Impact of Medicare Obesity Rules on California Health Care Examined
The Sacramento Bee on Tuesday looked at how changes to Medicare regulations regarding its coverage of obesity treatments will affect the California health care system (Rapaport, Sacramento Bee, 7/27). HHS Secretary Tommy Thompson this month announced 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 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.
The new policy does not specify which treatments will be covered, but treatments such as stomach-reduction surgeries, diet programs, and psychological and behavioral counseling may be considered. Medicare officials will extend coverage to "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 (California Healthline, 7/16).
If Medicare expands the treatments it covers, "the ultimate payoff for doctors and patients alike will come when government health programs and private insurers follow suit," the Bee reports. Under certain circumstances, most health plans in the state cover obesity-related surgeries -- such as gastric bypass surgery, which costs between $30,000 and $40,000. California health plan officials continue to consider coverage for other obesity treatments, such as medications and nutrition or fitness programs. Coverage for weight-loss education and diet and exercise programs is becoming more common, but "local physicians see plenty of room for improvement," according to the Bee.
"Right now, the only time HMOs really start covering obesity treatments is when physicians make the effort to pressure them to do it. With this Medicare decision, we will start to see a gradual shift in coverage decisions from the government that will force HMOs to loosen up their own coverage restrictions," Thomas Hopkins, a Sutter Health physician specializing in obesity, said.
Dr. Bruce Wolfe, who along with another physician has launched an obesity surgery program at Carmichael-based Mercy San Juan Medical Center, said, "We would expect to be very engaged in the debate that shapes which treatments Medicare covers" (Sacramento Bee, 7/27).