This column is dedicated to sharing the vast knowledge and opinions of the American Society for Metabolic and Bariatric Surgery leadership on relevant topics in the field of bariatric surgery.
This month: ASMBS “Obesity PAC” Political Action Committee Takes Fight for Patients to the Next Level
John M. Morton, MD, MPH, FACS, FASMBS
Chief of the Section of Bariatric and Minimally Invasive Surgery,
Stanford University, Stanford, California, and Past President, ASMBS
Bariatric Times. 2015;12(12):8–9.
Dr. Rosenthal: Congratulations on a successful term as ASMBS President and a successful ObesityWeek2015! Could you please provide a thorough update for our readers on the ObesityPAC, one of the newest initiatives of the ASMBS?
Dr. Morton: Thank you. It truly has been a great year for the ASMBS. I have really enjoyed serving as President, and I look forward to continuing to work on important initiatives, such as The Obesity Summit, ASMBS public service announcement project, and the newly formed ObesityPAC.
The Obesity Political Action Committee or ObesityPAC is the newly formed political arm of the ASMBS. It was formed this past November and launched during ObesityWeek 2015. The ObesityPAC enables the ASMBS to build the necessary relationships with members of Congress and key state policymakers, such as governors, state insurance commissioners, and state legislators, to educate them about issues surrounding patient access to, and coverage of, bariatric surgery. As a non-partisan PAC, ObesityPAC influences the make-up of Congress and state government by contributing to incumbents and candidates who have acted as champions for bariatric surgery, regardless of their party affiliation.
Dr. Rosenthal: Why was The ObesityPAC formed?
Dr. Morton: Many medical societies, including American College of Surgeons (SurgeonsPAC), the American Medical Association (AMPAC), and Academy of Nutrition and Dietetics (ANDPAC), have PACs.
The ObesityPAC, which is the first in the field of bariatrics, was formed out of necessity. Bariatric surgery remains under represented when it comes to patient access. The government runs a large majority of patient access, so it is necessary for us to work with them. We did the research and found that when you give a donation to a representative, you increase your chance of scheduling meetings six fold.
During the past three years, we have utilized all other avenues of urging change. We have met with local legislators and also representatives from the Centers for Medicare and Medicaid Services (CMS). We have written letters and submitted comments regarding important issues, especially surrounding the Essential Health Benefit (EHB). We have tried so hard and realize that a PAC is the next level. We believe that the facts are on our side and we are committed to continuing to speak up for our patients.
Dr. Rosenthal: Please tell us more about the obstacles and gaps in insurance coverage for patients considering bariatric surgery.
Dr. Morton: There are multiple obstacles patients with obesity face when considering bariatric surgery. We are tackling the following important issues: high deductibles, coverage denial of bariatric surgery in 27 states, and discriminatory benefit designs.
The Obesity Care Continuum (OCC), a coalition representing the interests of those affected by overweight and obesity, has done much work to secure state health exchange coverage for all evidence-based obesity treatment services. The OCC was formed in 2011 and includes the ASMBS, The Obesity Society (TOS), Academy for Nutrition and Dietetics (AND), Obesity Action Coalition (OAC), and Obesity Medicine Association (OMA).
Currently, 27 state health exchange plans exclude coverage for bariatric surgery and more than 90 percent of states don’t cover FDA-approved obesity drugs. Among the states that do cover bariatric surgery, many include discriminatory benefit designs, such as prohibitive patient cost sharing and lifetime procedure limits. For instance, a patient’s plan may cover the surgery, but with high out-of-pocket deductibles for the procedure and necessary medications. Patients may also be faced with plans limiting the number of procedures allowed in their lifetime to only one, and also limiting the time required to lose weight in a preoperative weight loss program. As healthcare providers, we are all for weight loss, but we are against dictating how much time it takes to lose a set amount of weight.
Last month, the OCC filed a complaint with the United States Health and Human Services (HHS). The complaint claims that the 27 states that deny coverage for bariatric surgery are in noncompliance with the Affordable Care Act (ACA) and that their failure to comply is discriminatory against women and people with disabilities, and violates the ban against denying coverage based on health status or a pre-existing condition. We found that the majority of insurance plans cover the treatments for the complications and consequences of obesity, while not covering treatment for obesity itself. For example, a plan might cover Roux-en-Y gastric bypass and medicine for the treatment of gastroesophageal reflux disease (GERD), but not for obesity.
Other organizations have similar complaints with HSS. In 2014, the AIDS Institute and the National Health Law Program claimed that four Florida insurers were in violation the ACA and federal civil rights laws by placing all covered HIV/AIDS drugs, including generics, in the highest drug tiers that require significant patient cost sharing. After the complaint, the insurers agreed to reduce out-of-pocket payments for most medicines. We are hopeful that we will see a similar outcome.
Dr. Rosenthal: What are the goals of the ObesityPAC? How can readers get involved and/or donate to ObesityPAC?
Dr. Morton: I’m proud to announce that we have 100 percent participation from the ASMBS Executive Council. We are aiming to receive participation from 20 percent of the ASMBS membership, and we expect to also receive support from our State Chapter Presidents and co-chairs. For the first year, we hope to raise $100,000 and then eventually get up to $500,00, which would place us among the top 10 medical PACs in the United States. The average amount raised by other medical society PACs is $1,000 per year per surgeon.
Only members of the ASMBS may donate to the PAC, and the money donated will go to candidates who support support bariatric surgery. Administrative costs are supported by the ASMBS and ASMBS Foundation.
If an ASMBS member is sick and tired of making little progress in the access to care fight, this is the time to put frustration to work. Currently, ObesityPAC is looking for people to help with multiple efforts, including fundraising. We are also looking for people to help with determining key areas of focus (e.g., high deductibles, EHB), and creating a legislative blueprint or battle plan for the year. ObesityPAC will also need people to help with coordinating meetings with members of Congress and key state policymakers, such as governors, state insurance commissioners, and state legislators.
Hopefully, through the ObesityPAC, we can help influence legislators to be friendly toward the obesity cause, thus further helping our patients.
To learn ore and to donate to ObesityPAC, visit:
Dr. Rosenthal: Thank you for informing us of this important step in access to care.
Funding: No funding was provided in the preparation of this manuscript.
Financial disclosures: The author reports no conflicts of interest relevant to the content of this article.