COLORADO TO INCLUDE BARIATRIC SURGERY AS PART OF STATE’S ESSENTIAL HEALTH BENEFITS IN 2017



Published in July/August 2015 Issue             


American Society for Metabolic and Bariatric Surgery Urges More States, Health Plans to Follow Suit as Urgency to Treat Obesity Increases



According to the American Society for Metabolic and Bariatric Surgery (ASMBS), despite a growing epidemic of obesity and severe obesity across the country, currently only 22 states require coverage of bariatric surgery in the state health exchanges established under the Affordable Care Act (ACA). That’s about to change. This month, Colorado became the first non-coverage state to reverse course by selecting a new benchmark plan that includes bariatric surgery and other obesity treatment services as an essential health benefit beginning in 2017.

In a recent news release, the Colorado Division of Insurance (DOI) announced the selection of the Kaiser State Employee Plan as Colorado’s Essential Health Benefit benchmark plan “for 2017 and beyond.” The DOI said the plan was selected based on stakeholder feedback and internal analysis.

The ASMBS, the nation’s largest organization for bariatric surgeons, the ASMBS Colorado State Chapter and other Obesity Care Continuum (OCC) groups were among the many stakeholders seeking inclusion of obesity treatment services including bariatric surgery in the benchmark plan, which serves as a blueprint for the minimum benefits that must be included in all individual and small-group plans offered
in Colorado.


John Morton, MD

“We are working very hard to ensure that all people with obesity, no matter where your home happens to be, can have insurance coverage and access to evidence-based prevention and treatment programs. We hope Colorado’s action is a real game changer,” said John M. Morton, MD, MPH, president of the ASMBS and director of the Bariatric and Metabolic Inter-Disciplinary (BMI) Clinic at Stanford Health in California. “By expanding coverage to include obesity treatment, Colorado is demonstrating new leadership in facing the realities of a growing epidemic and proven treatments that have been denied to too many for too long. We urge other states to follow suit.”


Jonathan Schoen, MD

Jonathan Schoen, MD, president of the ASMBS Colorado State Chapter added, “The state of Colorado and the Division of Insurance have made a landmark decision in choosing a benchmark essential health benefit plan for 2017 that includes bariatric surgery. This important decision will allow access to care for 1.12 million people in our state who suffer from the disease of severe obesity. Colorado is the first state to switch from non-coverage to coverage and is proof of our commitment to health and wellness.”

MBSAQIP developed the D.R.O.P. initiative, which stands for Decreasing Readmissions through Opportunities Provided. More than 130 centers nationwide are participating. The D.R.O.P. centers implemented nine specific interventions that will be compared to centers that are continuing their standard practice. This information will be shared to help centers determine best practices.

The Centers for Disease Control and Prevention (CDC) reports more than 72 million Americans have obesity and, according to the ASMBS, about 24 million have severe obesity. Individuals with a body mass index (BMI) greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals, as well as an increased risk of developing more than 30 obesity-related diseases and conditions including Type 2 diabetes, heart disease and certain cancers. In 2013, the American Medical Association (AMA) declared obesity a disease.