Taking the Battle for Access to Washington, DC

| November 21, 2011

The Obesity Action Coalition (OAC), American Society for Metabolic and Bariatric Surgery (ASMBS), and Their Partners Educate Elected Officials and Policymakers on the Importance of Access to Bariatric Surgery

by Joe Nadglowski

Joe Nadglowski is President and CEO of the OAC and Executive Director of the ASMBS Foundation.

Bariatric Times. 2011;8(11):14–15

Fighting for Access to Care in 2011
The Obesity Action Coalition (OAC) is a 501c3 nonprofit organization formed more than six years ago to represent individuals affected by obesity. The OAC has more than 33,000 members with 96 percent of whom identify themselves as being somewhere on the often life-long journey of living with obesity. Our primary policy initiatives focus on improving access to the treatments of obesity and reducing weight bias.

It has been a very busy year in the ongoing fight to improve access to bariatric surgery. The OAC, American Society for Metabolic and Bariatric Surgery (ASMBS), and our partners conducted hundreds of legislative visits, met with multiple regulatory agencies, and even took our message directly to the White House. Our main message is simply that bariatric surgery should be a standard benefit in all insurance plans.

Obesity Treatments as a Standard Benefit
With the implementation of healthcare reform continuing, one of the primary opportunities as well as one of the greatest threats to access to obesity treatments, including bariatric surgery, would be the inclusion or exclusion of bariatric surgery from the essential healthcare benefit package (EHBP). The EHBP is the standard scope of services that will be required to be included in any health insurance policy sold in the state healthcare exchanges created by the healthcare reform bill.

Healthcare exchanges will be set up in every state to pool individual and small-business plans into one standard benefit with the only variation being in cost sharing/copays (the so-called bronze, silver, gold, and platinum plans).

Assuming the healthcare reform bill survives until 2014, the following three primary possibilities exist when it comes to the EHBP and bariatric surgery:

1.    Bariatric surgery is included as a standard benefit. This would likely mean that nearly every American’s health insurance would include some coverage of surgery.
2.    Bariatric surgery is excluded. Our nightmare scenario as many suspect that many large employers will end up modeling their plans after what is offered in the healthcare exchanges.
3.    Bariatric surgery is not specifically included or excluded. This scenario would likely mean we would have to go state to state to fight the battle changing the battleground from one fight to 50 separate battles (See sidebar 2011 State Battles for Access to Bariatric Surgery).

Our Partners in this Effort
The OAC and the ASMBS have not been operating alone in this fight. Numerous other nonprofit organizations and industry programs have joined us including the following:

The Obesity Care Continuum. With a combined membership of more than 100,000 healthcare professionals and patient advocates, the Obesity Care Continuum (OCC) is dedicated to promoting access to and coverage of the continuum of care surrounding the treatment of overweight and obesity. The OCC also challenges weight bias and stigma oriented policies whenever and wherever they occur. The OCC is a coalition of the OAC, the Obesity Society (TOS), the American Dietetic Association (ADA), and the ASMBS.

The Allergan C.H.O.I.C.E Campaign. Allergan Inc. (Irvine, California) created the C.H.O.I.C.E (Choosing Health over Obesity Inspiring Change through Empowerment) campaign to provide a platform for consumers, healthcare professionals and Congress to work together to address the adult obesity epidemic. Through a dual focus on prevention and treatment, the campaign works to reduce the prevalence of obesity and ultimately help those who are affected by obesity regain their health and their lives. More than 17,000 participants have signed onto the campaign.

The STOP Obesity Alliance. STOP (Strategies to Overcome and Prevent) Obesity Alliance brings together a diverse and powerful group of consumer, provider, government, labor, business, health insurers, and quality-of-care organizations to stop, think, and change how we perceive and approach the problem of obesity, overweight, and weight-related health risks, including heart disease and diabetes.

Our Efforts
Recognizing the importance of essential benefits, efforts have focused on educating elected officials, regulatory agencies, including their contractors working on such efforts, and other disease or medical organizations on the importance of including obesity treatments (including bariatric surgery) as part of the EHBP.

Educating Congress. Recognizing Congress will play a continuing, if not reluctant role with the ongoing controversy around reform. With the implementation of healthcare reform, one of our primary focuses continues to be educating our elected officials through in-person visits and legislative briefings.

In 2011, the OAC and our partners conducted more than 150 congressional visits, held three OAC “Day on the Hill” legislative fly-ins and two legislative briefings. Nearly every Senator or Representative on key committees dealing with reform was visited (and in many cases, visited several times). The key message during such visits was always that obesity treatments should be a standard benefit. We supported this message by citing efforts such as the C.H.O.I.C.E Campaign as well as the STOP Obesity Essential Benefit White Paper.

The OAC’s three Day on the Hill events in partnership with the C.H.O.I.C.E. Campaign, ASMBS, and TOS brought together a combination of more than 50 patients and healthcare professionals to Washington, DC, working together to educate elected officials. Our two legislative briefings on the treatments of obesity featured Christopher Still, DO, FACN, FACP, and Scott Kahan, MD, respectively and attracted standing-room-only crowds of legislative staff from both the House and Senate.

Our efforts were rewarded with members of Congress supporting the inclusion of obesity treatments in the EHBP. On the House side, more than 50 House members joined Rep. Towns (D-NY) in signing a letter urging the Secretary of the Department of Health and Human Services (HHS) to include such services, and on the Senate side, Senators Inouye (D-HI), Akaka (D-HI) and Mikulski (D-MD) sent a similar letter.

Educating regulatory agencies. Much of the effort around the implementation of healthcare reform is falling to regulatory agencies and the contractors they hire to help in the process. Recognizing this, the OAC, ASMBS, and our partners held numerous visits with the Department of HHS, the Institute of Medicine (IOM), National Association of Insurance Commissioners, and even the domestic policy staff of the White House. Such efforts have led directly to invitations to testify before the IOM as well as being invited to participate in upcoming listening sessions on essential benefits with HHS.

Gathering medical community support. With obesity being the cause of so many underlying conditions, the OAC, ASMBS, and our partners have also focused on bringing other related-disease organizations into our efforts to encourage obesity treatment coverage. Recently, 14 organizations (including the Arthritis Foundation, the American Osteopathic Association, and many others) sent a letter similar to the letters we saw from the House and Senate urging the Secretary of HHS to cover obesity treatments.

The Response to Our Message
While almost every individual, group, agency, or legislator we have met with recognizes the impact of the obesity epidemic to an individual’s health, as well as on society and economics, and many agree with our belief that obesity treatment must be a standard health benefit, our biggest challenge continues to be convincing some that an investment now in treating obesity will pay dividends in the long run.

Reality is that the sheer number of individuals who need obesity treatment combined with the current high costs of health insurance scare many people. They may fear that the short-term costs of addressing obesity will make health insurance unaffordable. Our response to this is that the long-term consequences of not treating obesity will definitely make health insurance unaffordable and that an investment must be made at some point or we will continue down the path of unsustainable growth in the costs of health insurance.

Moving into 2012
The battle for inclusion of obesity treatments in the EHBP will likely continue well into 2012 with the battleground shifting to the states in late 2012/early 2013 (although the election may change or eliminate this time line). In the coming months, the key will be the interpretation of the IOM’s recent recommendations around essential benefits as well as HHS’s expected draft regulations/rules around essential benefits, which are expected in spring of 2012. The opportunities for and threats to coverage have never been greater. The OAC, ASMBS, and our partners are fighting the battle. We encourage you to join us in the fight.

Photos:
At the Capitol

Day on the Hill Sessions

Category: Brief Report

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