Obesity Deemed an Illness; Medicare Will Cover Costs of Certain Treatments
Byline: Marguerite Higgins, THE WASHINGTON TIMES
Obesity is now an illness and can be covered by Medicare, the federal health-insurance program for the elderly and disabled.
Health and Human Services Secretary Tommy G. Thompson announced yesterday the Centers for Medicare and Medicaid Services would remove language in Medicare's coverage manual that states obesity is not an illness.
"Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely," Mr. Thompson said at a hearing yesterday of the Senate Appropriations labor, health and human services, and education subcommittee.
The move stops short of classifying obesity as a disease.
Sixty-four percent of the U.S. population is overweight or obese, according to the Centers for Disease Control and Prevention. Obesity contributes to diseases such as diabetes, hypertension, stroke and sleep apnea.
The change means Medicare participants may ask for reimbursement for treating excessive weight.
Anyone with a body mass index of 30 or higher is considered obese, and those with an index of 25 to 29 are considered overweight. A healthy body mass index is 19 to 25.Patients are not guaranteed automatic coverage for treatment.
Medicare will review the requests, which could range from joining a weight-loss or fitness club to surgeries and counseling, and their rates of success before granting coverage.
Weight-loss drugs will not be covered, because the law creating the Medicare prescription program, which starts in 2006, prohibits the program from paying for those medications.
The decision to stop short of classifying obesity as a disease limits how much treatment Medicare must cover. Suggested obesity treatments must meet higher standards than medical interventions for diseases, which must be included in coverage.
By law, Medicare covers only medically necessary services for injury or illnesses. The coverage manual had stated obesity was not an illness, meaning nutritional and behavioral counseling were not covered.
Some medical conditions resulting from obesity, like diabetes, already were eligible for coverage.
CDC first requested removal of the obesity language in 2001. Now the second-biggest cause of preventable deaths in the United States, obesity contributes to 400,000 annual deaths, according to the CDC.
Obesity-related illnesses already are expanding the nation's health care expenses and costing businesses an estimated $17 billion, according to the CDC.
"With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese and its many associated medical conditions," Mr. Thompson said.
Although Medicare officials said it was too early to estimate the number of requests the policy change would bring, several business groups said they are worried that the swelling number of Medicare participants eligible for the coverage will increase health insurance costs.
Small businesses probably would see the largest rate increases, said Helen Darling, president of the National Business Group on Health, a Washington nonprofit for about 219 businesses and health care insurers.
Although unions and companies with more than 500 employees are big enough to decide which health options they will cover, small businesses must buy insurance packages that have minimum coverage requirements specified by the states, Ms. …