Chris Matthews Joins Fat Bashing Club

November 9th, 2013 No comments »

And here I thought liberals were supposed to be compassionate and not make fun of other people for their personal traits. Chris Matthews of MSNBC, joining Time magazine’s Michael Duffy and Eugene Robinson, in reference to Gov. Christie “crushing” his election opponent, says he “feels for his wife.” Wonder if he ever made fun of Tip O’Neil’s weight?

 

Will the 2016 election be a referendum on obesity?

November 8th, 2013 No comments »

Within hours of winning re-election as Governor of New Jersey, Chris Christie, recent recipient of bariatric surgery, was under snide, sophomoric attack for his weight. Leading the way was Michael  Duffy, Time Magazine Executive Editor which ran the above picture on its cover. Duffy created a juvenile ‘wink-wink’ explanation, calling Governor Chrisite “big” in the Republican Party who did a “huge” thing this week. Hey, clever! This is not a first for Time. In 2011, it published a blog calling for abusing persons with obesity. Really.

This is nothing more than the bullying which LGBT people get, but without any sympathy from the rest of society. A lot of people may not like Christie’s policies, many will not like his personality. But using his weight like this only stigmatizes every overweight child, man and woman in the country. It creates an “Open Season” on persons with obesity. Time and Michael Duffy should be ashamed of themselves.

 

Employer Wellness Issue Heats Up

May 20th, 2013 No comments »

The Equal Employment Opportunity Commission (EEOC) held a long hearing on May 8, 2013 on employer wellness programs. Opponents made a strong case that there was virtually no way that a mandatory health-contingent wellness plan could not discriminate against protected classes of workers. (See statement of Judith Lichtman) On the other hand, the more pro-business representatives argued that Congress and the Administration supported the changes in the Affordable Care Act and the programs where here to stay. It seems that all parties are urging the EEOC to provide guidances to employers.

The testimony came amid a backdrop of waiting for the final regulations from the Obama Administration. The comment period closed in January and many were expecting we would have final regulations by now. Politico reported that a group of corporate CEOs with the Business Roundtable were in Washington recently to lobby the Administration to avoid further weakening of the regulations.

Forbes magazine was reporting the CVS-Caremark was penalizing workers $600 annually if they failed to complete a health risk assessment. The article noted that most companies did not provide such stiff penalties but many were moving in that direction.

Meanwhile, several research articles provide only lukewarm support for weigh loss employer wellness programs.

A Health Affairs article by Ron Goetzel and colleagues, found only 22 % of employer health care costs could be attributed to 10 modifiable health factors (including obesity). This is actually a drop from 24.9% in 1998, even though rates of obesity have increased and costs related to obesity have gone up. Obesity contributed the most excess costs at $347 per capita. Goetzel, Pei, et al,

Another recent paper was a longitudinal study at the worker productivity in terms of absenteeism, presenteeism and job performance associated with changes in 19 modifiable well-being risks. These included physical health risks, health behavior risks, social and emotional health risks work-related risks and financial health risks.  The researchers found that, “Obesity, high cholesterol, tobacco use and excessive alcohol generally contributed to productivity changes insignificantly or unfavorable, possibly because of its multicolinearity with other risks that are closely correlated.” However, they noted that, “Health-related risk explained only a portion of the total productivity variances. For example, Riedel et al found that health risks accounted for 7.8% of the total variance in productivity impairment and acknowledged that the majority of the variation was left unexplained. Lenneman et al also found only 8.5% of the variance in productivity was contributed by health risks…We found that reductions in work-related well-being risks and financial health risks significantly contributed to improvement in productivity measures especially for measures of presenteeism and job performance that were not attributable solely to the more narrow definition of physical health.” They found modest numbers of workers were able to make improvements: 25% reduced their physical health risks 26% improved their health behaviors 16% improved their social and emotional health, 31% improved their work-related risks and 13% their financial health risks. Improvements in absenteeism, decrease in presenteeism and a modest improvement in job performance accompanied such changes. They calculated these improvements were equivalent to a savings of $468 per person per year. Shi, et al.

