Healthcare Reform and How it May Impact Those Affected by Obesity

by Joseph Nadglowski, OAC President and CEO

Summer 2009

Under much fanfare, 2009 started with a great deal of hope that healthcare reform would happen by year-end, as both the White House and members of Congress urged reform to happen. Although there have been some political stumbling blocks around some of the more controversial aspects of healthcare reform, there are still strong signs that some form of healthcare reform will take place before year-end.

It is important that our members and constituents stay informed on what is going on with healthcare reform. Here is a summary of the various aspects of healthcare reform and how they may impact those affected by obesity:

Increased focus on wellness and prevention

Healthcare reform will likely require increased coverage of both wellness and prevention programs to address obesity, as well as other chronic diseases, in hope of reducing future healthcare costs. Specifically, proposals include “improving the health of the American people” by establishing such entities as a National Prevention, Health Promotion and Public Health Council and establish a Prevention and Public Health Investment Fund.

The OAC strongly supports such efforts but has shared with legislators our concerns about financially penalizing individuals who do not participate or who are unable to meet specific weight-loss goals. All efforts to encourage such activities should be incentive-based and not penalty-based.

Expanded Chronic Disease Management

As chronic diseases, including obesity, are blamed for nearly 75 percent of healthcare costs, reform legislation will also likely contain efforts to control these costs. The concept of the “Medical Home” is just now beginning to gain traction.

Under the “Medical Home” approach, patients are cared for by a primary care physician that heads a team of healthcare providers that might include behavioral experts and dietitians. However, questions still remain about inclusion of surgical specialists under this model.

Elimination of pre-existing conditions

Reform will also likely include the elimination of pre-existing condition exclusions which may be helpful to many of our members who move from group insurance to individual policies. Those who were previously denied coverage due to weight issues or past bariatric surgery procedures hopefully will no longer face such exclusions.

Standardization of Benefits and the Public Plan Option

Also under consideration is the standardization of benefits (everyone would have the same coverage and exclusions) as well as the controversial Public Plan (government-run health plan) option. Both of these pose opportunities and threats for those who have sought or are seeking to address their obesity, mainly around what benefits would be included.

The OAC strongly urges that if these aspects of healthcare reform become a reality, they include a comprehensive benefit to address obesity ranging the full spectrum including dietary counseling, medical weight management and bariatric surgery.

Health Insurance Exchanges

Health Insurance Exchanges, or connectors, are also likely under healthcare reform. Such exchanges, which would be government-run, would serve as marketplaces for individuals and small businesses to pool their resources to find insurance coverage at group rates. There is hope that exchanges would encourage expanded benefits which include obesity treatments.

Conclusion

With healthcare reform likely to accelerate throughout the summer, the OAC will continue to be an active force in monitoring healthcare reform and informing legislators and the White House of the needs and interests of those affected by obesity.

Please Note: This information reflects healthcare reform proposals as of this magazine’s publication date. As healthcare reform is evolving each day, please visit the OAC Web site at www.obesityaction.org for the most current information and to get involved in our “Calls to Action.”

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