Original articleCovering bariatric surgery has minimal effect on insurance premium costs within the Affordable Care Act
Section snippets
Methods
Avalere, an advisory company focused on healthcare business strategy and public policy, provided summary statistics from their analysis of the 2015 Centers for Medicare & Medicaid Services’ Individual Market Landscape File and Plan Attributes Public Use File (Plan-PUF). These files present a variety of benefit design and plan information for exchange plans operating in a state with an exchange run by the federal government. To provide the summary statistics on “Bariatric Surgery,” Avalere
Bariatric surgery coverage
Overall, Oklahoma and Virginia provide greater access to bariatric surgery than Oregon. However, the majority of plans in each state do not cover bariatric surgery. In Oregon, only 10.5% of all plans cover bariatric surgery (46 of 436 plans). In Oklahoma, 36.7% of all plans cover bariatric surgery (73 of 199 plans). In Virginia, 44.6% of all plans cover bariatric surgery (41 of 92 plans).
Notably, none of the platinum plans in Oklahoma and Oregon cover bariatric surgery. In contrast, all
Discussion
Although bariatric surgery is the most effective intervention for morbid obesity and related co-morbidities, a fundamental issue that may hinder widespread utilization of bariatric surgery is that it may simply be considered too expensive in the face of current healthcare budget concerns. Insurance premiums are based on extensive actuarial analysis and reflect a multitude of factors, including expected cost of healthcare utilization by an expected enrolled population. Therefore, if utilization
Conclusions
In this study, we compared insurance premiums as a surrogate means of determining whether coverage of bariatric surgery is substantially more costly, and we found that plans covering bariatric surgery are not consistently more expensive. Bariatric surgery coverage does not appear to impose a significant economic burden and should be universally available for greater utilization in the war against obesity.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
Acknowledgments
We would like to acknowledge Mike Morseon, Director of Healthcare, Economics, Policy and Reimbursement at Medtronic, for providing the data to the authors. The Medtronic Minimally Invasive Therapy Group sponsored the data research and analysis conducted by Avalere. Medtronic had no role in gathering the data, analyzing the data, or writing, editing, or approving the manuscript.
References (12)
- et al.
States variations in the provision of bariatric surgery under Affordable Care Act exchanges
Surg Obes Relat Dis
(2015) - Greenhalgh J. Obesity maps put racial differences on stark display [cited 2015 Oct 1]. Washington, DC: National Public...
- et al.
Advances in the science, treatment, and prevention of the disease of obesity: reflections from a diabetes care editors׳ expert forum
Diabetes Care
(2015) - et al.
The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012
JAMA Surg
(2014) - Griffin RM. Obesity epidemic “astronomical.” WebMD; 2002 [cited 2015 Oct 1]. Available from:...
- et al.
Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes
N Engl J Med
(2014)
Cited by (12)
American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States
2020, Surgery for Obesity and Related DiseasesCitation Excerpt :A major limitation exists in assuming data from 1 state are generalizable and can be extrapolated to determine outpatient procedure numbers for the rest of the United States, but the task force members feel these data provide a better reflection of outpatient procedure activity throughout the United States and that previously published reports were likely significantly underestimated. Other factors that potentially contributed to the increase include the continued growth of supporting level 1 evidence, specialty society outreach, improved access to care, and messaging through media platforms [7–10]. Although adolescent patients represent only .17% of all procedures performed in the United States, substantial evidence supports the safety and effectiveness of surgical weight loss for children and adolescents, and robust best practice guidelines supporting these procedures were recently developed and endorsed by the American Academy of Pediatrics [11,12].
Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists
2020, Surgery for Obesity and Related DiseasesCitation Excerpt :Coverage for bariatric surgery is often lacking, even when there is a perception by employees that their wellness programs will reimburse for these procedures [354]. When available, coverage for bariatric surgery under the Affordable Care Act varies from state to state [355], even though 2015 data do not show an association of coverage with increased monthly premiums [356]. Unfortunately, in a retrospective study by Jensen-Otsu et al. [357] of patients having RYGB, patients with Medicaid coverage, in aggregate, had longer lengths of hospital stays and higher hospital readmission rates within 30 days of discharge compared with those with commercial insurance coverage.
Comment on: Impact of insurance plan design on bariatric surgery utilization
2019, Surgery for Obesity and Related DiseasesBarriers to bariatric surgery: Factors influencing progression to bariatric surgery in a U.S. metropolitan area
2019, Surgery for Obesity and Related DiseasesCitation Excerpt :A recent study by Love et al. [12] in 2017 found that some insurance requirements for patients in the United States may be a barrier for progression to surgery, specifically longer diet requirements, cardiologist and pulmonologist evaluation, advanced laboratory testing, and the potential costs associated with these tests may contribute to attrition. It must be noted that this study was performed at a single institution and reflect one state's insurance mandates [26]. Our study results show similar reasons for attrition, suggesting the degree of insurance coverage continues to be an issue for patients secondary to variation in state coverage.
American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016
2018, Surgery for Obesity and Related DiseasesCitation Excerpt :This preference for safety was well expressed by the National Opinion Research Center survey commissioned by ASMBS last year [8]. Other factors likely influencing growth of procedures remain access to care; coverage for obesity treatment is far from universal [9]. Also, there has been a steady rise in revisional procedures, underscoring the chronic disease aspect of obesity with variable outcome response to interventions [10].