A Virginia state delegate met resistance in his attempts to mandate insurance coverage for obesity surgery. John O’Bannon (R-Richmond) proposed a bill in the House of Delegates to require insurance companies to pay for some forms of gastric bypass surgery. The House Commerce and Labor Committee voted 14-7 against the measure on January 26.
Gastric bypass is a form of bariatric surgery that reduces the size of the stomach and allows food to bypass part of the small intestine.
Had Surgery, Lost Weight
O’Bannon’s colleague, Del. Melanie L. Rapp (R-York), testified to the committee the procedure was safe and often routine now. She had the surgery last year and lost 93 pounds. She urged her fellow delegates to consider mandating coverage.
But testimony also was provided by representatives of insurance companies and Virginia businesses who said the surgery is not without risk and could cost businesses and employees millions of dollars.
O’Bannon countered, “It’s going to save the insurance company that insures that patient a whole lot of money to pay for the procedure” rather than to pay for obesity-related illnesses over the years.
Insurers Fear Costs
The Virginia Association of Health Plans (VAHP) said mandating coverage for gastric bypass surgery would add about $6 per month to the premium for each insured person in Virginia.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, gastric bypass surgery costs between $20,000 and $35,000. Insurance coverage for the procedure varies from state to state.
NIDDK’s Web site recommends those interested in the procedure contact their regional Medicare and Medicaid offices to learn whether the surgery is covered.
Benefits, Risks Uncertain
More than 100,000 Americans had the surgery in 2003. The Journal of the American Medical Association published a study in October 2004 showing that in addition to effective weight loss, bariatric surgery led to improvement or complete resolution of conditions such as type 2 diabetes, hypertension, and obstructive sleep apnea in a substantial majority of morbidly obese patients. In October 2005, however, the journal reported risk of early deaths from the procedure were higher in Medicare patients who underwent the surgery than for patients with traditional insurance.
A physician who declined to be identified said, “It is an absolute last resort and [it is] controversial how effective it is.” He argued coverage of gastric bypass should not be a political matter. “In the insurance industry, does the quality of the product meet the needs of the consumer? Let the marketplace sort it out.”
O’Bannon’s legislation limited the coverage mandate to certain hospitals and surgeons certified by the American Society for Bariatric Surgery and Surgical Review Corporation. These “Centers of Excellence” would demonstrate resources and experience to satisfy insurance companies’ concerns and strengthen the legislation, he said.
Plans to Reintroduce Bill
“This is standard medical therapy, as I see it. Patients have the surgery and they throw their syringes away. They are cured of diabetes, high blood pressure, sleep apnea,” said O’Bannon, a neurologist.
O’Bannon said insurers fear policyholders will overuse the procedure and drive up costs. He pointed out that about 4,000 Virginians had the surgery in 2004 and 2005.
“Insurance companies will see the benefits, and then we won’t need the mandate,” O’Bannon said. “I’ve been [a delegate] for seven years, and this is the first mandate I’ve brought.”
O’Bannon plans to carry over the bill to next year and introduce it again.
Susan Konig ([email protected]) is managing editor of Health Care News.
