South Carolina to cover obesity surgery next year

[celeb_2006]

South Carolina to cover obesity surgery next year - Yahoo! News

COLUMBIA, S.C. – Obese government workers in South Carolina can get stomach-shrinking surgery through the state health plan under a pilot program that starts in January.

The state's employee insurance plan will cover gastric-bypass or Lap-Band surgery costs for 100 people statewide on a first-come, first-serve basis, said Stephen VanCamp, director of the employee insurance program.

The surgeries - which involve either surgically creating a smaller stomach or shrinking intake with a belt-like, adjustable device - cost about $24,000 each. Lawmakers required the test program in the 2010-11 budget as a way to address the state's growing obesity problem. The Budget and Control Board was directed to create it as part of workers' benefits plan for 2011, which it approved Thursday.

The Legislature funded the program, as well as an additional $19 million in costs next year because of the new federal health care law - largely for extending coverage to dependents up to age 26 - so employees' monthly health premiums will not change. Nearly 394,000 public workers, their dependents and retirees are covered under the state health plan.

Obesity rates in South Carolina have doubled since 1990, with 30 percent of adults meeting the definition. Nearly two of every three adults in the state are considered overweight or obese, according to the federal Centers for Disease Control and Prevention.

Obesity puts people at risk for a host of health problems, including diabetes, heart disease, certain cancers and sleep apnea. More than $1 billion annually is spent on obesity-related illnesses in South Carolina, according to the state's health agency.

At least six states require insurance companies to cover morbid obesity treatment, including gastric bypass surgery: Georgia, Illinois, Indiana, Maryland, New Hampshire and Virginia, according to the National Conference of State Legislatures.

Under South Carolina's pilot, the patients' results will be tracked for 18 months to check for complications and see if the surgeries lead to overall health savings.

Comptroller General Richard Eckstrom, a board member, said the state should encourage workers to control their weight, but bariatric surgery seems extreme. While there's hope the surgeries will result in savings, "as an accountant, you can't measure hope," he said. Eckstrom, who said he regularly works out, said the state should instead focus on preventing people from becoming so large that they qualify.

Qualifications for workers or their spouses to get their surgery covered include a body-mass index of at least 40, considered morbidly obese, which roughly translates to a 5-foot-7 adult weighing more than 255 pounds, a positive psychological exam, and post-surgical nutrition and support plans.

But a Republican state senator who has sought ways to encourage residents to live healthier said it makes no sense for the state to fund the costly operations during a recession. Sen. Greg Ryberg of Aiken also doubts they will save money long-term. Last year, he proposed charging obese public workers an extra $25 monthly in their health care premiums. But his colleagues balked at the idea, saying they supported the intent, but questioned how it would be enforced. The state already charges $25 extra for smokers on the health plan.

Next year, Ryberg said he will push for a bill that rewards people with healthy weights, instead of punishing overweight workers, by lowering their health premiums by $15 to $25 monthly.

"Those who are grossly obese probably incur greater costs to the health plan than those who smoke," he said.

[Sleuth]

How about educating people as to the reason why one might become grossly obese? I don't think stapling 100 stomachs is going to be helpful.

Drastic surgery like this should only be used as a last resort. I would bet that none of these potential candidates have taken serious attempts at changing their lifestyles.

[sluce]

I'll bet that your bet would lose. People are not approved for surgery unless they show they have tried other things first. In most cases insurance companies require a doctors recommendation that includes a list of other plans they have tied. They also get a psychiatric evaluation. It is life threatening surgery and people don't just wake up one day and say "hey I think I'll go get my stomach stapeled so I can be skinny."

[cupcake]

They can still gain it back if they don't change their habits.

[sluce]

Gee, ya think?

[nana51]

O.K. here is my obese view on it. I have been overweight since I was 11. I am now 60 and Kaiser will be paying for my lapband surgery. Over the years I have been on countless diets, and medically supervised fasts. They all worked..........for a while. Then of course by old brain went back to work and I gained it back. I have had type 11 diabetes for almost 20 years. Boy is it ever hard to lose weight on diabetic insulin and medication. I have been eating between 1,200 and 1,500 calories for 2 months and have lost 7 lbs. I don't think I can keep at that forever. I am having lapband after 6 months of therapy. I'm not terribly obese, I'm 5'7" and weigh 220lbs., big but not huge. I'm done. They have had great success with curing diabetes with these surgeries and for me it is a last resort. Soon the side effects of diabetes, (heart problems, kidney problems, and poor circulation, also eyesight) will be affected. So yes, I'm "giving up". I'm tired of living everyday with watching everything I put in my mouth. It has a tendency to make it worse when you are always thinking about food. Why am I overweight? I'm assuming it is my drug of choice for comfort. Unlike "real" drugs, I can't go cold turkey and quit, so it is a fight every day, every meal.

