Apr 28, 2014 By John Lowery 4 min read

OK, I signed up for The Affordable Care Act (also known as ‘Obamacare’) and paid my monthly premium.

There has been plenty of hoopla about how the insurance companies could not deny coverage based on pre-existing conditions. So, in an attempt to become healthy I decided to seek medical attention through both weight counseling and bariatric surgery, if necessary.

However, I quickly found out that Obamacare in Pennsylvania is causing the unintended consequence of denying patients access to bariatric surgery.

One of the key components of the ACA is a mandate that state health exchanges cover a set of health care service categories it has defined as Essential Health Benefits (EHB). Categories include ambulatory patient services, prescription drugs and chronic disease management, among others.

However, concerns over whether a uniform set of benefits could be too expensive in some states and a reluctance of the federal government to be seen making mandatory rules for all states, the U.S. Department of Health and Human Services decided to match benefits to the most popular small group plan sold in each state, reflecting local competitive forces. This led to obesity treatments not being covered in plans sold on the exchanges.

Currently, 22 states will have obesity treatments, including metabolic and bariatric surgery, as part of its EHB, and five will also cover weight loss programs. However, 27 states and Washington, D.C., currently have no plans to include it.

Twenty-two states chose benchmark plans that cover bariatric surgery. They include Arizona, California, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Rhode Island, South Dakota, Vermont, West Virginia and Wyoming

The five states that chose benchmark plans that cover weight-loss programs are California, District of Columbia, Massachusetts, Michigan and New Mexico.

Twenty-eight states chose benchmark plans that cover neither bariatric surgery nor weight loss programs. They are ? Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington and Wisconsin.

One state covers weight-loss programs but not bariatric surgery. That’s the District of Columbia.

States such as Pennsylvania, Alabama, Louisiana, Arkansas, Texas and Mississippi will not require the plans to cover any kind of treatments for weight loss, whether by prescription drugs or bariatric surgery. It has previously been reported by the Centers for Disease Control and Prevention that Mississippi has the highest obesity rate in the U.S. of 34.9 percent.

I note that if I lived an hour away in West Virginia, both weight counseling and bariatric surgery would be covered. How can this be? Obamacare was supposed to apply to all Americans equally. In April, The American Society for Metabolic and Bariatric Surgery Pennsylvania state chapter went to Capitol Hill to meet with legislative staff from seven congressional offices. They returned with a commitment from U.S. Representative Lou Barletta to spearhead a letter from members of Congress to U.S.Health and Human Services Secretary Kathleen Sebelius calling for the agency to define the management of obesity and metabolic disorders as part of “chronic disease management.”

Chronic disease management is one of 10 categories which must be included in each state’s EHB.

“The clock is ticking, and we have to make the noise now and continue to make noise to improve patient access,” said Christopher Gallagher, Director of the ASMBS Washington Office. “It doesn’t end in 2014 when the state health care exchanges get implemented. The defined Essential Health Benefits are subject to change again in two years, and we want obesity treatment covered by every state, not just a percentage.”

Thus, it seems that for Pennsylvanians covered under Obamacare, the next chance to have weight counseling and bariatric surgery will not come until 2016. I wonder what the direct and indirect costs of waiting will be in terms of missed days of work, illness, and even deaths until prevention and intervention will be able to save more lives and turn back the twin epidemic of obesity and diabetes.

John Lowery is a resident of Fayette City.