Ted Kyle reports in his blog that one program, Healthy Blue Living, requires obese participants to wear a pedometer which uploads their physical activity to the employer wellness program. The employees must meet daily step goals if they want to keep full health benefits. Not doing so could cost them each $2000 a year. Kyle notes (and I strongly agree) that this constitutes human experimentation without the protection of the federal regulation protecting human subjects, 45 Code of Federal Regulations Part 46. In fact, the program is not that successful. Promotional material notes that only 16% who agreed got their weight under a BMI of 30.

Yet another study published in Health Affairs looked at one hospital system’s wellness program. The program provide a substantial incentive/penalty for participation in a health risk assessment (which included automated feedback) signing a health pledge, health fairs and physician referrals. The study found a significant reduction in hospitalizations for conditions related to the conditions covered by the wellness program. However, there was an increase in medication costs. Combined with the costs of the wellness program and incentives, the authors concluded, “It is unlikely that the program saved money.” Gowrisankaran G, et al. A Hospital System’s Wellness Program Linked to Health Plan Enrollment Cut Hospitalizations But Not Overall Costs, Health Affairs 32 (3) 2013; 477-485. Gowrisankaran

A second paper also published in Health Affairs reviewed randomized controlled trials of workplace wellness programs. Their review raises doubts the employees with health risk factors such as obesity and tobacco use spend more money on medical care than others. They concluded that workplace wellness programs show little evidence of saving costs through health improvements without being discriminatory.  To test the assumptions of workplace wellness programs the authors, “reviewed research on the relationships among financial incentives, behavior, health status, and medical spending. We focused on randomized controlled trials involving four conditions- smoking, hypertension, high cholesterol and obesity- that are typically included in health-contingent programs. In our review, we found mixed evidence that employees with these conditions have higher health costs than other employees, which undermines the argument that employees with the conditions are particularly effective targets for incentives. We also found little evidence that working-age people change their behavior as a result of financial incentives, particularly over the long term. These findings suggest that program savings many not, in fact, derive from health improvements. Instead, they may come from making workers with health risks pay more for their health care than workers without health risks do. If true, this conclusion would jeopardize long-standing regulatory efforts, maintained in recently proposed Affordable Care Act regulations to prevent workplace wellness from being “a subterfuge for underwriting or reducing benefits based on health status. (citations omitted) Since low-income workers disproportionately suffer from conditions typically targeted by health-contingent programs, savings arising outside of health improvement may entail hidden, regressive redistributions increasing the burden imposed on low-income workers. “

In effect, they point out, wellness plans shift costs with the most vulnerable employees, those from low income groups with the most health risks probably subsidizing the healthier workers. Horwitz, JR, Kelly, BD, DiNardo, JE, Wellness Incentives in the Workplace: Cost Savings Through Cost Shifting to Unhealthy Workers, Health Affairs, 32 (3), 2013:468-476. Horwitz

The Agency for Healthcare Research and Quality (AHRQ) has issued another independent review. This time they reviewed studies of strategies to prevent weight gain in adults. The reviewers looked at 51 trials involving 555,783 subjects with at least one year of follow-up and a weight outcome. A meaningful difference between groups was considered to be 0.5 kg of weight (1.1 pound) or 1 cm of waist circumference. They found moderate evidence that workplace programs for the prevention of weight gain in adults. One study combining diet, physical activity and environmental components resulted in meaningful and statistically significant prevention of BMI change at 12 months and another that combined internet based diet and physical activity counseling resulted in significant prevention at 24 months. However, a third study found no difference. AHRQ Strategies to Prevent Weight Gain Among Adults, Comparative Effectiveness Review No. 97, AHRQ

Also cited as, Gudzune K et al Strategies to prevent weight gain in workplace and college settings: A systematic review, Prev Med. 2013 Mar 22. Gudzune

 

Christie’s Surgery Covered by Insurance

May 7th, 2013 No comments »


Governor Christie’s surgery was covered by state insurance, kind of. Here is what he said at a press conference this afternoon:

Question: [inaudible]

Governor Christie: My insurance. Yeah. The insurance that I pay for, yeah.

