2012: Georgia Cuts Weight Loss Surgery Coverage

Georgia joined Idaho, Kansas, Louisiana, Montana, Oklahoma and Pennsylvania recently as another state to cut a surgery from its public healthcare insurance coverage for cost-related reasons. According to Georgia, it cut its coverage of bariatric weight loss surgery because the costs were too high for its public healthcare program.

The Costs

According to Georgia, in the almost 3 years it covered bariatric surgery, 1,577 public insurance members had the surgery. It cost the state about $31 million dollars; this puts the cost to the state at about $20,000 per surgery.

Should Public Healthcare Insurance Pay the Cost?

On a recent debate on whether insurance should pay for bariatric surgery, Dr. Antony Youn, MD, plastic surgeon mentioned an interesting fact (watch video below):

Obese people spend on average $2,200 more a year in health care versus non-obese people. Bariatric surgery costs $10,000-$25,000, but this “investment” is paid off within 5-10 years because after bariatric surgery medical expenses are significantly lower because people are now healthier.

Based on this argument, the state of Oregon (unlike Georgia) helps low-income patients with surgery. Of course, bariatric surgery without a change in one’s lifestyle cannot improve  one's health. As Dr says, no state or government agency has a way of assuring the commitment of the patient when it comes to permanently changing their eating habits.

Do the Benefits Outweigh the Costs?

Whether or not the benefits of bariatric surgeries outweigh the costs to the state of Georgia is undetermined; the coverage was simply not in place long enough to determine its benefits.

Various studies have been conducted both in and outside of the United States on the long-term effects of bariatric surgery. Most demonstrate a slightly lower mortality rate, and improvements in patients’ cholesterol levels, blood pressure, and diabetes development.

According to Surgical Treatment of Obesity — Weighing the Facts, long-term studies on bariatric surgery demonstrate:

• A 17% reduction rate in mortality.
• Cardiovascular improvement.
• Diabetes recovery.
• Long-term weight loss.

However, most studies are conducted on very small test groups (less than 100 patients) making the implications of the studies inconclusive in relation to all bariatric patients; no one, large scale study has been conducted.

What is Bariatric Surgery?

Bariatric surgery is for those that are obese (i.e. specifically for those whose BMI is above 40) who have tried various venues to lose weight, but were not successful. It decreases the size of the stomach either by surgically removing a portion of the stomach or through the implantation of a gastric band on the stomach.

The risks of obesity are:

• Breathing problems, such as sleep apnea and asthma
• Cancer.
• Diabetes.
• Gallbladder disease.
• Gallstones.
• Gout.
• Heart disease.
• High blood pressure.
• Osteoarthritis.
• Stroke.

Bariatric surgery’s purpose is to eliminate or ebb obesity’s many risks.

Why Georgia May Eventually Reverse Its Decision

Some believe that Georgia’s decision, which only relates to 2012 coverage, will be reversed in 2013 based on Missouri’s experience with the same matter. Missouri eliminated bariatric surgery from its state coverage for 2011, and has decided to re-implement it in 2012 because the benefits of covering the surgery outweigh the costs of not covering it.

Amber Paley is a guest post and article writer bringing to us recent news in the world of weight loss. Amber also writes about nursing home abuse.