Decision could allow broader coverage of treatment plans
By Elizabeth Weise / USA TODAY
In a major decision that turns obesity from a personal failure into a medical problem, Medicare announced Thursday 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 such treatments as surgery to shrink the stomach and intensive in- and out-patient programs at hospitals that provide diet and exercise management. The Medicare decision may eventually result in private insurers providing similar coverage.
More than 60 percent of the U.S. population is overweight and about 30 percent is obese. Obesity contributes to diabetes, heart disease, cancer and arthritis. It is also believed to be 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 the Senate Appropriations Subcommittee on Labor, Health and Human Services and Education.
Earlier, Medicare couldn�t cover obesity treatments because the language in its 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 necessary treatments. But the change removes the reference to obesity not being an illness. That means approval of treatments is possible, but only if research proves them effective, so coverage won�t change immediately. The Medicare change does open the door for the program to gather information on treatments to see which are worthwhile.
�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 and Medicaid Services.
The new language won�t cover weight-loss drugs. The new Medicare drug benefit, set to begin in 2006, bars payment for them.
What it will do is �create positive publicity to the fact 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 but it truly is a medical concern that has very serious medical implication.