The Capitol

Health Insurance for Obesity After the ACA

Will health insurance for obesity change under the new Republican plan to replace the Affordable Care Act (ACA) with the American Health Care Act (AHCA)? The short answer is maybe and maybe not.

Some of the Basics

The new plan repeals the mandate for everyone to buy insurance or face a penalty. Instead, people will be whacked with a huge hike (30%) in premiums if they ever let their insurance lapse. Tax credits to help people afford health insurance will change dramatically.

Older, sicker, and poorer people will find their healthcare costs more difficult or perhaps impossible to afford. Federal funding for Medicaid will steadily dwindle. Wealthy Americans, health insurers, and providers will get a trillion dollars in new tax breaks. Young, healthy people with higher incomes will get a much better deal on health insurance.

Finally, we’ve got no information on what this will cost. House Republicans don’t have estimates from the Congressional Budget Office yet. Likewise, they have no estimates of how many people will lose coverage. Standard & Poor’s analysts said yesterday that lost coverage could hit ten million Americans.

Direct Impact on Obesity Care

The direct impact on obesity care might be limited. That’s because the direct impact of the ACA on obesity care was minimal. Essential health benefits are still in the proposal, but in most states, they didn’t cover obesity care. Fewer gains mean less to lose.

Indirect Impact on People with Obesity

The indirect impact on people with obesity will likely be considerable.

Obesity hits people hard economically. And it more often hits people who have less of a financial cushion. Many people with obesity gained health insurance for the first time under the ACA. Many of the people who lose it under the AHCA will be people with obesity.

Another indirect impact comes through big cuts in funding for chronic disease prevention. The bill will cut billions of dollars from such funding.

What’s Next

Expect a brawl.

Conservative Republicans hate the proposal because it’s not radical enough. Moderate Republicans hate it because it will hit their constituents – many of them Trump voters – especially hard. Hospitals and other providers have a lot to lose if millions of people lose coverage.

And Democrats hate it just because. Even if it didn’t violate all their core values (it does), they’d likely oppose it just because of the tribal politics behind it.

One thing we love about this story is the poetry of acronyms. The plan is to ditch the ACA and replace it with the AHCA. “Affordable” is out. “American” is in. That means more benefits for the wealthy and more pain for the poor if it passes in its present form.

“Nobody knew that health care could be so complicated.” – Donald J. Trump

Click here for an excellent overview from Health Affairs and here for an summary of reporting on the subject. For a view of the opposition lining up against it, click here.

The Capitol, photograph © angela n / flickr

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March 8, 2017

8 Responses to “Health Insurance for Obesity After the ACA”

  1. March 08, 2017 at 6:10 am, Sara Kyle said:

    To cut billions from chronic disease prevention is not only foolish for the long-term budget, but it is unquestionably cruel. And it is clearly not good for America.

  2. March 08, 2017 at 9:58 am, David Brown said:

    Shifting costs and eliminating programs is sort of like dealing with an increasingly leaky ships hull by installing more and more powerful pumps. With the insatiable demand for medical care and so much of this nation’s financial resources devoted to treating disease, eventually, politicians are going to find the ship of state dead in the water. How did we get into this mess? In part, we can blame it on the misuse of political power.

    “In 1970, cannabis was placed temporarily in Schedule I, the most dangerous controlled substances group, pending the results of a commission created by Richard Nixon to study cannabis and its medicinal effects. In 1972, this commission, the National Commission on Marijuana and Drug Abuse, recommended that cannabis prohibition end, which would remove it from Schedule I. Instead, Nixon disregarded the compelling results of his own appointed commission. Four decades later, cannabis remains a Schedule I classification along with heroine and cocaine.” http://naturalsociety.com/thank-president-nixon-dea-us-prison-industry-classifying-marijuana-schedule-drug/

    Another mistake was made in 1977 when the US Senate Select Committee on Nutrition and Human Needs, led by Senator George McGovern declared saturated fat a health hazard. https://health.gov/dietaryguidelines/2015-binder/meeting1/historycurrentuse.aspx

    These two actions set the stage for a steep decline in the public health by stifling cannabis research and terminating the healthy fats debate.

