Posts Tagged ‘Medicaid’

What is the Supreme Court Up to?

November 20th, 2011

This week the Supreme Court agreed to hear a legal challenge to the Affordable Care Act (ACA), President Obama’s signature health care reform legislation. The issues around the “individual mandate” have been well discussed. Timothy Jost, professor of law at William and Mary University School of Law and an insightful thinker on health care law. In a new post, he points to two critical issues in the Supreme Court’s review which are now below the radar but could become extremely compelling. The first is that the Supreme Court added review of the ACA’s expansion of Medicaid. This is not only a key channel for expanding health care coverage but the theory of the challenge, namely that Congress can use its spending power to unconstitutionally coerce states into certain programs. Such use of the spending power is common throughout many government programs. Overturning or even questioning the use of the spending power in this way could raise challenges to a host of federal programs.

The other issue is a more technical, legal issue of severability. Briefly, severability raises the question that, if the individual mandate (or any specific provision) is declared unconstitutional, does the rest of the law remain in place or is the entire statute voided. The Supreme Court has reserved specific time for arguments on both issues. High Court To Review ACA’s Minimum Coverage Requirement, Medicaid Expansion – Health Affairs Blog

Another Mean Season-Pt.2: Arizona

June 1st, 2011

Arizona has proposed imposing a $50 a year tax on smokers and obese childless adults because of their status as smokers or obese adults, evidently to close a budget gap. Whether $50 will close the gap or not is not clear. Nor is it clear at all, that the status tax will affect behavior. What is clear is that the New York Times interviewer, Timothy Williams, was not interested enough to ask the spokesperson for the Arizona plan, Monica Coury,  what was the basis for their belief that $50 would change behavior.  Under an Arizona Plan, Smokers and the Obese Would Pay Medicaid Fee – NYTimes.com  This is journalism? Really?

Another Mean Season?

May 13th, 2011

Previous years has brought the American Medical Association wanting to take away disability payments from persons with obesity and Dr. Toby Cosgrove of the Cleveland Clinic wishing he could refuse to hire any fat person. Now comes an Illinois state legislator,  Shane Cultra, who wants to take away the child deduction from parents if their child is obese, further devastating poor families. He is backtracking or, as they say, maybe just testing the water. What do you think? Check the video Illinois lawmaker getting international reaction to ‘fat tax’ suggestion

And, in South Florida, ob-gyns are refusing to treat obese women  whether they are pregnant or not. Overweight women: Some South Florida ob-gyns turn away overweight patients – latimes.com. Meanwhile, Arizona is proposing to fine poor Medicaid patients $50 if they don’t follow a strict physician regime for weight loss. BBC News – Is it fair to fine fat people for not dieting? And which regime would that be?

Intensive Counseling, State Data and Incentives- What’s new

September 29th, 2010

September 29, 2010

Look AHEAD, an NIH funded long term study of life style intervention on weight and cardiovascular risk factors has released its 4 year findings. One arm of the study received intensive lifestyle counseling; the other arm received usual dietary counseling. Averaged across the four years, body weight was reduced in the intensive group by 6.5% compared to 0 .88%, along with improvements in fitness, hemoglobin A1c, systolic and diastolic blood pressure, HDL cholesterol and triglycerides. Some of the gains decreased over time as one would expect but were still significantly better at the four year follow-up. See, Arch Intern Med — Abstract: Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus: Four-Year Results of the Look AHEAD Trial, September 27, 2010, The Look AHEAD Research Group 170

George Washington University School of Public Health and Health Services has released new data on obesity coverage under the Medicaid program, state employee coverage and mandates for obesity coverage, as well as their new study on the personal costs due to obesity. See Health Policy | School of Public Health and Health Services | George Washington University

The American College of Physicians has released a paper, Ethical Considerations for the Use of Patient Incentives to Promote Personal Responsibility for Health: West Virginia Medicaid and Beyond. The paper addresses evolving wellness programs which involve “incentives” or “penalties,” depending on one’s point of view. The paper cautions, “”motivating behavior change is much more complex than can be accomplished with a single strategy and requires both an individual commitment to health as well as societal collaboration to eliminate barriers. The College adds that such programs “must be designed to allocate benefits equitably;  must not include penalties.”    See,       http://www.acponline.org/running_practice/ethics/issues/policy/personal_incentives.pdf

