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Affordable Care Act obesity coverage

Majority of US states deny obesity coverage despite ACA

Credit: Careilly5801/Wikipedia
The groups say there is a significant disparity between the 27 ACA benchmark plans that deny or exclude coverage for bariatric surgery, and the major private and government health insurance plans that provide coverage
Five groups file complaint with US Health and Human Services citing non-compliance and discrimination in 27 states

The American Society for Metabolic and Bariatric Surgery (ASMBS) and groups including The Obesity Society (TOS) and Academy for Nutrition and Dietetics (AND), filed a complaint this month with US Health and Human Services (HHS) claiming the 27 states that deny coverage for bariatric surgery are in non-compliance with the Affordable Care Act (ACA) and that their failure to comply is discriminatory against women and people with disabilities, and violates the ban against denying coverage based on health status or a pre-existing condition. 

The ASMBS, TOS, and AND are joined in the complaint by the Obesity Medicine Association (OMA) and the Obesity Action Coalition (OAC), a patient advocacy group with more than 50,000 members. All five groups belong to the Obesity Care Continuum.

John Morton

"Qualified health plans should not be able to discriminate against people with the disease of obesity and unfortunately this is happening in most states,” said Dr John M Morton, President of the ASMBS and Chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine. “The time has come for equitable treatment for the millions of patients affected by obesity. There needs to be one America where treatment for obesity is an option for everyone.”

He added that treatment/s for chronic diseases other than obesity are routinely covered. Obesity was classified as a disease by the American Medical Association in 2013. 

In the complaint, the groups say there is a significant disparity between the 27 ACA benchmark plans that deny or exclude coverage for bariatric surgery, and the major private and government health insurance plans that provide coverage. Medicare, 49 state Medicaid plans, the Federal Employees Health Plan, the majority of state health plans, and the majority of employer-based plans with 500 employees or more cover bariatric surgery.

The groups cite that a qualified health plan under ACA may “not employ marketing practices or benefit designs that have the effect of discouraging the enrolment of such plan by individuals with significant health needs.”

They say this is being done to individuals who have obesity. In addition, the ACA prohibits the denial of health care benefits on the basis of disability. The groups say severe obesity falls under the American Disabilities Act, as currently defined.

Finally, the groups argue that “empirical research consistently demonstrates that obesity has a proportionally disparate adverse impact on women” in comparison to men, when it comes to hiring and earnings, and those with severe obesity who joined ACA qualified health plans within the last two years did so with obesity as a pre-existing condition. 

“There’s a double standard when it comes to obesity,” said Morton. “Most insurers are covering the treatments for the complications and consequences of obesity, but are not covering the treatment of obesity itself. We believe there should be a single, consistent obesity health benefit for the entire country, and as part of that benefit proven obesity treatments such as bariatric surgery would be covered for those who need it," said Morton.

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American Society for Metabolic and Bariatric Surgery

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