Question: [inaudible follow-up]

Governor Christie: No, I’m not going to price it out for you. No. No. No. Anymore than you have any right to know what Sheila pays for when she goes to the doctor, what Armando pays for when he goes to the doctor or anybody else. No, you don’t have a right to know that, that’s my personal business. That’s called HIPAA. That’s a federal statute. Familiarize yourself with it.

Question: [inaudible follow-up]

Governor Christie: Yeah. It is a procedure that is covered when you go through the steps that you need to go through by the State Health Insurance Plan that myself and my family are covered by. Yes.

 

NJ Gov Christie Has Lap-Band Surgery

May 7th, 2013 No comments »

New Jersey Governor Chris Christie has had lap-band surgery, according to a report in today’s Politico. Christie’s weight has long been an opportunity for fat-bashing humor and has been considered an obstacle to a potential Presidential run. However, Christie, who had the operation on his 50th birthday, said that he had the operation to be healthier for his wife and children.

 

Most Obese States Drop Medicaid Expansion

October 17th, 2012 No comments »

If you follow developments in obesity at all, you are familiar with the CDC maps showing the increases in obesity across the nation. Likewise, it is clear from these maps, the obesity is a major problem in the South.

Unfortunately, and tragically for many obese poor persons, the governors of Florida, Louisiana, Georgia, South Carolina and Texas have now been joined by the governor of Mississippi in rejecting the expansion of Medicaid in their states. The expansion is authorized under the Affordable Care Act (Obamacare). St.LouisPostDispatch_Mississippi Decides Medicaid Dollars not Worth Cost

Under the Affordable Care Act, the federal government will pay 100% of the cost of expanding Medicaid from 2014 to 2016. Between 2017 and 2020, the federal share drops to 90% and the states’ contribution gradually rises. The Kaiser Family Foundation projected that Mississippi would receive $23 dollars from Washington for every $1 from the state.

While state budgets are clearly under pressure, many see politics at work as all of the Governors in these states are Republicans and are opposed to Obamacare. Regardless, Mississippi has the highest rate of childhood obesity in the nation with nearly 40% of children up to age 17 meeting the obesity criteria. In all of these states, the lower income groups, who would be covered by the expansion of Medicaid, have major health problems. Refusing to participate in the Medicaid expansion only perpetuates these issues.

 

Obesity and the 2012 Elections

October 1st, 2012 No comments »

At this point the election is some 36 days away. How would different outcomes in the races for President, and control of the Senate and House of Representatives affect health care policies relating to prevention or treatment of obesity? What are the issues? What are the candidates saying about them? What policies might or might not change?

THE ISSUES

One of the major issues in the campaign has been the Affordable Care Act (ACA) with Republicans vowing to repeal and/or replace it and Democrats pledging to defend it.

The Affordable Care Act (ACA) is also referred to as “Obamacare.” While Republicans initiated the term ‘Obamacare’ as a derisive term, Democrats, including President Obama, have become more comfortable using it.

This may be because their overall favorability rating in the polls has gone from very unfavorable to 50% favorable. While the reasons for the shift are not clear, it is likely that it is at least in part due to some of the benefits kicking in, such as no pre-existing conditions exclusions for children, coverage of children on their parents plan up to age 26, and state insurance programs for those unable to acquire individual insurance coverage, strengthening of consumer’s hands in appealing insurance denials, covering USPSTF preventive services without charge in new (i.e. not grandfathered) health plans, rebates to consumers of $1.1 billion this spring from health insurers with excessive administrative costs.