December 30th, 2009

December 29, 2009

Study disputes ‘healthy and obese’ fallacy  Study Debunks Notion of ‘Healthy Obese’ Man – BusinessWeek

December 29, 2009

Vivus announces plans to submit Qnexa for FDA approval Vivus says it asked FDA for marketing approval of its obesity drug candidate Qnexa — latimes.com

December 24, 2009

Arena Pharmaceuticals submits New Drug Application for lorcaserin to FDA. Arena Pharma seeks US FDA approval for obesity drug lorcaserin – International

December 11, 2009

New York Times feature on poor children getting obesity-inducing anti-psychotic medications on Medicaid Children on Medicaid Found More Likely to Get Antipsychotics – NYTimes.com

December 7, 2009 Lincoln University ends controversial BMI-graduation policy Lincoln Ends BMI Requirement – The Paper Trail (usnews.com)

December 4, 2009

America Samoa tops lists of world’s most obese countries Size matters: American Samoa tops ‘globesity’ scale

December,  2009

Diabetes cases and costs expected to double in next 25 years. Projecting the future diabetes population size and… [Diabetes Care. 2009] – PubMed result

November 27, 2009

University takes flak for singeling out obese students A University Takes Aim at Obesity – The Choice Blog – NYTimes.com

November 24, 2009

CDC releases county obesity rates.  Obesity and Overweight for Professionals: Data and Statistics: U.S. Obesity Trends | DNPAO | CDC

See interesting commentary from Richard Florida of the Atlantic The Geography of Obesity – Richard Florida

November 23, 2009

It seems obesity drugs can’t catch a break. Now there is news that Abbott’s Meridia is being watched by the Food and Drug Administration for increased cardiovascular deaths. It was widely known to increase blood pressure. New Meridia SCOUT Trial has Major Implications for Obesity Drug Development – GLG News This means that for companies bringing new products to the FDA for approval will find even greater scrunity.

November 17, 2009

USA Reports rising costs of obesity epidemic Rising obesity will cost U.S. health care $344 billion a year – USATODAY.com

ACOG issues guidelines on bariatric surgery and pregnancy Bariatric surgery and pregnancy.

Yale course by Kelly Brownell on psychology, biology and politics of food available on line for free The Psychology, Biology and Politics of Food — Open Yale Courses

ASMBS offers on line CEU course on bariatric surgery American Society for Metabolic and Bariatric Surgery

America’s Health Rankings sets obesity state by state projections to 2013 Projected Prevalence of Obesity

November 11, 2009

HHS issues report on health care reform and diabetes Preventing and Treating Diabetes: Health Insurance Reform and Diabetes in America

Dr. Sharma takes on lifestyle choice or chance? Dr. Sharma’s Obesity Notes » Blog Archive » Obesity: Lifestyle Choice or Lifestyle Chance?

November 9, 2009

Downey Obesity Report joins call for health reform to address morbid obesity 15 Million Americans at Greatest Risk of Disease/Death Have Been Left Out of Health Reform Debate – SmartBrief

Study confirms link between swine flu and extra weight

November 5, 2009

California reports important link between obesity and swine flu

Obesity causes over 100,00 new cases of cancer Obesity linked to specific cancers – USATODAY.com

Obesity causing problems in military recruiting Obesity, poor education big obstacles to military recruiting – washingtonpost.com

November 4, 2009

California swine flu report point to obesity risk. In a study published today in JAMA, researchers looked at deaths and hospitalizations due to H1N1 flu in California. They state, “A large proportion of our adult cases had other comorbidities that are not established risk factors for severe influenza, including hypertension and obesity. Of adults with BMI data available, more than half were obese and one-quarter were morbidly obese…Almost one-third ob obese cases did not have other established risk factors for severe influenza, although 27% had other comorbidities (eg, hypertension) Others have reported this novel association in pandemic 2009 influenza A (H1N1) infection; diabetes and obesity were the most frequently identified underlying conditions in fatal cases older than 20 years worldwide, and anecdotal observations of high prevalence of obesity in severe and fatal cases have been reported from Chile, Manitoba and Mexico. Factors associated with death or hospitalization d… [JAMA. 2009] – PubMed result

