Tinker Cliffs Benchmark

Shifting Benchmarks to Cover Obesity Care

One bit of encouraging news about access to evidence-based obesity care is coming out of Colorado. It relates to benchmarks for health plans under the Affordable Care Act. Colorado has just adopted a new benchmark, for 2017 and beyond, which will take it from requiring no obesity treatment services in health insurance plans to requiring that every plan cover bariatric surgery.

Let’s start with a bit of background Every state with its own health insurance marketplace is beginning to make decisions about the benchmark health plan that will define the minimum level of benefits for 2017 and beyond. These decisions replace decisions that were made back in 2012 to guide the plans that were offered for 2013 through 2016. In Colorado, just like 27 other states, the benchmark did not require coverage of bariatric surgery.

In announcing their new benchmark, Colorado Insurance Commissioner Marguerite Salazar specifically mentioned the importance of covering obesity care:

While the selected 2012 benchmark plan, the Kaiser Ded/CO HMO 1200D plan, was the largest small group plan, the stakeholders who commented in this year’s process identified stronger support for the Kaiser State Employee Plan because it offers benefits in three areas that are not in the current benchmark: obesity services (specifically bariatric surgery coverage), services provided by chiropractors, and some infertility coverage.

The Obesity Care Continuum, with leadership from the American Society for Metabolic and Bariatric Surgery, deserves credit for this progress. The hard work of this group of healthcare professionals and patient advocates (the Obesity Action Coalition) has made an impact that will help people living with obesity in Colorado for years to come.

We hope this and other work underway will set the stage for continuing improvements in access to evidence-based care for obesity.

Click here for Salazar’s memorandum to stakeholders and here for more background on essential health benefits for obesity care.

Tinker Cliffs Benchmark, photograph © Seuss / flickr

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