ANNAPOLIS – Jacquelyn Leach has been obese her entire life. The 29-year- old speech language pathologist has struggled through numerous diet and exercise programs and tried different medications, but nothing has worked.
When Leach stumbled across information about weight loss surgery last year, she decided it was her last chance to lose weight. But her hope faded quickly when she discovered her insurance company, UnitedHealthcare, does not cover medical or surgical treatment for obesity.
Leach was one of several people at a hearing in the Economic Matters Committee Thursday testifying for a bill to require HMOs and other insurance carriers to cover surgical treatment for morbidly obese patients when all non- surgical treatment options have failed.
In Maryland, only state employee plans, such as CareFirst BlueCross BlueShield and Medicaid, pay for weight loss procedures. Surgical treatment for morbid obesity can cost as much as $20,000.
“I was devastated at that point,” said Leach of Baltimore, who works for a small, non-profit organization. “I had finally found a viable option for losing weight, only to be told that my medical insurance would not pay for this medically necessary procedure.”
This is the third time Sen. Barbara Hoffman, D-Baltimore, proposed the bill, which passed the Senate last year, but died when the House took no action.
This year, Delegate Marilyn Goldwater, D-Montgomery, introduced an identical bill in the House, marking the first time the bill has been introduced in both chambers. No action has been taken on either bill.
“Morbid obesity is a life-threatening condition,” said Goldwater. “Individuals afflicted with this disease deserve the same surgical intervention that is available to others who are afflicted with life-threatening diseases.”
Under this year’s amended bill, insurance companies are only required to cover procedures recognized by the National Institutes of Health, such as gastric bypass surgery and stomach stapling, both designed to limit a person’s food intake. It also exempts small group carriers from providing coverage.
The bill has met no opposition from the insurance industry, said Hoffman.
However, Dr. Thomas Pozefsky, an endocrinologist at Johns Hopkins University School of Medicine in Baltimore, worries that excluding small group carriers from providing coverage will hurt many morbidly obese patients, who work for small companies.
Obesity is the second leading cause of preventable death, exceeded only by smoking, according to the National Obesity Association. It reports that obese people are more likely to develop hypertension, type 2 diabetes, coronary heart disease and stroke.
Morbidly obese people make up 1.75 percent of the national population, said Hoffman. People who suffer from the disease have a body mass index greater than 40 kilograms per meter squared or are more than 100 pounds overweight. The bill covers people with a BMI of 35 and higher. BMI is calculated as weight in kilograms divided by height measured in square meters.
“These are people who have tried everything,” said Hoffman. “You can’t diet your way out of it. Morbid obesity is a deadly disease, just like heart disease, hpyertension and diabetes.”
Michelle Englemann is one of those people. At 344 pounds, she had tried pills, low calorie diets, shakes, fasts, exercise, national weight loss programs, endocrinologists and psychoanalysis. But the more she dieted, the more weight she put on.
Englemann is lucky though. Her Medicare and Maryland State Medicaid Health Insurance plans paid for her weight loss surgery last July. She has since lost 90 pounds and no longer suffers from diabetes, sleep apnea, hypertension, asthma or high cholesterol.
“This surgery is not a quick fix,” said Englemann of Rockville. “It is not for those who aren’t willing to work for weight loss. It is a drastic last-ditch effort to save lives. “This is not cosmetic surgery we are talking about. We are talking about life and death.” -30- CNS-3-16-01