Insurance

Health Insurance Covering More Obesity Care

Slowly, but surely, the Affordable Care Act (ACA or Obamacare) is nudging health insurance to cover more obesity care. Passage of the ACA held promise for obesity treatment and prevention because of its strong emphasis on chronic disease management and prevention. Though hopes for radical improvements in access to care have been dashed, a number of signs are pointing to better health insurance coverage coming for obesity care.

An early disappointment came with the specification of essential health benefits under the ACA. Obesity activists pressed for evidence-based obesity treatment to be included, but it was not. Hopes for a rational approach to obesity collided with a harsh financial and political reality. The administration did not want to set the bar so high for benefits that policies under Obamacare would be unaffordable.

But other factors suggest that improved access will come steadily. For starters, the ACA requires that preventive services be provided with no out of pocket cost. That means intensive behavioral counseling for obesity to everyone who needs it, at no cost. America’s Health Insurance Plans, an industry association, gets the message, saying in a recent release:

Physicians and other clinicians also have an important role to play, and body mass index (BMI) screening and counseling around weight-related behaviors are often a first step in helping individuals and families learn about the dangers of unhealthy weight and what they can do about it.

But translating this policy into actual obesity care will take some work, and likely result in a great deal of variability in what’s available under different plans. For now, it looks like coverage will be best at both extremes of treatment intensity. Bariatric surgery has been covered by Medicare for almost a decade. Medicaid in many states as well as many private insurance plans also cover it, largely because of the dramatic improvements in health, survival, and subsequent health costs that successful patients enjoy.

Combine this history with the mandate to cover intensive behavioral counseling and we are left, for now, with a gap for patients who need more than Weight Watchers or a health coach, but something less that bariatric surgery. These patients are the ideal candidates for referral to the growing cadre of Obesity Medicine Physicians, certified by the American Board of Obesity Medicine.

Coverage for intensive medical management of obesity by such specialists is spotty. For example, about one-half of prescription drug plans will cover the cost of obesity drugs at present. Even in plans that cover them, the co-pays for obesity drugs are frequently higher than they are for more routinely prescribed medicines for diabetes and hypertension.

Where does that leave us? Health insurance covers obesity care better than ever before. We’re still far short of providing people with adequate access to evidence-based obesity treatment.

Health reform and the cost of ignoring obesity will keep prodding health plans in the right direction.

Click here to read more in USA Today, click here to read more in Counsel and Heal, and click here to read more from the Obesity Action Coalition.

18th Century Insurance Plaque on Aberdeen’s High Street, photograph © Nick Thompson / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.