For many months, the ACA has been under legal attack as unconstitutional, especially the requirement that all individuals purchase health insurance. However, in June, 2012 the Supreme Court upheld the law’s constitutionality in this respect.

The ACA has many provisions of importance to persons with obesity. (See http://www.downeyobesityreport.com/category/policy/health-care-reform-policy/page/2/)

In addition to the above mentioned policies, the biggest benefit to persons with obesity is being able to access insurance without their weight being considered a pre-existing condition. This will come into fruition in 2014 when the state health exchanges are operational but state insurance programs are available now until the exchanges are operational. The ACA also established a Prevention Wellness Fund and a National Prevention Council which developed a national prevention strategy. The strategy has been developed and grants have been issued to a number of states.

The ACA did not change Medicare coverage of bariatric surgery; nor did it eliminate the exclusion of drugs for weight loss in Part D. The decision by the Centers for Medicare and Medicaid Services to expand Medicare benefits to include intensive behavioral counseling for obesity in adults, as recommended by the US Preventive Services Task Force, was authorized by prior Congressional statute, not the ACA. Therefore, were the ACA to be repealed, it would not affect this coverage.

Medicaid was greatly expanded by the ACA but the Supreme Court decision in NFIB v. Sebelius has thrown this aspect into some doubt. Medicaid coverage of bariatric surgery, anti-obesity medication and counseling vary widely (See http://www.stopobesityalliance.org/research-and-policy/research-center/gw-research/)

Other provisions of the bill expanded comparative effectiveness research, required employers with over 50 employees to provide private areas for breastfeeding newborns and restaurant chains with 20 or more outlets are required to post calorie information on the menu boards. A controversial provision, offered by Republicans, provides added ‘incentives’ for employer wellness programs in terms of having employees pay more of their health insurance premium costs if they not reach certain specific health metrics, such as BMI. More and more employers have expanded using these ‘incentives’.

The Democrats have no reluctance to pointing to Republican nominee Governor Mitt Romney’s own legislation in Massachusetts as the grandfather of Obamacare, particularly the individual mandate to purchase insurance.

Other policies can affect persons with obesity, outside of the ACA. Balancing the federal budget, reducing the federal debt are also issues in the campaign and can affect funding for the National Institutes of Health and other federal research programs. “Entitlement reform” referring to changes in the Medicare, Medicaid and Social Security programs can also affect both participation in those programs and how benefits of those programs are structured.

The Presidential Race

Recently, the New England Journal of Medicine published editorials by Governor Romney and President Obama on their health care proposals, giving us the most recent and authoritative statements for each camp.

President Obama’s editorial is an strong defense of the ACA. He writes, “Today, 105 million people have seen a lifetime cap on their coverage lifted, so your patients no longer face the tragedy of approaching a lifetime limit in the middle of a round of chemotherapy or an episode in the ICU. Most of your patients can now get preventive care without paying deductibles and copays, care that you know saves lives, from early colon-and breast cancer screenings to cardiovascular tests and flu shots. Because of these new limits on insurance overhead costs, 13 million Americans got more than $1 billion in rebates – and by 2019, economists believe, family premiums will be about $2,000 less.” He goes on to cite saving seniors an average $600 by closing the ‘donut hole’ in Medicare drug coverage, adding 3 million young adults under age 26 to their parent’s insurance coverage, providing that up to 17 million children with preexisting conditions are no longer at risk of being denied coverage. He looks forward to 2014 when 30 million currently uninsured Americans will have health insurance which will stay with them, regardless of employment status. He promises to work on ACA implementation, fix the Medicare physician payment problem and supports medical malpractice reforms without arbitrary “caps”, continue support for the life-sciences research (read NIH) and ensure that the regulatory system (read FDA) helps bring new tools to patients and health care professionals. Finally, he criticizes the Republican ticket for proposing a budget which would eliminate 1,600 NIH grants, make Medicaid into a block grant and cut funding by 1/3 and turn Medicare into a voucher program. NEJM: Perscpective_President Obama

