Georgia to Cover
Bariatric Surgery, Again
         
After Dropping Coverage in 2011,
State Signs on for Pilot Program


Published in May 2014 Issue             


Georgia Governor Nathan Deal signed into law a bill that will provide insurance coverage of bariatric surgery for selected state employees. This comes after the state cut surgical weight loss from the Georgia State Employees Health Benefit Plan in 2012 to help close a budget shortfall. The self-funded plan, which covers 650,000 people, had a projected deficit of $815 million for 2012 and 2013.

The new law creates a two-year pilot program under the state Department of Community Health. Participation in the program is limited to no more than 75 people per year. Eligibility requires that participants have a body mass index (BMI) greater than either 40 or 35 and also suffer from co-morbidity such as diabetes, hypertension or sleep apnea.


Rep. Katie Dempsey

In a press release, State Representative Katie Dempsey (R-Rome), the sponsor of the recently signed bill, said almost four years of work led to the new legislation, which she said was supported by the Georgia Chapter of the American Society for Metabolic and Bariatric Surgery, Obesity Action Coalition (OAC), Georgia Hospital Association, Georgia Society of the American College of Surgeons, Medical Association of Georgia and Johnson & Johnson.

When Georgia announced it was dropping the bariatric surgery benefit for state employees, the OAC sprung into action bringing together a coalition of groups and individuals determined to find a way to reverse a decision it felt could be harmful to patients.

“The Georgia state health plan covers a lot of lives, so it meant a lot to the patients in Georgia, including teachers and retirees,“ said Joe Nadglowski, OAC President and CEO. “It also would set a bad precedent in that it could have started an avalanche of other states doing the same. Thankfully that didn’t happen and instead we are hopeful for a full restoration of the benefit, and the start of a new precedent for coverage.”

Most states do cover bariatric surgery for state employees, but when any starts to reconsider coverage, the impact may be felt outside a state’s borders.


Titus Duncan, MD

“It was definitely an everyday struggle to get this bill through and sent to the governor’s desk,” said Titus Duncan, MD, president of the ASMBS Georgia Chapter and a bariatric surgeon in Georgia. “A lot of individuals and groups worked very hard to create this pathway that we hope will eventually restore the bariatric surgery benefit to all state employees.”

State Chapter members made phone calls, wrote emails to legislators, and solicited and organized support from both experts and state employee patients who had benefitted from bariatric surgery. OAC advocates also engaged in a grassroots campaign to reach elected officials to convince them to support this important legislation. The ASMBS national organization provided support for the efforts.

Under the new law, a panel of medical and insurance professionals will review the pilot program every six months to determine the success of bariatric surgery in reducing weight and obesity-related conditions, as well as associated costs. Measures will include the total cost of each participant's annual health care costs prior to surgery and for three years after surgery. The panel will prepare a final report by December 15 of the last year of the pilot.

“I think the data from the pilot program will be eye opening for Georgia. It will improve health, increase longevity, reduce absenteeism from work and save the state money,” Dr. Duncan commented. “The state cannot afford to not cover bariatric surgery.”

The state benefit program did cover bariatric surgery from 2009 to 2011. It was reported that the plan paid nearly $31 million in benefits for 1,577 members during this time.


Jaime Ponce, MD

“The national data shows that bariatric surgery saves lives, and as an added benefit, saves money in the long-term,” said Jaime Ponce, MD, past president of the ASMBS and a bariatric surgeon in Georgia. “We expect the data from the pilot program to be consistent with previous data on the subject.”

Georgia has some of the highest obesity, diabetes and hypertension rates in the nation. The Centers for Disease Control and Prevention (CDC) reports 64.8 percent of adults were overweight and 29.6 percent obese had obesity in 2010. The American Diabetes Association says more than 1 million people in Georgia suffer from diabetes.

“We think the data gathered from the pilot program in Georgia will lead to full restoration of the bariatric surgery benefit for all state employees. The data is on our side,”
added Nadglowski.