New evidence from mouse studies on genetic transmission Do Fat Parents Have Taller Babies? Mice study indicates surprising relationships between food, height, and families. – The Human Condition Blog – Newsweek.com

October 28, 2009

DPP 10 year results A Decade Later, Lifestyle Changes or Metformin Still Lower Type 2 Diabetes Risk, October 29, 2009 News Release – National Institutes of Health (NIH)  10-year follow-up of diabetes incidence and weight… [Lancet. 2009] – PubMed result

A Diet for the New Administration

September 27th, 2009

December 30, 2008

By Morgan Downey

At this time of year, millions of Americans are hoping the new Administration will solve our seemingly intractable problems at home and abroad. Millions are also hoping to lose weight in the New Year. The two are not unrelated.

Over the past three decades, obesity has increased among all segments of the population, in the United States and abroad. Obesity is now recognized as the fuel behind many major health problems from cancer to diabetes to heart disease, and a significant cause of increasing health care utilization and health care costs.

While this recognition has increased among both Republicans and Democrats (for the first time, both parties recognized obesity in their 2008 party platforms), changing public policy has not caught up with the problem. Under President George W. Bush, Medicare did undo its policy that obesity was not a disease and did expand coverage of surgery for the treatment of obesity. There have been modest increases in the research and prevention budgets at the National Institutes of Health and the Centers for Disease Control and Prevention. But by and large, the efforts of the last eight years have been largely educational: tell people they should lose weight, eat more nutritiously, and exercise more.

Duh! We get it. And it doesn’t work. Frankly, other than bariatric surgery, nothing works very well to lose significant amounts for a long period of time. There simply is not one ‘fix’ that will reverse this disturbing trend.

So here is some advice to the incoming Administration. It should be noted that many appointees named so far have a solid exposure to obesity from a public policy perspective, including former Senator Tom Daschle, nominee for Secretary of Health and Human Services, Peter Orszag, named to head the Office of Management and Budget, Governor Bill Richardson, nominated for Secretary of Commerce, and Melody Barnes, incoming chief of domestic policy at the White House.

Universal health insurance is often put forward as the panacea for all ills. However, Democrats may have to learn that expanding health insurance coverage alone does not translate to a healthier population, especially if obesity continues to increase among children and adolescents. Truth be told, we do not have adequate medical interventions to affect the rates of obesity and its effects. So, if we do not know how to truly prevent obesity or create a long term treatment, what should a new Administration do? Basically, it should focus on how to create the conditions where it is more likely than not that we will find effective strategies for prevention and treatment in the future.