Governor Romney’s editorial criticizes Obamacare and pledges to repeal it and replace it with “not another massive federal bill that purports to solve all our problems from Washington, but with common- sense, patient-centered reforms suited to the challenges we face.”  Under his plan, “families will have the option of keeping their employer-sponsored coverage, but they will also be empowered to enjoy the greater choice, portability, and security of purchasing their own insurance plans.” He argues that this will increase competition, improve quality and lower costs. He would eliminate mandates (presumably state benefit mandates), facilitate purchasing pools and open up an interstate market. Regulation (presumably federal) would prevent insurers from discriminating against people with pre-existing conditions “who maintain continuous coverage.” He pledges better approval of innovations by the FDA and malpractice reforms. He would replace the current Medicare program with one like how Members of Congress choose from among plans, “including today’s traditional fee-for-service option.” The government will provide premium support…more for low income seniors and less for well off seniors…in purchasing their plans. He notes that insurers have said that they would keep coverage for children up to age 26 on their parent’s plans, regardless of Obamacare because they are responding to the market. Finally, he promises to transform Medicaid into a block grant. NEJM: Perspective_ Governor Romney

Three items of interest. First, President Obama nowhere mentions the “public option” which was a major issue within his own party during the legislative process. That idea is clearly off the table. In fact, the Democratic party platform did not mention it, nor does it appear that any Democratic Members of Congress running for re-election who supported the idea are campaigning on it.  Second, Governor Romney did not repeat his promise, made on his website, that on “day one” he would grant waivers from the Obamacare to all fifty states. MittRomney.com:Issues/health care. There is no way of knowing if this omission indicates a change in his position but he may have learned that the ACA does not provide for waivers for states from its mandates. A couple of specific provisions have allowance for waivers. But the key section, regarding the individual mandate, only allows waivers where states offer innovative plans for its citizens which are at least as comprehensive and affordable as the ACA and cover at least as many residents, i.e. Vermont’s single-payer system. Waiver applications from the states have to be reviewed by Department of Health and Human Services and the Internal Revenue Service. Waivers are limited to 5 years but can be renewed. Public hearings are required as well as a 10-year budget plan and periodic evaluation of the program. In any event, waivers are not available until 2017, the year after the next President’s four year term. Of course, Congress could pass legislation to provide waivers by the President on his own volition but if Congress were to do that, why not just repeal the statute altogether? Third, both candidates, but especially President Obama are inexplicitly silent on Medicaid and the Supreme Court’s opinion that Medicaid expansion be “optional.” Medicaid has become even more important in this recession as the health care safety net for millions of Americans who have lost private coverage. Tim Jost Health Blog: behind-the-uninsured-numbers-a-diminishing-sense-of-urgency/ In 2013, the provision of Obamacare which gives a state an additional 1% of the federal share of Medicaid spending in that state if they cover USPSTF recommendations, such as intensive behavioral counseling for adult obesity, is scheduled to go into effect. There is no indication if or how the Supreme Court opinion might affect this provision’s implementation.

(For a detailed non-partisan analysis of the health plans of President Obama and Governor Romney see this report just issued by the Commonwealth Fund: http://www.commonwealthfund.org/Publications/Fund-Reports/2012/Oct/Health-Care-in-the-2012-Presidential-Election.aspx?page=all.

This leads us to the variations in the Congressional elections.

CONGRESS

The Presidents proposes but the Congress disposes is an axiom of American government. Obviously, whatever a President may want, it is up to Congress to decide what he gets to sign into law or veto. So, what are the possible President-Congress combinations, and how would they affect the above policies?

