Published in December/January Issue             

Most states do not cover bariatric surgery under the Affordable Care Act (ACA) despite the need for effective treatments for obesity and the minimal impact it has on monthly premiums, according to research presented at ObesityWeek 2015.

Researchers from Vanderbilt University Medical Center in Nashville, TN and the University of South Carolina in Greenville examined plans in three states – Oklahoma, Oregon and Virginia – where a portion of the plans cover bariatric surgery. Insurance premiums were generally higher with a surgery benefit, but not by much. In Oregon and Oklahoma, the difference in premiums was about $24.67 and $29.33, respectively. But, in Virginia, monthly premiums were actually lower, by $14. Currently, only 23 out of 51 State Health Exchanges include coverage for bariatric surgery.

Wayne English, MD

“This study shows it’s not really a cost issue as to why bariatric surgery isn’t covered,” said study co-author Wayne English, MD, associate professor of surgery, Vanderbilt University Medical Center. “It may be an issue of false notions about the true costs of bariatric surgery or it may be discrimination. Either way, poor policy is affecting millions of people every day, in many states. It shouldn’t matter where you live as to whether or not you have access to bariatric surgery. There is great inequality throughout state health exchanges operating under the Affordable Care Act.”

The data in the study was obtained from Avalere PlanScape?, which performed an analysis of the 2015 State Exchange Plan features using information from the Centers for Medicare & Medicaid Services (CMS) Plan Attributes and Benefits and Cost Sharing Public Use Files (PUF). Only Oklahoma, Oregon and Virginia have one or more regions within their states in which a portion of the plans cover bariatric surgery.

John Morton, MD

John M. Morton, MD, MPH, immediate past president of the ASMBS and chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine says though obesity is a national epidemic that knows no boundaries, obesity treatment under ACA is left to each individual state to decide.

“There is a real geographic disparity,” said Dr. Morton, who was not involved in the study. “And it's sad to say that many of the states expected to exclude obesity treatments can be found in the South, where the highest rates of obesity can also be found. We are working very hard to change the equation so that all people with obesity, no matter where your home happens to be, can have access to evidence-based prevention and treatment programs including bariatric surgery.”

In addition to Dr. English, study authors of the abstract entitled, “Covering Bariatric Surgery has Minimal Effect on Insurance Premium Costs within the Affordable Care Act,” include, Brandon Williams, MD, Vanderbilt University Medical Center and John Scott, MD, University of South Carolina.