  1. Being a role model is not enough. It’s been noted that George Bush and Barack Obama share a passion for physical activity. Unfortunately, the habits of the chief executive do not translate to population changes. And then there is the smoking thing. Being a role model is not an excuse for inadequate policies.
  2. Make someone responsible for obesity policy development. Right now there is no one tasked at the upper levels of the U.S. Government with dealing with obesity. True, periodically the heads of different agencies give a speech, start a new website or create a new task force but little happens because so many do so little with scant coordination.
  3. Prepare to spend some money. For one of the most significant health problems in the country, the federal government spends vastly less than on obesity than other conditions. Research, prevention and treatment costs for diabetes and heart disease, to name but two, swamp comparable figures for obesity. The federal government is spending more on getting TV converters boxes in US homes than the entire NIH research budget on obesity.
  4. Do not just focus on childhood obesity. While childhood obesity is critical, remember that the population between 7 and 16 spans only 9 years out of a lifetime. Look at obesity over the lifetime and look for relevant interventions. Support childhood prevention programs but require that they have a competent evaluation method so we will know what is working and what is not.
  5. Do focus on research. Perhaps 90% of what we know about obesity has been learned since the discovery of leptin in 1994. Too many people believe that we know everything we need to know about obesity and do not need any more research. That’s not true. A great deal is known but there are many more questions than answers. Scientific credibility on issues around body weight is sorely needed. Every hour on television another weight loss program or product is hyped as being based on doctor’s advice or scientific study. What can help on both fronts is for the Administration to create a National Institute of Obesity Research at the National Institutes of Health. A new entity like this can reenergize researchers on obesity, can more closely coordinate the many disparate programs across NIH, provide leadership to other federal agencies, states and local governments and provide much needed focus on the social and economic impacts of obesity. Furthermore, a director who is articulate can help lead policymakers and the public away from harmful and dangerous products and keep a focus on developing effective interventions. The NIH bureaucracy will oppose “disease specific” research but their interests should not trump the public health needs and the best use of taxpayer dollars.
  6. As part of your health care reform package, remove the bias against drugs for weight loss in the Medicaid statute and change the exclusion of these drugs under Medicare Part D. Then have the Food and Drug Administration revisit its risk/benefit views of drugs to treat obesity. There are few fans of pharmaceutical companies in a Democratic Congress and Administration and there are even fewer who favor drugs to treat obesity. Nonetheless, there is a huge treatment gap. We have more and more effective surgical options, one over-the-counter FDA approved pill, a couple of tried medicines, commercial plans and self-help. What we do not have are the drug treatment options we have for high cholesterol, hypertension or diabetes. Recently, major pharmaceutical companies such as Merck, Pfizer, Solvay and Sanofi-Aventis have dropped or cut back on their programs to develop drugs for obesity. There are two reasons. First, insurance companies will not reimburse for most obesity treatments, including counseling, drugs and surgery. For the pharmaceutical industry, it just did not make economic sense to invest in drugs which were not going to be reimbursed. This is where leadership by Medicaid and Medicare is critical. If these programs support obesity products, private insurance may follow. This is in the government’s long term interest because insurers can avoid treating or preventing obesity knowing that the big effects, like diabetes and heart disease will not be seen until later in life, when Medicare will become the payor. Second, many involved in obesity drug development feel, rightly or wrongly, that the Food and Drug Administration is so risk-averse that they simply cannot afford the long and expensive trials necessary to meet the rising bar of safety. A National Institute of Obesity Research can help shape clinical trials needed by the FDA and speed the process along.
  7. Look to multiply your opportunities. For example, you can use the public works part of the economic stimulus package to construct new gyms in schools, sidewalks, playgrounds, green spaces and biking/walking trails to encourage more physical activity.
  8. Let the states experiment with taxes and proposals like displaying caloric content in restaurants. Vending machines, non-diet soft drinks, high-fat foods have all come under fire in recent years for contributing to the obesity epidemic. The problem is that these products still only contribute a fraction to an individual’s total caloric intake. But no one is sure that they won’t be replaced by other calories. Likewise, there will be voices to restrict food advertising to children through the federal government’s regulatory powers. Use your National Institute of Obesity Research to design evaluation studies so that there is an objective review to see if these policies will work.
  9. Take some leadership internationally. The United States has a long history of involvement in global health issues, such as HIV/AIDs. However, very little is done on the federal level to learn from other countries’ experiences and to help shape global patterns of eating and physical activity.
  10. Avoid the single fix ideas. The obesity field is full of good advice and scant evidence. Focusing on a single fix, such a TV advertising, agricultural subsidies or sweetened beverage may consume a great amount of political resources without producing the outcome you seek.

The obesity epidemic is more likely than not to continue to grow over the next four to eight years. However, the new Administration can position the United States for meaningful change if it takes its time and devotes attention to organizing the effort. With any luck, we can make future New Year’s resolutions more likely to be successful.

Downey Fact Sheet 3 – Costs

September 27th, 2009

pdficon_small Printable PDF

New analysis indicates costs attributed to obesity are estimated to be $147 billion per year. Annual Medical Spending Attributable To Obesity: P…[Health Aff (Millwood). 2009] – PubMed Result In 1998 the medical costs of obesity were estimated to be $78.5 billion, approximately half financed by Medicare or Medicaid.National Medical Spending Attributable To Overweight And Obesity: How Much, And Who’s Paying? — Finkelstein et al., 10.1377/hlthaff.w3.219 — Health Affairs.

