Medicare Redefines Obesity As Medical

By Elizabeth Weise, USA TODAY, July 16, 2004 

In a major decision that turns obesity from a personal failure to a medical problem, Medicare announced Thursday that it would remove barriers to covering anti-obesity treatments after 40 years of saying fat was not an illness and not covered.  

The change, disclosed by Health and Human Services Secretary Tommy Thompson at a Senate hearing, could open the program to covering surgery to shrink the stomach and intensive  and outpatient programs at hospitals that provide diet and exercise management. Medicare, a government insurance program, provides medical coverage for more than 40 million Americans 65 and older as well as those with disabilities. The change suggests that private insurers likely will feel pressure to provide similar coverage. 

“It will put more pressure on them in terms of medical and surgical procedures,” says health-financing researcher John Newman of Georgia State University. 

More than 60% of Americans are overweight, and about 30% are obese. In the Medicare population, 37% are overweight and 18% are obese. Obesity contributes to diabetes, heart disease, cancer and arthritis. It also is believed responsible for about 300,000 deaths a year. “Treating obesity-related illnesses and complications adds billions of dollars to the nation’s health care costs,” Thompson told a Senate subcommittee.

Previously, Medicare’s Coverage Issues Manual said obesity was not an illness, and by law, only illnesses and injury could be covered. The new HHS language stops short of calling obesity a disease, which would have required Medicare to pay for treatments. But the change removes the reference to obesity not being an illness. That means approval of  treatments is possible, but only if scientific research proves them effective and a national Medicare panel agrees. So coverage won’t change immediately. HHS officials say they can’t predict what this will cost Medicare because they don’t know yet what it will be asked to cover. 

“Medical science will now determine whether we provide coverage for the treatments that reduce complications and improve quality of life for the millions of Medicare beneficiaries who are obese,” says Mark McClellan, administrator of the Center for Medicare & Medicaid Services. 

The new language won’t extend coverage to weight-loss drugs. What it will do is tell the public “that this is something that needs to be medically dealt with,” says Carlos Hamilton, president of the American Association of Clinical Endocrinologists. “It’s not just a lifestyle or a habit issue.”

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