Snow and Angst

How Will Health Policy Angst Affect Obesity Care?

Efforts to repeal and replace Obamacare have come and gone this year. They may come again. But for now, seven years after passage of the Affordable Care Act, the direct impact on obesity care has been hard to see. At the ObesityWeek advocacy forum Wednesday, you could hear just about any perspective you wanted. The only constant is health policy angst.

For Clinicians: Little Change

Scott Butsch and John Scott opened the forum with the perspective of clinicians caring for people with obesity. In clinical care, change is hard to see in the midst of many frustrations.

From the perspective of a medical obesity care provider, Butsch tells us that health plans generally offer very little. Coverage for behavioral support is variable. For obesity medicines, coverage is mostly non-existent. Exceptions exist, but as a rule, he’s seen only minimal progress in access to behavioral support programs. For drugs, only some of the more generous employer plans offer coverage.

As a surgeon, John Scott sees a disparate patchwork of access to care. On one hand surgery can offer the best chance for better health and life quality. But poor policies and outright discrimination limit the access to care for many patients. Some plans don’t cover it at all. Others impose restrictions and hurdles that put bariatric surgery out of reach. His aspiration? It’s universal access to surgical care.

For Policy Advocates: Impressive Progress

Reporting on ten years of work by the STOP Obesity Alliance, Bill Dietz could point to some significant advances. Just in the last year, diverse stakeholders have come together and agreed on core competencies for obesity care. Across healthcare professions, we can expect better training for new providers. FDA is now approving more innovative therapies. Among providers and the public, issues of stigma and bias command more attention.

For a Big Health System: Openings to Innovate

Trina Histon brought a unique perspective. She works system-wide within Kaiser on programs to address obesity – both in clinical care and in programs to promote the health of Kaiser’s workforce. In particular, Histon focused on Kaiser’s commitment to a culture of health and well-being.

For Legislators: Public Engagement

Perhaps the most interesting perspective came from Matt Gallivan, who is Health Policy Director for Senator Bill Cassidy. Cassidy is one of the Senate’s few physicians. He bears a few scars from trying to advance an alternative to Obamacare that went down to defeat.

One cause of that defeat was the activation of people who were angry about the possibility of losing health coverage they had only recently gained. And yet, to his credit, Gallivan encouraged people to engage with their elected representatives. Not just a little and not just once. But consistently over time.

And this is what will bring change. Consistent engagement.

You can find presentations from the forum here, here, here, and here. For a detailed obesity policy agenda, click here.

Snow and Angst, photograph © Hartwig HKD / flickr

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November 2, 2017