Repealing Obamacare: read the fine print

January 10th, 2017 No comments »

Washington is preparing a re-start of the 8 year battle over Obamacare, formally the Affordable Care Act (ACA). With Republicans in control of both Congress and the White House, it is widely expected that they will have to live up to their promise to repeal the law. But repeal is not as easy as it sounds. The ACA is a large and complicated law embedded not only in the health care system but more widely in American life.

Many aspects of the repeal effort will be hotly debated in the near future. Behind the headlines will be the details, where, as we know, the devils reside. Take two important issues: coverage of persons with pre-existing conditions and employer wellness programs. President-elect Trump and many Republicans have promised to continue the ACA’s provision that pre-existing conditions cannot be used as a basis for denial of insurance coverage. But the ACA’s provision has a second element: insurers cannot charge more for covering persons with pre-existing conditions. (Obesity and related conditions are considered “pre-existing” conditions.) However, a proposed repeal bill developed by the House of Representative Republican Study group would provide coverage for pre-existing through state high-risk insurance pools. Premiums could go up to 200% of the average premium charged in a state. Clearly, such premiums would make policies unaffordable by many with chronic health conditions, especially without subsidies for low-income Americans as provided for in the ACA.

If one took repealing the ACA literally, we could assume that its provisions relating to employer wellness programs would be eliminated. If repealed, the maximum reward/penalty would revert from 30% of the total employer-employee to the previous level of 20% established by ERISA. Wrong.  Under the Republican Study Group, the maximum would actually increase to 50% from 30%.  The Republican Study Group may be one of the more conservative proposals we will see but it provides an important lesson: read the fine print.

Medicaid and the obesity population

July 13th, 2016 No comments »

A recent study indicates that midlife obesity predicts nursing home admissions. This could be critical for Medicaid which pays the majority of nursing home costs.  Overweight was not associated with greater nursing home admissions. Discrimination may be the reason. See post. Recent data show a 24.2% of nursing home residents take antipsychotic medications which can cause weight gain. 5.8% or residents show unintended weight loss.

2016 State Medicaid coverage of fee-for-service obesity treatments

May 2nd, 2016 No comments »

The STOP Obesity Alliance has updated its state-by-state information on fee-for-service obesity treatments in the Medicaid program. See here.

Debunking ‘progress’ on childhood obesity

May 2nd, 2016 No comments »

Much has been made recently of a purported drop in childhood obesity, particularly among children age 2 to 5. (See my Oct. 2015 blog, Did the White House Spin CDC Study to show progress in childhood obesity?) Now, a new study finds “no evidence of a decline in obesity prevalence in any age group, despite substantial clinical and policy efforts targeting the issue.” The paper by Ashley C. Skinner, Eliana M. Perrin and Joseph A. Skelton in Obesity used NHANES data from 1999-2014 and found, “A clear, statistically significant increase in all classes of obesity continued from 1999 to 2014.” They also reported that severe obesity (classII and III) showed a significant increase in adolescents and non-Hispanic black children.  They state, “By including severe obesity, our results also highlight particular areas of concern. In 2013-2014, nearly 10% of adolescents met criteria for Class II obesity, and nearly 5% also met criteria for class III obesity…The 4.5 million children and adolescents with severe obesity will require novel and intensive efforts for long-term obesity improvement. With scarce resources, and increasing costs of comorbid conditions, there is an urgent need for targeted interventions to stem the rise in severe obesity among children, in addition to policies and clinical efforts designed to prevent obesity. Policy efforts are yet to yield substantive changes in obesity prevalence but few have specifically targeted severe obesity.” Amen

The Biggest Loser study shows persistence of slower metabolism after 6 years

May 2nd, 2016 No comments »

Gina Kolata of The New York Times has a front-page story on May 2, 2016, covering a study of winners of the TV ‘reality’ show, The Biggest Loser. The study published in the journal Obesity shows that not only is most the lost weight regained, but that the slower metabolic rate, which occurs during active weight loss, persists for up to 6 years in the subjects. This is the process of adaptive thermogenesis which we have discussed on several occasions. What the article does not mention is that most of the weight loss programs used in employer wellness programs are based on The Biggest Loser. In other words, thanks to Obamacare, employees can be penalized for failing at a weight loss program where failure is all but assured.

Persons with Obesity Excluded from Nursing Homes

December 15th, 2015 No comments »

The New York Times published yesterday a sobering view of the discrimination faced by persons with severe obesity to access nursing home care. It is a sobering picture and one that is not likely to get better anytime soon.

Employers Promote Fat-Shaming: New Post

December 11th, 2015 No comments »

Fellow blogger Al Lewis has an excellent post on Huff  Post Business on the promotion of fat-shaming in “employer wellness” programs. He points out that (a) these programs do not cause weight loss, (b) they are  often structured to embarrass and harass overweight employees by their colleagues, (c) the penalties for failure to reach an employer goal of a specific BMI or weight loss amount are outrageous. What he might add is that millions  of American workers are affected by these programs,   them the largest human experiments in history. No doubt  the numbers of affected employees dwarfs those in medical or surgical treatment programs. What he does not explain is the absence of outrage in the scientific and medical community over these  scams.

Something To Be Grateful For

November 25th, 2015 No comments »

Modern HealthCare magazine reports that Mississippi is planning to add bariatric surgery to its Medicaid program, citing research from the STOP Obesity Alliance.