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Several obesity groups have joined together to file a discrimination complaint with U.S. Health and Human Services, with the goal of forcing all states to offer bariatric surgery coverage under the Affordable Care Act (ACA).
Just 23 states cover weight-loss surgery for qualifying patients under ACA, and the 27 states not covering the procedure have some of the highest obesity rates in the nation.
The complaint, filed earlier this month, charges states not offering coverage for bariatric surgery with violating the provision of the ACA prohibiting the denial of coverage to people due to existing disability and with discriminating against women, Stanford University School of Medicine chief of bariatric surgery John M. Morton, MD, told 番茄社区.
Morton is president of the American Society for Metabolic and Bariatric Surgery (ASMBS), which filed the complaint along with the The Obesity Society (TOS), the Obesity Medicine Association (OMA), and the Obesity Action Coalition (OAC). The five groups make up the organization .
"About 82% of bariatric surgery patients are women," Morton said. "Denying coverage for a therapy that is predominantly accessed by women is discriminatory."
Obesity was classified as a disease by the American Medical Association in 2013.
Morton noted that the condition of 'severe obesity' is considered a disability under the American Disabilities Act. The complaint cites a provision of the ACA that prohibits employing "marketing practices or benefit designs that have the effect of discouraging the enrollment of such plans by individuals with significant health needs."
He added that the federal government and major health insurers such as Blue Cross, Cigna, and Aetna now cover certain types of bariatric surgery for patients considered to be candidates for the procedures. The ASMBS criteria includes patients with BMIs of 40 or more or BMIs of 35 or more with at least two obesity-related co-morbidities who have tried repeatedly to lose weight through non-surgical means.
"We feel, like most major insurers do, that this surgery should be covered," Morton said. "The fact that 27 states chose not to cover it under ACA seems arbitrary and HHS has the power to extend the coverage of this surgery to all 50 states."
The issue of the cost to insurers was addressed in several studies presented at , held last week in Los Angeles.
Researchers from Vanderbilt University Medical Center in Nashville, TN, and the University of South Carolina in Greenville examined the added cost of plans in Oregon, Oklahoma, and Virginia -- where a portion of the plans cover bariatric surgery.
They found insurance premiums to be somewhat higher with the surgery benefit, but not much higher. In Oklahoma and Oregon, average monthly premiums were $29.33 and $24.67 higher, respectively, and in Virginia premiums were actually lower by, on average, $14 a month.
Study co-author Wayne English, MD, of Vanderbilt University Medical Center told 番茄社区 that cost does not appear to be driving payer decisions about covering bariatric surgery.
"Insurance companies do a pretty good job of looking at actuarial numbers," he said "So if this is not a cost issue, it is reasonable to think that it really comes down to discrimination. The state a patient lives in shouldn't determine whether they have access to this surgery."