    Regarding cannabis:

    “For nearly 50 years, marijuana fell from popular pharmacopoeia and was labelled as illicit in the minds of Americans. Then the endocannabinoid system was defined in the early 1990’s when Lisa Matsuda announced that her team at the National Institute of Mental Health had first identified a THC-sensitive receptor in lab rat brains. Following this revelation, the National Academy of Science predicted the 1990’s would be the “Decade of the Brain”. It turned out to be true as the following 10 year period would produce “more advances in neuroscience than in all previous years combined” (Lee, 2012). Since then, scientists have labored to learn as much as they can about the endocannabinoid system, our naturally occurring cannabinoids, and the ways cannabis alters this balance, publishing over 20,000 scientific studies referencing cannabinoids in just the last two decades.” http://www.medicalmarijuanainc.com/the-endocannabinoid-system-an-overview/

    “There have been around 20,000 articles and research papers written on cannabinoids, so you might think we already know all there is to know about them, but in fact, there are large gaps in our knowledge. In particular, our understanding of the way that cannabinoids, cells and other systems interact is incomplete.” https://www.cbdoilsuk.com/what-is-the-endocannabinoid-system/

    As for saturated fat, the establishment still vigorously opposes any suggestion that saturated fats might be healthy. https://www.medpagetoday.com/primarycare/dietnutrition/63527

    Outside the United States there’s growing realization that dietary advice to restrict saturated fat intake is bogus. https://www.credit-suisse.com/us/en/articles/articles/news-and-expertise/2015/09/en/fat-the-new-health-paradigm.html

    In India: “Clarified butter remained India’s culinary star for centuries till it was sidelined in the 1980s by vegetable oils because of its high saturated fat. The new oils were aggressively marketed as superior and heart-healthy. Of late, research has shown that saturated fats have no link to obesity, heart disease or early death. In January 2015, the US dietary guidelines declared for the first time that total dietary fat and cholesterol intake are not a concern for healthy people. Now, on the back of some recent studies which maintain that it reduces fat and lower cholesterol, ghee too is making a big comeback in India. It is also making a splash abroad in alternative health circuits.” http://timesofindia.indiatimes.com/home/sunday-times/Ghee-with-glee/articleshow/52057801.cms

  3. March 08, 2017 at 10:35 am, Christine Gallagher said:

    Ted – the article you referenced on the chronic disease prevention cuts is written by Chrissie Juliano – who worked for Resolve – the group we contracted with to help with the FDA roundtables. Thanks for sharing it – as I had lost track of her!

  4. March 08, 2017 at 11:22 am, Ted said:

    Smart people tend to stay in view. Thanks for the insight.

  5. March 10, 2017 at 2:17 pm, U. Inge Ferguson DO said:

    Encourage your representative to support the Treat and Reduce Obesity Act in congress. Obesity is the only disease I know of which is treated by diet alone. We don’t treat diabetes, hypertension or cancers via diet alone? No wonder treatment of obesity has failed. The obesity epidemic is the elephant in the room which some are hesitant to serious address. Obesity is a chronic disease.

  6. March 10, 2017 at 4:40 pm, Ted said:

    I agree with you completely. Thank you!

  7. March 11, 2017 at 1:02 pm, TraciMalone said:

    One of the pieces of the ACA that falls under preventative care is nutrition counseling coverage. It’s covered at 100% with no co pays. Will this benefit be cut?

  8. March 12, 2017 at 5:16 am, Ted said:

    Good question, Traci. It seems like everything is on the table in a battle to push these changes through. In general, cutting requirements to cover specific services, like dietary counseling, seems to be a key goal.