Obesity has reached crisis levels in the U.S. and is getting worse. Experts predict that fully half of Americans will have obesity by the end of this decade. Obesity is directly linked to the leading causes of death in the U.S., including heart disease, stroke, diabetes, and cancer. The economic toll of obesity, currently estimated at an astounding $1.4 trillion per year, negatively affects labor market outcomes and healthcare costs. Yet, following years of stigma and relying on lifestyle modification alone, the healthcare system is only now shifting to view obesity as a serious but treatable chronic disease.
Like other chronic diseases, successfully treating obesity requires a continuum of care. For obesity, the continuum ranges from primary and specialist care to anti-obesity medications (AOMs) and surgical interventions. While this continuum of care can be highly effective in managing obesity, numerous barriers remain in the way of patients receiving the full range of treatments. Insurance coverage for obesity treatment continues to be limited.
While there has been significant progress in this area over the last several years, there remains a patchwork of coverage for the full continuum of obesity treatment across the states. Better equipping state leaders to address this important problem is the focus of a new RPA publication released today entitled, “Broadening Coverage to Combat the Obesity Crisis: A Toolkit for State Innovation.”
“State policymakers continue to grapple with the high cost of healthcare, but they should not lose sight of the goal—to help their citizens lead healthier, more productive lives,” said Randy Pate, Founder of Randolph Pate Advisors LLC and former Deputy Administrator, CMS and Director of the CMS Center for Consumer Information and Insurance Oversight. “The cost of inaction on obesity grows each year and can no longer be ignored. If undertaken carefully and appropriately, the approaches discussed in this toolkit not only stand to help state residents lead healthier, more productive lives, but can also save money in the long run.”
As explained in the toolkit, state leaders wishing to address coverage barriers to effective obesity treatments have several options to expand access in a cost-effective and fiscally responsible manner, including:
• Making changes to Essential Health Benefits (EHB) benchmark plans
• Applying for state waivers from federal requirements, including ACA Section 1332 State Innovation Waivers
• Including obesity treatment coverage in Medicaid
• Including coverage for obesity treatments in State employee health plans