States Ponder WLS Legislation
By NOREEN GILLESPIE, Associated Press Writer
HARTFORD, Conn. - A proposal before Connecticut lawmakers would
require insurance companies to cover the surgery for people with a
body-mass index of 30 or more if a doctor deems the surgery medically
necessary. The BMI is a widely used formula based on height and
weight.
The Connecticut proposal may not get off the ground this session
because lawmakers are struggling to define under what medical
conditions the surgery should be covered, said Sen. Joseph Crisco, a
Woodbridge Democrat who chairs the legislative committee looking at
the issue.
The debate is not unlike others across the country. Georgia lawmakers
are considering a similar bill this year. And in Louisiana, 40 state
employees were chosen last year from 1,200 applications to get the
surgery on the state’s dime.
The standard surgery, which can cost between $20,000 and $35,000,
involves using staples to separate a small pouch at the stomach’s top
from the rest of the stomach, greatly limiting the amount of food
that can be eaten. The procedure also involves bypassing much of the
small intestine so that less food is absorbed into the body.
Blue Cross and Blue Shield of Alabama recently stopped paying for the
operations while it decides how to handle claims; Blue Cross and Blue
Shield of Florida has also decided to stop paying for the operation.
In Connecticut, many major plans offer coverage only for large
numbers of employees. Others are considering offering the coverage
for an additional charge.
“What we’re starting to see is an increase in what we would consider
at best, unnecessary, and at worst, unsafe, surgery,” said Keith
Stover, a lobbyist for the Connecticut Association of Health
Plans. “Many plans decide the best course of action simply is to
exclude coverage.”
But many physicians say the long-term benefits of weight loss surgery
outweigh the risk. Gastric bypass surgery can help cure obesity-
related health problems such as high cholesterol, high blood
pressure, sleep apnea and even diabetes, said Dr. Jonathan Aranow,
director of the Middlesex Hospital Center for Obesity Surgery.
It can also cut down on the long-term cost of medications, he said.
“The surgery pays for itself in under three years,” he said. “There
is no question that there are cost savings.”
Last year the federal government opened the door for Medicare
coverage of gastric bypass surgery.
But some lawmakers and insurers are also worried about risks. State
Rep. Anthony D’Amelio, R-Waterbury, said noted two people in his
district died after having the operation.
Complications strike as many as 1 in 5 patients having the surgery,
and it is believed that for every 200 patients, 1 to 4 will die.
Estimates are that more than 100,000 people will have the surgery
this year.
“I would rather see people try to do it the harder way, exercise and
eating properly,” D’Amelio said. “I know it’s a struggle … I think
it’s the safest route.”
But for some patients, the hard way hasn’t worked.
Deborah Sicaras, 36, of Wethersfield, has tried Weight Watchers,
Jenny Craig, diet pills and liquid diets; she also teaches ballet,
tap and jazz four days a week.
“I’m one of the fortunate ones who will be able to have this surgery
in the very near future,” she said. “I can’t do this by myself. I
need assistance. I’ve dieted my whole life.”