Total health care expenditures of obese adults increased by more than 80% from 2001 to 2006.

During this time, the proportion of health care expenditures for obese adults increased from 28.1% of total health expenditures to 35.3%.

The mean annual health care expenditure for obese adults increased from $3,458 in 2001 to $5,148 in 2006. AHRQ News and Numbers: Health Care Spending for Obese U.S. Adults Rose More Than 80 Percent From 2001 to 2006

Total health care costs attributable to obesity/overweight are projected to double every decade, accounting for 16-18% of total US health care costs. Will all Americans become overweight or obese? Will all Americans become overweight or obese? est…[Obesity (Silver Spring). 2008] – PubMed Result compared to about 9% at present.

Elevated BMI levels in children is associated with $14.1 billion in additional prescription drug, emergency room and outpatient visit costs annually, indicating that the economic consequences of childhood obesity are probably much greater than previously indicated. The Impact of Obesity on Health Service Utilizatio…[Obesity (Silver Spring). 2009] – PubMed Result.

Health Care Reform and Obesity – The Issues

September 27th, 2009

The current health care reform debate has crucial implications for the prevention and treatment of obesity. This debate will be followed closely in the months, if not years, ahead. Here is my view of some of the critical issues in the current debate. MD

October 16, 2009

Senate Finance wellness loophole undercuts reform goals.  Wellness Incentives Could Create Health-Care Loophole – washingtonpost.com

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Has America Reached its Tipping Point on Obesity?

downey_youtube 

The two most recent surgeons general, Dr. David Satcher, left, and Richard H. Carmona, center, join Morgan Downey, right, at the STOP Obesity Alliance panel discussion at the Newseum in September. 

The recommendations of the group will provide policymakers guidelines in dealing with obesity in forthcoming reform bills. STOP Obesity Alliance 

Richard H. Carmona, M.D., M.P.H., STOP Obesity Alliance Health & Wellness Chairperson, 17th Surgeon General of the United States (2002-2006) Richard H. Carmona, M.D., M.P.H., STOP Obesity Alliance Health & Wellness Chairperson, 17th Surgeon General of the United States (2002-2006) 

David Satcher, M.D., M.P.H., The Satcher Leadership Institute Director, 16th Surgeon General of the United States (1998-2002) David Satcher, M.D., M.P.H., The Satcher Leadership Institute Director, 16th Surgeon General of the United States (1998-2002) 

Jeff Levi, Ph.D., Trust for America’s Health Jeff Levi, Ph.D., Trust for America’s Health 

Christine Ferguson, J.D., STOP Obesity Alliance. Christine Ferguson, J.D., STOP Obesity Alliance Director. 

 

 

 

August 11, 2009

President Obama calls for health insurance reform to cover obesity treatments, stating, “All I’m saying is let’s take the example of something like diabetes, one of — a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family — if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 — immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. Text – Obama’s Health Care Town Hall in Portsmouth – NYTimes.com

July 27-29

Centers for Disease Control and Prevention hold Weight of the Nation Conference in Washington, D.C. Speakers include former President Bill Clinton and HHS Secretary, Katherine Sebelius. For full conference information go to CDC Features – Weight of the Nation

July 12, 2009

From Morgan Downey: The ways in which health care reform can address obesity

  1. Prevalence of Obesity in Uninsured Population

There appears to be a high prevalence of overweight and obesity in the uninsured population. A study published in 2000, indicated that, “Smokers, obese individuals, and binge drinkers, were more often uninsured than adults without these risk factors. In contrast, people with self-reported hypertension, diabetes mellitus, and elevated cholesterol were less likely to be uninsured than adults without these conditions.” Ayanian, JZ, Weissman, JS, Schneider EC, Unmet Health Needs of Uninsured Adults in the United States, JAMA, 2000;284:2061-2069. Free full text at Unmet Health Needs of Uninsured Adults in the United States — Ayanian et al. 284 (16): 2061 — JAMA

