Louisiana Decides to Cover a Little Bariatric Surgery

For state employees in Louisiana, this might seem like a big step forward. Or it might be so small that it doesn’t amount to much. Last week, the Governor of Louisiana signed a bill into law that requires the state employee health plan to cover bariatric surgery. However, it comes with some serious limitations. Thousands of state employees have a medical need for the surgery. But the state will pay for no more than 300 of these operations. Complications that require a second surgery? Sorry, employees are on their own. Their health insurance won’t cover it.

So compared to zero coverage, this is infinite progress. Compared to the medical need, it’s pathetic.

A Little Help for a Big Problem

State Senator Regina Barrow has been working on this problem for years. But other state policy makers balked – because of the cost. Of course, the state is already paying for the high cost of untreated obesity. Heart disease, diabetes, kidney failure, joint disease, and certain forms of cancer all result from obesity that goes untreated. These avoidable complications all contribute to the cost of providing healthcare to state employees. Nonetheless, Louisiana has long been one of very few states that won’t cover bariatric surgery for its employees.

“Louisiana is number one in the nation in rates of severe obesity,” says Phil Schauer, Professor of Metabolic Surgery at the Pennington Biomedical Research Center. So of course he sees this as a big deal. “This is very good news for a lot of citizens in Louisiana. Employees did not have access to this procedure. This is an important step in the right direction.”

That step is a baby step, however. The state will reserve this procedure for people with the most severe obesity, even though earlier treatment is better for preventing health complications from this progressive disease. Patients will have to pay stiff co-payments – 20 percent of pre-op costs and a $2,500 co-pay for the surgery. Even with all of these limitations, the state will not approve surgery for more than 300 of its 64,580 employees.

Denying Medical Care to People with Obesity

These limitations for a life-saving procedure should be surprising, but they are not. That’s because it is common to deny decent medical care for people with obesity. It’s too much trouble. Many providers are not equipped or prepared to care for patients with obesity. Others will see these patients and blame all symptoms on their size. Rich Schapiro of NBC News describes this “ongoing nightmare” for people living with obesity in a new report.

Really, what it amounts to is medical apartheid – one standard of care for persons with smaller bodies and a lower standard of less care for people with obesity. This bias is systemic in healthcare, so when Louisiana is so slow to offer needed care for its employees with obesity, we are not surprised.

But in human terms, it is hard to justify.

Click here and here for more on this development in Louisiana.

New Orleans Street Magician, photograph © Jonathan Cutrer / flickr

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

June 28, 2021