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Weighing the Odds for Healthcare Reform

by Chris Gallagher, OAC Policy Consultant

Summer 2017

Please Note: At the time of this article, healthcare reform was still being debated. Therefore, this article may not reflect the most current information. Please visit the OAC site at for the latest information on healthcare reform.

Party Time?

On May 4th President Donald Trump invited Republican members of Congress to the White House for a celebration because they had just passed the American Health Care Act (AHCA) – the House Republican healthcare reform bill. Watching and listening to all the speeches on the White House lawn that day, many might think they were seeing the final step in the Republican effort to repeal and replace the Affordable Care Act (ACA) – more commonly known as “Obamacare.” In truth, Republicans who now control both houses of Congress and the White House had successfully completed only the first step of the process of how a bill becomes a law.

That May 4th celebration at the White House was about Republicans narrowly passing the AHCA in the House of Representatives after weeks of negotiations between House leadership, the White House and conservative and moderate Republicans. The result was a bill that included many controversial provisions such as rolling back expansion of Medicaid coverage, weakening preexisting condition protections, allowing states to opt out of covering mandated essential health benefits (EHB) and allowing them to base monthly insurance premiums on an individual’s health status – provided the state also establishes a high-risk pool for those individuals that are no longer able to afford health coverage under the new system.

On June 22nd, United States Senate Majority Leader Mitch McConnell (R-KY) unveiled the Senate Republican leadership healthcare reform bill – the Better Care Reconciliation Act (BCRA) of 2017. While the Senate bill is slightly more moderate than its House counterpart, the Senate version would still allow states and insurance companies to opt out of many of the ACA patient protections. For example, while the Senate bill bars states from using waivers to charge people with preexisting conditions higher rates, states could still allow insurance companies to drop providing coverage for certain essential health benefit categories such as maternity care, mental health services, or emergency care. In addition, the Senate bill would impose a six-month waiting period when purchasing insurance for individuals whose coverage lapsed for 63 days or more during the previous 12 months.

At the time of this report, the Congressional Budget Office (CBO) had just released its estimate of the spending and coverage impact of the BCRA. Among other things, CBO found that: the number of uninsured would increase by 22 million in 2026 relative to current law, for a total of 49 million; about 15 million more people would be uninsured in 2018, primarily due to elimination of the individual mandate; and that average premiums would increase in the non-group market prior to 2020 compared to current law; after that, premiums are projected to be relatively lower, largely due to the reduced actuarial value of the benchmark plans, which will cover a smaller share of health care services than under current law.  CBO estimates that fewer low-income people will purchase plans starting in 2020, despite being eligible for premium tax credits, due to higher deductibles and copayments.

Should Senator McConnell be able to secure enough Republican Senators to pass the BCRA, the GOP healthcare reform package would still face a very tough conference committee where House and Senate leaders must iron out the differences between the two bills and merge them into a single compromise package that would be able to be passed by both houses of Congress. Finally, the House and Senate compromise language must meet President Trump’s approval before he signs the legislation into law. In short, congressional Republicans are far from the finish line in their effort to repeal and replace Obamacare.

How Does Obamacare Treat Obesity?

When the ACA was signed into law in 2010, many in the obesity community were hopeful that Obamacare would finally open the door to better patient care for the millions of Americans affected by obesity. Patients would no longer be rejected for health insurance coverage because of their weight or pay thousands of dollars for additional coverage to treat their obesity.

These hopes were based on the belief that Obamacare would provide wide coverage for those with chronic disease like diabetes and heart disease. Sadly, people with obesity are not treated the same as those with diabetes or heart disease. Yes, these people now have health insurance coverage but their plan will often deny payment for any type of weight-loss treatment because health plans continue to see obesity as a lack of self-control.

At the center of this hope was the ACA-mandated 10 broad categories of essential health benefits that all state health exchange plans must cover, including:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

To see how state exchange health plans were including coverage for obesity treatment under these 10 EHB categories, the obesity community conducted a study of obesity treatment coverage language contained in EHB benchmark plan submissions for each of the 50 states and the District of Columbia for 2017. The study focused on coverage language specific to obesity screening and referral for counseling for weight management – a key recommended preventive service. The study also evaluated coverage language pertaining to other evidence-based obesity treatment services such as FDA-approved drugs and bariatric surgery to examine any or all treatment options for those individuals that are diagnosed with obesity through the preventive services screening benefit.

The study confirmed that a large majority of states continue to exclude coverage for obesity treatment services. For example, 27 states continue to exclude coverage for bariatric surgery and 48 states and the District of Columbia do not cover FDA-approved obesity drugs. Even coverage for obesity screening and counseling services was excluded in 24 states despite this benefit being an ACA-mandated preventive healthcare service – just like periodic screenings for cancer and heart disease.

Does the OAC Support either the House or Senate Healthcare Reform Bills?

No. Unfortunately, both the AHCA and the BCRA would likely do more harm than good for those with obesity. Both bills would allow states to eliminate or weaken many key patient protections that are currently guaranteed under Obamacare, such as strong prohibitions on health plan coverage language that discriminate against individuals that have a preexisting health condition. These and other Obamacare protections allow individuals with obesity to buy quality and affordable health insurance across all health plans. Finally, states would be allowed to define their own essential health benefits package, which could lead many states to drop coverage for services related to mental health, substance use or maternity care. This would lead to many patient and disease-specific groups fighting over coverage.

How is the OAC involved in the Healthcare Reform Debate?

Throughout the last nine years, OAC President/CEO Joe Nadglowski, OAC Board members and OAC patient advocates have participated in more than 900 visits with congressional offices and federal regulators to educate policymakers about obesity being a complex chronic disease that needs to be both prevented and treated. Earlier this year, the OAC joined with the other member groups of the Obesity Care Continuum (OCC) in developing the OCC’s Healthcare Reform Principles.

The OAC helped create the Healthcare Reform Principles to call out lawmakers in Congress to make sure they don’t pass any kind of healthcare reform that ignores those with obesity. These principles ask legislators to make sure these individuals:

  • Have access to counseling
  • Have access to obesity drugs and bariatric surgery
  • Are protected against unfair patient cost-sharing
  • Are treated the same as any other person suffering from a chronic disease

Following is a summary of the OCC Healthcare Reform Principles:

  • Recognize that obesity is a chronic disease.
  • Ensure that patients can access all kinds of obesity treatment such as counseling, drugs and surgery.
  • Ensure that those with obesity are not denied coverage or charged more for their treatment than those with other types of chronic disease.
  • Ensure that health plans cannot place unnecessary hurdles in the way of people seeking treatment for their obesity. If these prior authorization programs are for sound medical reasons, they must still be done as quickly and efficiently as possible so patient care is not delayed.
  • Ensure that federal and state governments are making sure that health plans are providing coverage for Obamacare-mandated obesity screening and counseling services.
  • Ensure patient access to current and new obesity treatments.
  • Protect employees from employer-offered health or wellness programs that discriminate against employees with obesity.

If you are an OAC member and would like to share the OCC’s Healthcare Reform Principles with your legislators on Capitol Hill, please email the OAC at and we will help you reach out to your Senators and Representatives within your state!

About the Author:
Christopher Gallagher has more than thirty years of legislative and lobbying experience where he specialized in healthcare, tax and education issues. He currently manages several healthcare issues while working with different organizations.

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