  1. President Obama, Democratic Senate, Republican House

Today, this appears the most likely outcome, identical to the past four years. However, strategies might change. The Senate would block any House legislation to repeal Obamacare. However, it is unclear if the Republican strategy would change or not. For the past four years, the Republican strategy has been to limit President Obama to one term by denying him major legislative accomplishments. With an Obama victory, this strategy no longer has meaning. Depending on the extent of an Obama victory, Republicans may decide not to oppose virtually everything. Winning counts and Republicans may decide to become somewhat more cooperative. The Democrats are likely to be comfortable with staying with the implementation of the ACA and only making legislative changes of narrow scope, much like the changes to Medicare and Medicaid which Congress makes on a pretty regular basis.

2. President Obama, Democratic Senate, Democratic House

It is possible, that with only a change of 25 seats needed, that Democrats could take back control of the House of Representatives. While some very liberal members might bring up the ‘public option,’ in my opinion the White House and Congressional leaders will have little stomach for another health care fight when other pending issues have gone unattended, like immigration reform and the federal deficit. The one factor that can change this is the Supreme Court’s limitation on Medicaid expansion. Making Medicaid expansion optional may mean than more people will remain uninsured than expected. If the numbers bear this out, the Dems may be forced to go back to the drawing board. At this point and given the Supreme Court decision, the public option could be back on the table.  This complete Democratic control is probably the only scenario in which Medicare Part D would be re-opened, providing an opportunity to change the statutory language prohibiting payment for drugs causing weight loss.

3.  President Obama, Republican Senate, Republican House

This is a nightmare scenario for the White House. While President Obama has said he would veto a repeal of the ACA this would be very problematic especially if repeal were included in must-do legislation. Remember Obama agreed to extend the Bush tax cuts which he opposed because he needed Senate votes to approve a treaty extension with Russia and continuation of unemployment benefits. All kinds of legislative games could be played with repeal of the ACA.

4.  President Obama, Republican Senate, Democratic House

It is highly unlikely that both the Senate and House would flip party control but all things are possible. In this scenario, more gridlock is foreseeable.

5.  President Romney, Democratic Senate, Republican House

Gridlock. A Democratic Senate could kill most bills coming from a Republican House. Romney needs the Senate to confirm his Cabinet and other personnel, so Senate Democrats would have a lot of leverage. Democrats would not be expected to announce that they will act to make a President Romney a one-term President, but they will probably act that way. President Romney would have the power to re-open many of the regulations already issued to implement the ACA. The law also provides for a great deal of interpretation by the Secretary of Health and Human Services in its implementation which a Romney Administration could affect. Probably the provision of most importance and undefined at this point is the definition of “essential health benefits” which would be included in plans offered in the federal and state health exchanges. Here, a Romney Administration would have significant latitude.

6.  President Romney, Republican Senate, Democratic House

This is probably the least likely scenario. While Democrats would control one House of Congress, the greater constitutional authority in the Senate would give an edge to enactment of the Republican agenda. However, regarding the ACA, that agenda may be a little murky. In elections in 2014 and then in 2016, when President Romney would run for re-election, 37 Republican Senate seats will also be on the ballot compared to 32 for the Democrats. 2016 will have one of the most un-balanced slates facing the Republicans in some time with 24 Republican seats and only 12 Democratic seats up. It is likely that a number of Republican Senators would not want to see their opponents using repeal of popular ACA provisions against them. So, rather than outright repeal, they might want a more ‘nuanced’ approach which doesn’t leave them politically exposed. Just what that would look like is very unclear. Also, there are a number of provisions of the ACA favored by Republicans including the employer wellness program incentives and the development of Affordable Care Organizations or ACOs.

