HHS Secretary Tommy Thompson Announces New Medicare Policy on Obesity Treatments
As expected, HHS Secretary Tommy Thompson on Thursday announced at hearing of the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education that the department would remove language from Medicare's coverage manual that states obesity is not an illness, but the program will not classify obesity as a disease, the Washington Times reports (Higgins, Washington Times, 7/16). The decision will allow for expanded Medicare coverage of obesity treatments. Previously, the program only covered obesity treatments when beneficiaries also had related conditions such as diabetes (California Healthline, 7/15). The new policy does not specify which treatments will be covered, but it "opens the door to what is expected to be a flood of applications from individuals, doctors and companies for Medicare to begin paying for therapies," such as stomach-reduction surgeries, diet programs, and psychological and behavioral counseling, the Washington Post reports. Coverage will be extended for "interventions [that] improve health outcomes for seniors and disabled Americans who are obese," according to Thompson. CMS plans to review scientific evidence on treatments for obesity at a meeting this fall and determine which treatments Medicare will cover, according to CMS Administrator Mark McClellan (Stein/Connolly, Washington Post, 7/16).
CMS officials said that it is too early to estimate how many beneficiaries will seek treatment for obesity, the Washington Times reports. According to CDC, which requested the policy change in 2001, obesity contributes to 400,000 deaths each year, making it the second-leading cause of preventable deaths nationwide, the Washington Times reports (Higgins, Washington Times, 7/16). Currently, 37% of Medicare beneficiaries are overweight and 18% are obese, according to the American Obesity Association. Between 1991 and 1998, the prevalence of obesity among people between the ages of 60 and 69 increased 45%. Last year, Medicare and Medicaid spent $75 billion on obesity-related illnesses, according to a joint report by CDC and RTI, a North Carolina-based research group. U.S. Surgeon General Richard Carmona last year said that the nation spent $177 billion on obesity-related illnesses in 2000 (Simon/Rivera, Los Angeles Times, 7/16).
The policy change "suggests that private insurers likely will feel pressure" to make similar policy changes, according to USA Today (Weise, USA Today, 7/16). Several insurers already cover obesity treatments, and many companies said the announcement "will not lead to a change in their policies," according to the Washington Times. About 50% of all large employers cover bariatric surgery, in which the stomach is stapled to make patients eat less, and about 33% of employers offer coverage for the procedure on the condition that employees also participated in behavior-modification programs, according to a 2003 William Mercer National Survey of Employer-Sponsored Health Plans. An unnamed national panel member of the Society for Human Resource Management said the Medicare policy change could lead to higher health care costs for employers and their workers. "It's going to put more pressure on the system. There's going to be less coverage, higher deductibles and more copays," he said (Haberkorn, Washington Times, 7/16). "From an insurance point of view, you would look at covering things that are more expensive," according to Morgan Downey, executive director of AOA. However, he added, "We think going to the root of the medical problem is better than just treating the symptoms" (Glassman, New York Times, 7/16). Helen Darling, president of the National Business Group on Health, said the new Medicare policy could lead states to adopt mandates on additional obesity coverage, which would increase overall rates and could cause small businesses to drop health plans altogether (Higgins, Washington Times, 7/16). Karen Ignagni, president of America's Health Insurance Plans, said, "We're going to be watching this very closely. We're going to be looking at what they are evaluating and what their results are" (Washington Post, 7/16).
"Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely," Thompson said (Higgins, Washington Times, 7/16). McClellan added, "The question is not whether obesity is a disease or risk factor. What matters is whether there's scientific evidence that an obesity-related medical treatment improves health" (New York Times, 7/16). The decision "recognizes that obesity is not simply a cosmetic issue," Richard Atkinson, president of AOA, said. He added, "This decision will open the door not only for better insurance coverage but more medical research and increased education on obesity at the nation's medical and other health schools." Dr. Peter Pressman, an obesity specialist at the University of Southern California, said, "I'm hoping [the decision] will in effect coerce us as a profession to be more responsible about considering clinical nutrition and obesity as an expanding component of our formal education" (Los Angeles Times, 7/16). Paul Campos of the University of Colorado-Boulder, author of "The Obesity Myth," said the decision is "not just a bad idea -- it's completely unscientific" because being underweight is a greater health problem for the elderly than being overweight (Washington Post, 7/16). Sen. Tom Harkin (D-Iowa) said the measure is a good first step but added, "[W]e are doing precious little to address the root problem: our neglect of prevention and wellness" (Higgins, Washington Times, 7/16). He added, "This is illustrative of the problem we have with Medicare. If you've got a problem, we'll fix you. Medicare should have programs to prevent obesity" (Washington Post, 7/16).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.