Essential Health Benefits and Obesity Treatment

Transcript:Essential Health Benefits and Obesity Treatment:
Essential Health Benefits and Obesity Treatment Coverage Life expectancy, smoking prevalence and use of drugs and alcohol have improved over the last three decades In contrast, obesity prevalence has nearly tripled in the last 50 years Over 2/3 of Americans are overweight and obese 35.7% of Americans are obese It is projected that 42% of the population will suffer from obesity by the year 2030 It is major cause of death attributable to heart disease, cancer, and diabetes according to the Centers for Disease Control and Prevention Obesity National Institutes of Health (NIH) recognized obesity as a disease in 1991 American Medical Association (AMA) in 2013 officially recognized obesity as a disease Governmental agencies recognizing obesity as a disease US Internal Revenue Service (IRS) Centers for Medicare & Medicaid Services (CMS) Other organizations supporting surgical treatment of obesity American Heart Association (AHA) American College of Cardiology (ACC) American Diabetes Association (ADA) International Diabetes Federation (IDF) Obesity is a Disease 2000 Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2010 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care Essential Health Benefits Each State decides whether the disease of obesity is a covered benefit within the qualifying health plans participating in the State Health Insurance Exchange 27 states and Washington DC do not cover bariatric surgery Medical treatment for obesity is a covered benefit in only 5 states Obesity Is Not Covered Under the Essential Health Benefits Essential Health Benefit Benchmark Plan Coverage of Weight-Related Services CA WY MT ID NM UT AZ OR NV WA HI WI IA MN NE SD ND CO VT ME NH MA RI CT NY PA NJ MD DE WV VA SC GA FL AL NC TN TX OK AR LA MS KS MO IL OH KY IN MI AK Current as of 12-10-2012; Coverage may have changed since this printing Does not cover bariatric surgery nor weight loss programs Covers weight loss programs but does not cover bariatric surgery Covers bariatric surgery but does not cover weight loss programs Covers bariatric surgery and weight loss programs DC