Overweight Insurance
In the years prior to the Affordable Care Act, insurers routinely charged extra premiums for people that were overweight and obese. They also charged more for persons that regularly smoked.
The variation was noteworthy, compared to a healthy person weighing 180 pounds, an obese person with the same age and height paid up to 25 percent more. Combined with smoking, an obese consumer would pay a much heavier premium assuming they could get coverage at all.
Under the Affordable Care Act, obesity screening is a required essential benefit.
While smoking is genuinely a self-inflicted source of illness and health complications, it does represent a persistent and profound chemical addiction. For many middle-aged persons, or those living in certain areas of the country, nicotine dependence flourished in a tolerant culture.
Accepted widely and glamorized in media, smoking became a socially accepted vice even as evidence of terrible health consequences became irrefutable. Currently, smokers comprise approximately 19 percent of the adult population.
When combined with obesity, smoking achieves highest level of caution for predictors of short and long term illness.
Obesity was regarded as equally a social and health problem. The medical profession recognized the immediate and long-term connections to severe disease and illness, but the urgency that could have been associated with it did not materialize until the national debate over healthcare reform.
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Healthcare Reform
The affordable care act imposed a major policy change upon the insurance industry on the issue of pre-existing conditions. Given freedom to choose, the insurance industry developed a long list of excludable conditions.
They included pregnancy, prior health conditions like hypertension, and obesity. While many insurers used these conditions to decline coverage, most used them to exact higher premiums and restrict coverage.
Under the terms and rules of the Affordable Care Act, insurers can adjust premiums on permissible factors only. Premiums can reflect the policy holder’s age, family size, geographic region, and smoking status. Insurers will still be allowed to charge as much as 50 percent more for smoking.
The Act also provides for counseling and other medical support services aimed at treating chronic health conditions. Obesity screening, treatment, and smoking cessation are required elements of medical care.
Obesity and Health Care Reform
The recent history of medical treatment of obesity is not particularly enlightening. The medical profession had a difficult time incorporating obesity into the place it deserved.
The medical profession’s research and empirical survey evidence showed consistently that obesity added hundreds of dollars per person year to medical costs for care, treatments, and prescriptions. It was the cause of countless medical interventions and emergency services.
In terms of health care providers, the primary care physician model seemed especially unworkable for obesity. The conventional approaches to treatment involve extensive time for evaluation and individual counseling. Primary care physicians might only allocate a ten minute slot to check vitals and adjust medications.
By its evidence, the medical professions have determined that obesity is a major driver of severe illness and premature death. It is not comforting to say that heart attacks happen in healthy athletic men as well as inactive, obese subjects.
Medical researchers understand the connection between obesity, inactivity, and heart disease. They do not yet understand the connection between genetic predisposition and sudden heart events.
Obesity is a confirmed source of serious medical complications. They include debilitating diseases like diabetes, conditions with unpredictable and severe effects like hypertension, and physically damaging conditions involving bones, joints, and muscles.
With so many medical- service intense consequences, obesity was a prime candidate for chronic disease treatment and preventive services.
Medical doctors specializing in obesity treatment fall into two categories, those specializing in surgical intervention, and those employing prescriptions and nutritional services. Often seen in terms of degrees of severity, the usual protocol would employ noninvasive measures before defaulting to surgeries that are often not reversible.
The available services under the ACA include a range from counseling to Bariatric surgery.
Many health services providers feature Wellness theory and programs in their mix of services. These can take the form of facilities dedicated to fitness and exercise, nutrition education activities, and counseling.
Employers that provide health coverage have taken a more consistent response. Corporate medical approaches follow the process of improving productivity and performance. Employers increasingly monitor key indicators including cholesterol, weight, blood pressure, and glucose levels.
For large employers, employee health has a prominent focus, and it relates to defined elements of the corporate bottom line such as losses due to illness and injury, and productivity.
Wellness and Obesity
ACA support for anti-obesity treatment came from many parts of the medical community, and wellness advocates clearly had a voice in the policies.
Obesity has been a primary goal of wellness. Its emphasis on integrating health, diet, nutrition, and fitness into medical care was reflected in the scope of the Affordable Care Act. Prevention is the most cost-effective form of medical treatment.
Checkups and monitoring suspected health issues are far preferable to expensive hospitalizations, surgeries, and long-term care for chronic poor health.
Insurers who correctly choose to fight obesity among their subscriber populations have support in the ACA federal marketplace and state-operated exchanges. While they cannot charge more for obesity as a pre-condition, they are permitted to offer incentives for persons who lose weight and otherwise improve their health.
Insurers can reward changes like smoking cessation, improvement in cholesterol, better blood glucose, and lower body mass. In employer-sponsored plans, they have become pleasantly routine.
The ACA rewards employers that conduct health improvement programs in the workplace. It may evoke an odd image of people working for low wages in mind and body depleting jobs who nonetheless take part in exercise and diet improvement programs.
However, it is obvious that these are the very places such programs are most needed. Many jobs contribute to health problems by employment conditions, routines and activities that discourage healthy lifestyles.
Finally A Medical Resolution
The Affordable Care Act policies led the way in this field, and it established obesity as a national policy target. The law required no-cost screenings and counseling for obesity in every qualified health plan under the prevention essential benefits. In this way, obesity demonstrates the remarkable difference that the ACA makes for overweight Americans.
In the past, one would have had to diet and lose weight to attempt to get coverage. Today, one gets coverage, and the plan covers the urgent need to improve health and weight.
The American Medical Association took a long overdue step in the summer of 2013 when it revised its policy on obesity. Previously rated as a major American public health problem, it was revised to a disease, and one that medically requires interventions for treatment and prevention.
Comparison Shopping for Weight Management
While obesity screening is an essential benefit in qualified health plans, treatment options vary in a wide range as determined by insurers. The essential benefits basic services set the stage for follow-up care. Plans vary and attempt to promote the goals of fighting obesity according to a dominant philosophy such as wellness, or in terms of cost effective resources.
A typical scenario might include a screening that records a body mass of 30 or greater. This screening takes into account weight and height and determines of an overweight person is clinically obese. The provider must offer follow-up services. This can begin with counseling.
Insurers within network resources can use referrals. Chronic disease specialist treat obesity and some have shown remarkable rates of success. Some insurers have used existing outside resources like weight-watchers for milder cases.
Consumers concerned with weight and services related to health and wellness can use comparison shopping to identify plans that feature services and resources. Plans sometimes offer searchable indexes of medical care providers and specialties.
Auto-renewal will continue current coverage for millions who do not exercise their options to change policies. Given that there are new plans in every state and new providers in nearly all areas, consumers should compare alternatives and find plans that fit their needs and resources.
A FREE comparison tool, such as the one below, can reduce the time and effort needed to find the ideal plan and premium.