Locked Out

Obesity: Still Locked Out of Healthcare

Many people with obesity still find themselves locked out of healthcare for the biggest threat to their health — obesity. How can this be, you ask? Didn’t the Affordable Care Act (ACA) solve all those problems? Not quite.

Don McNay’s story illustrates the problem quite well and it’s well worth reading over at the Huffington Post. For many people with severe obesity, like McNay, their best shot for avoiding an early death, stroke, heart attack, and a host of other problems that stem from obesity is bariatric surgery. He and many others who find themselves in the same situation have exhausted all other options.

But here’s the rub. Unless you work for a large employer or you’re on Medicare or Medicaid, odds are that your health insurance doesn’t cover a gastric bypass — or any other bariatric procedure. It’s true for McNay, who is a licensed health insurance consultant. It’s true for everybody who works for the Obesity Action Coalition. That’s because the decision about what’s an essential health benefit was mostly left up the states. And most of them just went with the benefits that were typical for small group plans. Meaning no bariatric surgery is covered in 28 out of the 50 states. And odds are — like McNay — you can’t buy insurance that covers it at any price.

But it gets worse. Even if you can afford to pay $20,000 or more that bariatric surgery will cost, your health insurance carrier might use that procedure as an excuse for denying coverage of future health problems. In McNay’s words:

If I pay for my own surgery and had a heart attack the day after, my health insurance won’t cover it. If I don’t get the surgery and have a heart attack induced by my obesity, the insurer will pay for that.

So yes, even with the ACA working well in some ways, many people with obesity are locked out of the healthcare they need to live a fuller and healthier life. We’re following the tortured logic expressed by Therese Hanna, Executive Director of the Mississippi Center for Health Policy:

If you try to include everything, the cost would be so high that people wouldn’t be able to afford the coverage, so you defeat the purpose. The discussion in Mississippi focused on providing care for things like high blood pressure, diabetes and heart disease. So we have a lot of needs to be covered other than obesity itself.

It’s raining so hard that nobody wants to get out and fix the roof.

Click here to read more in the Huffington Post. Click here to read more about bariatric surgery coverage under the ACA.

Locked Out, photograph © Justin Jensen / flickr

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


2 Responses to “Obesity: Still Locked Out of Healthcare”

  1. August 27, 2014 at 11:53 pm, Walt Medlin said:

    Obesity is a chronic, but treatable disease – period. It should BY LAW in the ACA be treated under all health plans – period. The same benefits, the same copays, no unusual barriers.

    • August 28, 2014 at 3:38 am, Ted said:

      Let’s figure out how to make it so!