Likewise, it is estimated that nearly half of all uninsured, non-elderly adults report having a chronic condition. Common reported chronic conditions are diabetes, hypertension, arthritis-related conditions, high cholesterol, asthma and heart disease, all of which are either caused by or highly associated with, overweight and obesity. “Uninsured American with Chronic Health Conditions: Key Findings from the National Health Interview Survey, Uninsured Americans With Chronic Health Conditions: Key Findings from the National Health Interview Survey – RWJF

2. Limiting Use of Pre-Existing Conditions

When individuals, outside of group plans, with obesity try to purchase health insurance policies on an individual basis, they find they are unwelcome. Many private health insurance programs exclude individuals with certain Body Mass Index from accessing individual policies. According to F as in Fat report by the Trust for America, many companies will charge additional premiums for persons with a BMI between 30 and 39. Over a BMI of 39, a person may find no company willing to provide individual coverage. Other plans may classify persons as “unhealthy” or “uninsurable” due to obesity. Companies are free to make their own definitions of these terms. Few states restrict these practices. 14-14 (See F as in Fat: How Obesity Policies Are Failing in America 2008 – RWJF)

Even if the person with obesity can overcome the weight hurdle, their coverage may be limited by the use of the common ‘pre-existing condition’ requirements which restrict a person for a period of time from accessing their plan’s benefits. As indicated above, many chronic diseases are associated with obesity and these can form additional hurdles to obtaining needed care.

Some health insurance plans have started to take very small steps to deal with obesity. For the most part, these efforts include bariatric surgery for additional premiums or offering employer’s a worksite wellness program, also for an additional payment.

Finally, few states have any kind of mandated benefits related to obesity treatment or prevention. In such cases, the insurance industry typically fights such proposals extremely vigorously. (See statement of Bob Clegg former Republican majority Senate leader, New Hampshire at The Challenge of Obesity for Policy Makers: Recommendations for the Next Administration: Republican Convention Forum – health08.org)

  1. Coverage of Obesity Interventions

Once insured the question arises, “Will offered health plans address obesity prevention and treatment?” If the uninsured health plan does not address the, or one of the, root cause of an individual’s health concerns, will any progress be made in using this entire health reform effort to improve individual and public health? The current situation of health insurance, in its avoidance of obesity prevention and treatment, perpetuates a focus on the conditions caused by obesity. Millions spent on heart disease or type 2 diabetes (not to mention the other ill effects, see above) will only continue. Only by addressing the root problem will Americans and America’s health see improvement.

The question has been raised of using the Medicare and Medicaid coverage criteria as the model for the legislation’s covered services. In terms of obesity, these programs cover obesity treatment and prevention inconsistently and inadequately. Regarding Medicare,

  1. In 2004, Medicare eliminated language in its coverage manual to the effect that obesity was not a disease. This opened the door to treat obesity in its own right as a disease.
  2. In February 2006, CMS significantly expanded its national coverage policies to cover more bariatric surgery procedures when performed in designated centers of excellence.
  3. Medicare Part D does not cover drugs for the treatment of obesity.
  4. Medicare does not cover physician or dietetic counseling for weight loss.

Regarding Medicaid,

  1. Most Medicaid plans have no to limited coverage of drugs for the treatment of obesity. The Medicaid statute actually bans states from including such pharmaceutical products but allows a waiver on request of the state. Few states have sought or received such a waiver.
  2. Bariatric surgery, while nominally covered in many states, is subject to such low reimbursement rates that few surgeons want to provide it. Other limitations on is provision further limit its ability to help individuals who meet the NIH recommendations from receiving the surgery.

