Posts Tagged ‘health care reform’


April 18th, 2012

Guess what state is seeing their health insurance premiums drop…for the second year in a row? Here’s a clue, the state’s former governor, who passed a sweeping health reform legislation, is the likely Republican candidate for President of the United States. Give Up? Read on


Republicans Struggle with Obesity-Related Issues, Mandates

December 13th, 2011

If you are following the debate over health care reform and the Republican presidential race, you know that governmental mandates are a hot issue.

Michele Bachmann (R-MN)  made Texas Governor Rick Perry’s mandate that girls in Texas receive the HPV vaccine a big issue. Michele Bachmann’s mistakes pile up – The Washington Post Now comes a Florida Republican legislator, Larry Metz,  is so opposed to government mandates he has introduced legislation to repeal the state’s requirement for physical education for 6th to 8th graders. Bill would cut physical education mandate –  Newt Gingrich, according to ThinkProgress, has called for government mandated physical education, K through 12, as a way to combat obesity. He also has called for soft drink companies to develop healthy alternatives or have reduced access to the youth market. Gingrich Supported Expanding Federal Physical Education Mandates In 2008 | ThinkProgress

Meanwhile, ThinkProgress quotes Rick Santorum as saying, “If hunger is a problem in America, they why do we have an obesity problem among the people who we say have a hunger program? Santorum: We Don’t Need Food Stamps Because Obesity Rates Are So High | ThinkProgress. Well, part of the answer regarding the food stamp program, now called SNAP, can be found at SNAP to Health! | Snap To Health

Firms to hike health insurance premiums on overweight Americans

October 31st, 2011

As predicted, companies are now expected to raise health insurance rates on persons who are overweight or obesity, thanks to a provision in President Obama’s Affordable Care Act, which gave a financial inducement to companies to discriminate against persons with obesity. Firms to charge smokers, obese more for healthcare | Reuters It evidently does not seem to matter that financial incentives are not effective at weight loss.

STOP Pushes Obesity Tx as “Essential Benefit”

September 26th, 2011

As readers know, President Obama’s health care reform legislation has a critical provision for covering millions of uninsured persons for what are termed “essential benefits.” These benefits were undefined in the legislation.  Now, what will be covered and what will not be covered is becoming a major issue. In a recent Huffington Post, STOP Executive Director Christine Ferguson discusses STOP’s position on including obesity treatments as “essential benefits. Christine Ferguson: Giving Obesity Equal Weight in the Health Care System

Obama Administration Orders Free Gestational Diabetes Screening

August 1st, 2011

The Obama Administration has announced, that, as part of the Affordable Care Act (the health care reform legislation), new health plans will be required to provide free counseling for gestational diabetes to women Affordable Care Act Ensures Women Receive Preventive Services at No Additional Cost Gestational diabetes is a recognized risk for pregnant, obese women  Maternal Obesity and Risk of Gestational Diabetes Mellitus  and is associated with increased risk of obesity in their offspring. Intrauterine exposure to gestational diabetes, chi… [Am J Hypertens. 2009] – PubMed result

DOL Reports on Essential Benefits

May 31st, 2011

The future of health care reform relies on the development of state exchanges whereby individuals can go and select among health insurance plans. But the plans must meet certain minimum requirements. One of them is that they provide “essential benefits.” The Department of Labor was instructed to conduct a survey of employer-sponsored health plans to determine the benefits typically covered by employers. The Department of  Labor (DOL)just sent its report to the Department of Health and Human Services (DHHS).  Essential Health Benefits: Overview of the Department of Labor Report on Benefits Offered Under a “Typical” Employer Health Plan – Health Reform GPS: Navigating the Implementation Process

No mention was made of obesity treatments or obesity preventive services. So the prospects of inclusion of obesity treatments in the final essential benefit package looks unlikely without a huge lobbying campaign. It is interesting that even diabetes care management was one of the least mentioned benefits with 73% of plans not mentioning it.


January 3rd, 2011

January 21, 2011

As part of health care reform legislation, the Department of Health and Human Services was tasked with reporting to Congress on the status of obesity prevention efforts in Medicaid program. Here is their announcement of sending the report to Congress and a link to the full report. HHS Report to Congress on Availability and Status of Obesity Prevention Programs in Medicaid – Kaiser Health Reform

January 18, 2011

A new federal study estimates 129 million Americans , 1 out of 2, have a pre-existing condition which could disqualify them from obtaining insurance coverage. Obesity is one of the pre-existing conditions. At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: | The study is part of the debate over repeal of President Obama’s signature health care reform law. The law guarantees health insurance to persons with pre-existing conditions. The vote to repeal, expected in a day or two, is not likely to be approved by the Senate or signed into law by the President.

2011 will be a critical year in implementing the Health Care Reform Legislation, the Affordable Care Act. About the Affordable Care Act |  Unless, of course, it is repealed or the courts throw all or part of the milestone legislation out. In any event, how critical pieces of the legislation affecting obesity will be implemented is important and we will follow it here.

Coming, 2011              The Food and Drug Administration isexpected                    to   finalize rules for chain restaurants to provide calorie information on their menu offerings.

