small businesses pool together to buy insurance coverage similar to larger companies. The core list of services that will be offered in each exchange is known as the essential benefit. Each state will have the ability to determine what their essential benefit and exchange will look like (and if they don’t do the work, the Federal government will do it for them).

Why we call this area too soon to tell is that we don’t yet know if obesity treatments like metabolic and bariatric surgery and/or obesity pharmaceuticals will be included as part of essential benefits. If they are, this will be a major victory. If not, a major disappointment. With each state deciding, we’ll likely have varied coverage across the United States meaning the true answer will be somewhere in the middle. Essential benefit has been the major policy focus of OAC since reform passed and will continue to be moving forward.

Leaving politics aside, healthcare reform contains pros, cons and unknowns for those affected by obesity. We’ll continue to update you as details emerge.

Making a Difference Together,

Joe



3 Comments for this Post
  • Brooks Green
    July 4, 2012 at 2:59 pm

    Will cash only bariatric offices eventually need to be insurance based in order to stay competitive if the ACA remains in effect?


  • JoeNadglowskiOAC
    July 5, 2012 at 1:04 pm

    Brooks,

    If we see universal coverage of bariatric surgery in the essential benefits package (plan includes coverage), I believe that will put tremendous pressure on practices to accept insurance. However, if you live in a state that ultimately decides not to include bariatric surgery in their essential benefit plan, we may see a rise in the cash pay business. It’s probably too soon to tell, but I’d keep a close eye on the development of your state exchange and essential benefit package.


  • Pam Davis
    July 7, 2012 at 12:30 pm

    A really informative overview of what healthcare reform and the ACA means in relation to obesity prevention and treatment options. I encourage everyone to be prepared to write letters, give testimonials, and shake hands to help us insure each state includes obesity prevention and treatment in the essential benefits.

    Pam Davis, RN, CBN
    Chair, Obesity Action Coalition



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