The Internal Revenue Service, through a change in a revenue ruling in 2000, allows individuals to deduct the costs of weight loss programs upon recommendation of a physician. Of course, taxpayers must meet the threshold of 7.5% of adjusted gross income to qualify for the medical deduction at all. Therefore, Congress should use the expert, evidence-based recommendations of the NIH to decide covered services. (See, http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf)

Similar recommendations adopted by the American Academy of Pediatrics and 15 national medical societies should be adopted by children and adolescents as indicated. (See, Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report — Barlow and and the Expert Committee 120 (4): S164 — Pediatrics)

The Baucus Plan (Call to Action Health Reform 2009, November 12, 2008, Senate Finance Committee) would leave coverage decisions to a new independent health coverage council. This is probably insufficient and Congress should make this decision on coverage of obesity interventions, both prevention and treatment, itself. This would be consistent with the Baucus Plan’s goal, “Prevention must become a cornerstone of the health care system rather than an afterthought. This shift requires a fundamental change in the way individuals perceive and access the system and community-based wellness approaches at the Federal, state, and local levels. With a national culture of wellness, chronic disease and obesity will be better managed and, more importantly, reduced.” (See, http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf (at p. 28)

5. Eliminating the Itemized Deduction

As mentioned earlier, in 2000, the Internal Revenue Service issued a revenue ruling allowing the expenses for weight control which were recommended by a physician to be deductible as a medical expense. While the scope of this ruling is constrained by the limitation that such expenses must exceed 7.5% of adjusted gross income, it is nevertheless the only federal financial support for treatments for obesity outside of the Medicare coverage of bariatric surgery (which is limited to Medicare elderly and non-elderly disabled populations). As such, it should not be modified or repealed unless Congress mandates the benefit package described above.

6. Taxing Sugar-sweetened beverages

The role of sugar sweetened beverages in the increase of obesity, particularly childhood obesity, has been well documented. The evidence from epidemiological and experimental studies indicates that a greater consumption of sugar sweetened beverages is associated with weight gain and obesity.( See, Malik VS, Schulze MB, Hu FB, Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006;84:274-88. Intake of sugar-sweetened beverages and weight gai…[Am J Clin Nutr. 2006] – PubMed Result) Replacing sugar sweetened beverages with water could result in an average reduction of 235 calories per day. ( See, Wang YC, Ludwig DS, Sonneville K, Gortmaker SL, Impact of changes in sweetened caloric beverage consumption on energy intake among children and adolescents. Arch Pediatr Adolesc Med 2009 Apr; 163(4):336-43.Impact of change in sweetened caloric beverage con…[Arch Pediatr Adolesc Med. 2009] – PubMed Result)

The Senate Finance Committee options, however, do not indicate the level of taxation under consideration. Only a significant tax level is likely to affect consumption and its effect on obesity is predicated on the sugar sweetened beverage not being replaced by foods or beverages of similar caloric value. A significant tax, however, is likely to presage decline in consumption over time with an accompanying decline in tax revenue over that time. Therefore, its contribution to financing tax reform would be offset by its value in reducing obesity. As no state or jurisdiction has undertaken this policy option, there is no way of knowing with some certainty whether obesity levels would fall. This may not be a reason not to impose such a tax.

8. Tax on ‘Cadillac Plans’

Also, proposals have been made to treat as income to employee the costs of “Cadillac” health insurance plans, i.e. those that have extensive benefit packages, very low co-payments or deductibles or both. In regard to obesity, probably most of the health insurance plans which now cover surgery, drugs and behavioral modification for persons with obesity would be regarded as such a plan. To tax the employee for these benefits may undo the goals of obesity prevention and reduction. The time has come for employers and payors to provide comprehensive coverage of obesity treatments. Enactment of a tax on the extra costs of such plans is likely to have a negative effect. (See, Swallowing the Cost of Obesity Treatment | workforce.com)

April 21, 2009

Somerville MA tagged as model for health care reform Mass. town takes steps to trim fat (really), health care costs – USATODAY.com

March 5, 2009

Obama addresses obesity at close of national health care forum The White House – Press Office – Closing Remarks by the President at White House Forum on Health Reform, followed by Q&A, 3/5/09

Feb 4, 2009

President Obama Signs SCHIP Bill, Includes Childhood Obesity Demonstration Project.

The new SCHIP legislation contains a requirement for the Secretary of HHS in consultation with the Centers for Medicare and Medicaid Services to conduct a “systematic model for reducing childhood obesity.” The model is intended to identify behavioral risk factors for obesity through self-assessment, identify, through self-assessment, needed clinical preventive and screening benefits among children identified as target individuals on the basis or such risk factors and provide ongoing support to such individuals to reduce risk factors and promote use of preventive and screening benefits and “be designed to improve health outcomes, satisfaction, quality of life, and appropriate use of items and services available under Title 19 (Medicaid) or Title 21.