January 3, 2011           Medicare beneficiaries will get the “Welcome to Medicare” physical without cost sharing. An annual Wellness visit will be covered with no cost sharing. Physicians or the health team will take height, weight, waist circumference, and blood pressure. A health risk assessment will also be provided. Preventive services of the USPSTF will be covered with no cost sharing. (It is our understanding that Medicare still does not cover intensive behavioral counseling for obesity.)

January 1, 2010           Medicare will boost primary care reimbursement to keep doctors and nurses working in primary care as the expected numbers of persons now with insurance coverage will surely increase.

September 23, 2010    New group and individual plans must cover services recommended by the US Preventive Services Task Force (USPSTF) which includes intensive behavioral counseling of adults on obesity. Screening for Obesity in Adults: Recommendations and Rationale These services must be provided without applying copayments or coinsurance for in-network services. Cost sharing can be applied to out-of-network providers.

Interim final rules are issued to allow children up to age 26 to stay on a parent’s health insurance plan. Dependent Coverage of Children Who Have Not Attained Age 26

 Also, new rules governing appeals of claim denials, including independent reviewers go into effect. Appealing Health Plan Decisions under the Affordable Care Act |

July 1, 2020                 Persons without health insurance due to pre-existing conditions can obtain health insurance through their state government or the federal government. Pre-Existing Condition Insurance Plan (PCIP) under the Affordable Care Act |

Insurance is in effect until 2014 when state insurance exchanges will be operational.

Follow Health Care Reform implementation at these websites:

Department of Health and Human Services   Home |

HHS Office of Consumer Information and Insurance Oversight  Regulations and Guidance

Department of Labor Affordable Care Act

Internal Revenue Service Affordable Care Act Tax Provisions  and Affordable Care Act of 2010: News Releases, Multimedia and Legal Guidance

Other:   Excellent blog on the ACA implementation from Timothy Jost Implementing Health Reform: Little-Noticed But Important Guidances – Health Affairs Blog

Insurance Coverage for Intensive Behavioral Counseling

September 21st, 2010

September 21, 2010

RE: Interim Final Rules for Groups Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection and Affordable Care Act, FR 75:41726, July 19, 2010 I would like to express support for the inclusions of coverage of preventive services, particularly that relating to obesity, for group health plans and health insurance issuers. Specifically, the interim final regulations incorporate the level B recommendation of the United States Preventive Services Task Force requiring intensive behavioral counseling of adults for obesity. The background information makes clear that coverage of obesity prevention and reduction services can have extremely positive effects both for individuals and the country as a whole. The background information finds that even modest weight loss produces meaningful improvements in health and reductions in health care spending. The USPSTF recommended high intensity counseling and found insufficient evidence for low or moderate counseling. Their recommendation states, It is advisable to refer obese patients to programs that offer intensive counseling and behavioral interventions for optimal weight loss. The USPSTF defined intensity of counseling by the frequency of the intervention. A high-intensity intervention is more than 1 person-to-person (individual or group) session per month for at least the first 3 months of the intervention. A medium-intensity intervention is a monthly intervention, and anything less frequent is a low-intensity intervention. There are limited data on the best place for these interventions to occur and on the composition of the multidisciplinary team that should deliver high-intensity interventions This is the only specification of the minimum level of frequency, intensity and duration of services. The Overview Section of the regulations state that ?These interim final regulations provide that if a recommendation or guideline for a recommended preventive service does not specify the frequency, method, treatment or setting for the provision of that service, the plan or issuer can use reasonable medical management techniques to determine any coverage limitations.? (At p.41828) Unfortunately, there is not an optimum medical management paradigm for the diverse population which will be covered by this recommendation. This may mean that many health plans will not have guidance on the level of frequency, intensity or duration of behavioral counseling adequate to meet the requirement for ?intensive? and not moderate levels of counseling. The National Institutes of Health funded multicenter clinical trial, LOOK AHEAD, is in the process of identifying optimal intensity and duration of treatment. Their research protocol provides: For the first 6 months, one individual and three group session per month with a recommendation to replace two meals and one snack a day wit liquid shakes and meal bars For months 7-12, one individual and two group meetings per month and continue meal replacements Starting at month 7, more intensive behavioral interventions as well as weight loss medications Year 2-4, treatment on a monthly basis, including at least one on-site visit per month and a second contact by phone, email or mail. Short term-refresher groups and motivational campaigns are also offered three times yearly. After year 4, participants are offered monthly individual visits, as well as one refresher group and one campaign a year. (see The Look AHEAD Study: a Description of the Lifestyle Intervention and the Evidence Supporting it, Obesity 2006 May;14(5):737-752) This ongoing trial is producing significant reductions in weigh loss and associated lipid and cardiovascular risk factors. (Waddent TA, et al, One Year Weight Losses in the Look AHEAD Study: Factors Associated with Success, Obesity (2009)17:713-722) The final regulations direct group health plans and health insurance issurers to the ongoing results of the Look AHEAD trial to identify the optimal level of frequency, intensity and duration of intensive behavioral counseling. In the alternative, the USPSTF could be charged with updating their recommendation based on current clinical studies. Thank you for this opportunity to comment.