[angelais]

They can still gain it back if they don't change their habits.

One of my friends had surgery about five years ago, lost a ton of weight and then last year had a tummy tuck. I mean a major tummy tuck. She looked awesome. Next thing you know, it's a year later and you can't tell she had a tummy tuck. She can't eat a lot at a time, but she eats several tiny meals which consist of too many carbs and she gained a lot of weight.

[nana51]

Yep, that happens. It is a hard thing to change. I don't know the complete answer, but it does help some people.

[Dorito_dirtbag]

I am in SC. I don't know how food stamps or whatever they're called work in other states, but here, everything but hot, prepared food is covered. Meaning, you can buy whatever junk food (chips, candy, snack foods), high dollar food (crab legs, steak, etc) and bullshit food (drink mixers, like margarita mix, Bloody Mary mix) on your food stamps.
Then you can turn around and have weight-loss surgery done for free.

In SC, our gov't will make your ass fat then pay to make you skinny.

[IceQueen]

so they've funded $19 million for the surgeries, but can't contribute anything to come up with the $143 million deficit that they are complaining about not receiving from the federal government to fund education AND will cut 120 teaching positions? Where are the priorities here?

Education funding for SC in jeopardy - WMBFNews.com | Myrtle Beach/Florence, SC | News, Weather, Sports

[VenusInFauxFurs]

I am in SC. I don't know how food stamps or whatever they're called work in other states, but here, everything but hot, prepared food is covered. Meaning, you can buy whatever junk food (chips, candy, snack foods), high dollar food (crab legs, steak, etc) and bullshit food (drink mixers, like margarita mix, Bloody Mary mix) on your food stamps.
Then you can turn around and have weight-loss surgery done for free.

In SC, our gov't will make your ass fat then pay to make you skinny.

SC here too.

[Novice]

I'll bet that your bet would lose. People are not approved for surgery unless they show they have tried other things first. In most cases insurance companies require a doctors recommendation that includes a list of other plans they have tied. They also get a psychiatric evaluation. It is life threatening surgery and people don't just wake up one day and say "hey I think I'll go get my stomach stapeled so I can be skinny."

I heard something recently & it was about whether the NHS should pick up the tab of people that have had this type of surgery done privately when it goes "wrong" & they've not for the money to pay for it to be corrected.
The criteria was very interesting & the actual vote was "yes" because they more than cover the cost in what they save in other areas.

so they've funded $19 million for the surgeries, but can't contribute anything to come up with the $143 million deficit that they are complaining about not receiving from the federal government to fund education AND will cut 120 teaching positions? Where are the priorities here?

Education funding for SC in jeopardy - WMBFNews.com | Myrtle Beach/Florence, SC | News, Weather, Sports

You'll probably find that healthcare & education come from separate purses.
What is spent on saving people from obesity now will (in all probability) more than cover the other costs of healthcare needs today, if not creating a lot more savings in the future.

Someone commented on teach people to eat "correctly" - well, without addressing why they are eating what they are eating, its not going to be successful. It needs to be a multi-prong attack.

[OrangeSlice]

I'll second that Novice. My cousin had the surgery two years ago this past August and I was by her side for the whole process, before and after. She was only 21 when she had the operation, but she really needed it desperately. She already had so many weight related issues, such as diabetes, joint problems, back problems, etc. Her father was morbidly obese and wound up dying about a year after her surgery from all of the health issues related to his weight. He was on VA disability and his medical bills were astronomical. If she had continued to live like she was for the next forty years to be the age that he was when he died, I cannot fathom the cost, both physically and financially. His VA money paid for her surgery and her health (thankfully) is radically different today.

She still has back issues, but no longer takes diabetes medication and no longer has issues with her kidneys and her joints. Investing a few tens of thousands two years ago probably saved at least a few hundred thousand in the long run. She went from well over 400lbs to around 175 in less than two years.

She had to go to counseling before and has had to go to counseling and to see a nutritionist regularly for at least two years after her surgery. With the amount of stress in her personal life, I keep encouraging her to keep up with her counselor and nutritionist even after the required amount of time, just to make sure she continues to take care of herself.

So, to the point, I'm in favor of states covering obesity surgery, provided they also require the counseling and nutritionist visits.

[Novice]

Wow, thanks for the first hand experience OrangeSlice!

Maybe I have more interest & empathy in this because I'm battling with my weight too? (although I guess I'm lucky that I'm not as large as your cousin) it's something I find hard.