As long as the Republicans controlled one house of Congress, they could use the “reconciliation” process to avoid a Senate filibuster and enact legislation by majority vote. (Democrats used this at the end of the legislative process to make key changes in the ACA.) However, reconciliation is not for every issue. Under what is known as the “Byrd Rule” a provision excluded from a reconciliation bill if extraneous, i.e., it does not produce a change in federal outlays or revenues; or it produces changes in outlays or revenues that are merely incidental to non-budget components of the provision; or would increase the deficit. So a reconciliation bill could address equalizing the tax treatment of individual and employer purchased health insurance; Medicaid expansion; premium tax credits or the individual mandate. But reconciliation could not be used for changing the insurance reforms, banning use of health status on underwriting or the ban on pre-existing conditions. See Tim Jost Health Blog: dismantling-the-affordable-care-act-what-could-a-president-romney-and-hill-republicans-do/ On the other hand, were a reconciliation bill to repeal the Medicare provisions of the ACA, the federal deficit would actually increase, and so run afoul of the Byrd Rule. (Widely misunderstood, the Byrd Rule is not a Senate Rule but  a federal statute.)

7.   President Romney, Republican Senate, Republican House

While this sounds like a dream scenario for the Republicans, it is actually fraught with danger. The Republican base will expect the party to deliver on its promises on the ACA, Medicare and Medicaid and on the deficit. How the public will react to seeing the Republican positions move from rhetoric to reality will be fodder for pundits and policy-makers for years. Will the public be comfortable with governmental programs, Medicare, Medicaid, Obamacare, being largely turned over to the private insurance market? Certainly, Republican control of Congress and the White House will allow for the de-funding of ACA implementation, including areas like comparative-effectiveness research and the fund for prevention programs.

8.  President Romney, Democratic Senate, Democratic House

This is Romney’s nightmare scenario. Democrats would be expected to pass legislation almost begging for a veto. Romney would have to demonstrate great skill to show leadership on the national political agenda. Given his signature health care legislation as Governor of Massachusetts, I would not expect a President Romney to pick a fight with a Democratic Congress over repeal of Obamacare.

In the meantime, we should not lose sight that many businesses, health care providers, insurers and others are anticipating that current law, i.e. the ACA, will continue. They are making changes to their businesses accordingly. For example, of the 29 state governments under Republican control, only seven are not developing state health care exchanges, while 22 are.

States setting up their own exchanges are submitting their list of ‘essential health benefits.’ We know that Colorado is including the preventive recommendations of the USPSTF, evidently including the recommendation for intensive behavioral counseling for adult obesity while Oregon has decided not to include bariatric surgery.

Litigation over provisions of the ACA will continue. However, it is unlikely that any future challenge will change the Supreme Court’s interpretation of its constitutionality. Implementation may also present problems in satisfying the law’s requirements. Specific provisions may change and will need to be addressed in remedial legislation.

Looking at specific obesity treatment modalities, for bariatric surgery, it seems as if current Medicare coverage will stand. Indications are not good that it will be part of many states’ essential benefit packages under the ACA. Medicaid coverage is unlikely to change because of the election.

Coverage of drugs to  treat obesity has gradually improved over the past few years. It may be that the newly approved drugs by the Food and Drug Administration will spur additional private sector coverage. However, adding such drugs to Medicare Part D or Medicaid Plans remains a long shot. I have not seen what states may do with drug coverage under essential health benefits for the state health exchanges but I would expect most states will go with what they cover in the Medicaid program.

The recent coverage of intensive behavioral counseling for adults with obesity would continue even if the ACA were repealed. However, the ACA would bring intensive counseling in other programs, such as Medicaid and non-grandfathered health plans. So repeal of the ACA would delay or deny expansion of intensive counseling.

So this election and the subsequent make-up of Congress will have a major impact on obesity.

 

The Real Campaign-Barbecue

September 16th, 2012 No comments »

OK, it’s not really about obesity but how the Presidential candidates approach food issues tells us a lot about food and politics in the USA today. Here is one of the best observations from Esquire magazine. Jim Shanin reveals the secret barbecue campaign. http://www.esquire.com/blogs/food-for-men/obama-romney-barbecue-11975971