Score 3

Obesity Score 3-2 for the Affordable Care Act

Speaking at the 13th Annual Bariatric Summit in Nashville yesterday, Ted Kyle tallied a score of three pluses and two minuses for people living with obesity under the Affordable Care Act (ACA), also known as Obamacare.

On the plus side of the ledger, Kyle identified three key gains:

  1. More People Have Insurance. Uninsured RateFor the first time in recent history, more than 90% of Americans had health insurance in 2015. The uninsured rate is down by more than four points since the ACA took effect. Previously, many people with obesity were unable to obtain health insurance because of preexisting health conditions. Now, that’s illegal.
  2. Better Access to Intensive Behavioral Care. Intensive behavioral care for obesity is well-accepted as an effective preventive health service. Under the ACA, preventive services are mandated for free coverage. Health plans of all kinds are scrambling to deliver various forms of the Diabetes Prevention Program.
  3. A Ban on Discriminatory Health Plans. Health plans are barred from designing their benefits in a way that discriminates against people based on any health-related condition. So in theory, plans that keep people with obesity from getting good medical care are operating outside of the law.

Two glaring negatives offset the gains:

  1. Essential Health Benefits. The definition of health benefits that every plan must offer under the law is set state by state. More often than not, obesity care is not on the list of mandated benefits. Only 23 states mandate coverage for some weight management services. Usually, that service is bariatric surgery.
  2. Persistent Discrimination. Even though discriminatory health plan designs are illegal, discriminatory practices aren’t hard to find. Advocacy groups have begun the tedious work of challenging the bad actors.

The bottom line is that the ACA has brought some significant progress in access to care, but it’s been incremental. Access to evidence-based obesity care has long been extremely limited. Movement is in the right direction, but routine access to obesity care requires much more work.

Click here for Kyle’s presentation and here for more from Morgan Downey and Chris Still regarding the ACA’s impact For people with obesity.

Score 3, photograph © photophilde / flickr

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September 18, 2016

4 Responses to “Obesity Score 3-2 for the Affordable Care Act”

  1. September 18, 2016 at 8:09 am, Brian Edwards MD said:

    In KS I am told Medicare covers Obesity visits. I could not find this in the slides. It must be true in the rest of the country. Part D does not pay for Diet medications however. Also Medicare patients cannot use the coupons to discount the cost of the diet medications.
    The slide also did not show that KS medicaid does cover Obesity visits and I believe diet medications.

    • September 18, 2016 at 8:22 am, Ted said:

      Excellent perspective, Brian. Thank you!

  2. September 19, 2016 at 10:06 am, Allen Browne said:

    What about the children?
    Actually the IBT bit does allow coverage for kids in an appropriate program with the correct level of intensiveness.
    But we need awareness, coverage, and availability (ACA) of more tools – devices and meds – as well as coverage for those who ultimately need bariatric surgery.
    The children remain the elephant in the living room.

    Thank you – very useful post and links.

    • September 19, 2016 at 10:16 am, Ted said:

      You’re asking the right question about a very big gap, Allen.