November 30, 2008

CEO’s Talk Up Obesity CEOs’ Healthcare-Reform Priorities: Obesity and Tort Reform, But Not Universal Coverage | BNET Healthcare Blog | BNET

August, 2008

For the first time in history, the two major political parties in the United States recognized the importance of obesity in their respective party platforms

Democratic Party Platform addresses obesity

The Democratic Platform, adopted in Denver, Colorado on 25 August 2008, refers to obesity three times:

“Our nation faces epidemics of obesity and chronic diseases as well as new threats like pandemic flu and bioterrorism. Yet despite all of this, less than four cents of every health care dollar is spent on prevention and public health.” (p 8)

An Emphasis on Prevention and Wellness. Chronic diseases account for 70 percent of the nation’s overall health care spending. We need to promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions, such as obesity, diabetes, heart disease, and hypertension.” (p 9)

Public Health and Research. Health and wellness is a shared responsibility among individuals and families, school systems, employers, the medical and public health workforce and government at all levels. We will ensure that Americans can benefit from healthy environments that allow them to pursue healthy choices. Additionally, as childhood obesity rates have more than doubled in the last 30 years, we will work to ensure healthy environments in our schools.” (p 10)

A forum on obesity was held by the Obesity Society. The forum at the Democratic National Convention, held on 25 August 2008 at the Denver Art Museum, featured Gary Foster, president, James Hill and Robert Eckel of the University of Colorado, past presidents, and Caroline Apovian with Melody Barnes, Director of Policy for the Obama for President Campaign, and Karen Kornbluh, principal author of the 2008 Democratic Party Platform. Also presenting were Congressman and chairman of the Congressional Black Caucus John Conyers (D-MI-14), Jim Rex, Superintendent of Education in South Carolina and R.T. Rybak, Mayor of Minneapolis, Minnesota. Sally Squires, former columnist for the Washington Post and founder of the Lean Plate Club, moderated the event. Discussions ranged far and wide about expanding treatment and improving prevention of obesity, especially the role of schools in childhood obesity.

The Republican Party Platform, adopted a week later in St Paul, Minnesota, provides:

“Prevent Disease and End the ‘Sick Care’ System. Chronic diseases—in many cases, preventable conditions—are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital. To reduce the incidence of diabetes, cancer, heart disease and stroke we call for a national grassroots campaign against obesity, especially among children.”

On 2 September 2008, The James L. Hill Research Library in St Paul, Minnesota, was the scene of the Republican forum. Speakers included Caroline Apovian, Eric Finkelstein, and Michael Jensen, also a past president of the Society. Allen Levine and Charles Billington (another past president) presented welcoming statements from the University of Minnesota. Lesley Stahl, correspondent on CBS News’ 60 Minutes, moderated a panel consisting of former Secretary of Health and Human Services, Tommy Thompson, representing the campaign of Senator John McCain, former Presidential candidate and Arkansas Governor, Mike Huckabee and State Senator Bob Clegg of New Hampshire. Huckabee enthralled the audience with accounts of trying to get attention to health care issues and obesity in the presidential debates and within his own party. Bob Clegg told his personal story of his fight with obesity and subsequent bariatric surgery. Clegg was the Republican majority leader in the New Hampshire State Senate, and push through the legislature, a bill mandating insurance companies cover bariatric surgery. His personal story combined with the legislative maneuvering was compelling.

Video and transcript of Republican National Convention Forum is available at: http://www.kaisernetwork.org/
health_cast/health2008hc.cfm?hc=2970

Video and transcript of Democratic National Convention Forum is available at: http://www.kaisernetwork.org/
health_cast/health2008hc.cfm?hc=2962

The video and transcript of the 19 September 2007 forum on what the next administration should do can be found at: http://www.kaisernetwork.org/
health_cast/hcast_index.cfm?display=detail&hc=2353