May OCC Advocacy News

May 2018 Newsletter of the Obesity Care Continuum (OCC)
Prepared by Christopher Gallagher, OCC Washington Coordinator

OCAN Submits Comments on Short-Term, Limited-Duration Health Plans

On April 23, the Obesity Care Advocacy Network (OCAN) submitted comments in response to the February 21, 2018, proposed regulations that the Trump Administration released regarding short-term, limited-duration health insurance plans.

According to the proposed regulations, the rule would amend the definition of short-term, limited-duration insurance to include those offering a maximum coverage period of less than 12 months and that “this action is being taken to lengthen the maximum period of short-term, limited-duration insurance, which will provide more affordable consumer choice for health coverage.”

OCAN raised concern that expansion of these types of insurance products could have a chilling effect on patient access to care in the individual health insurance market, as the target for these plans will be predominantly young and healthy individuals. Proliferation of these short-term health plans will lead to adverse selection and significantly raise the cost of coverage for people affected by obesity or other serious chronic health conditions. Additionally, OCAN warned that these short-term, limited-duration health plans are not subject to the key patient protections encompassed under the Affordable Care Act, such as minimum coverage standards and rules that prohibit medical underwriting, rescissions, pre-existing condition exclusions, and lifetime and annual limits.

CMS Issues Final Regulations on National Benefit and Payment Parameters

On April 17, the Trump Administration also released final regulations governing national benefit and payment parameters for 2019 — regulations that the Administration touts will “increase state flexibility, improve affordability, strengthen program integrity, empower consumers, promote stability, and reduce unnecessary regulatory burdens.”

Of particular note, the final regulations make significant changes to the way states can select an essential health benefit (EHB) benchmark plan for 2020 and annually thereafter. It also grants insurers greater flexibility to substitute benefits across the 10 EHB benefit categories, if permitted by the state.

For example, the final rule permits states to change their EHB benchmark plan using one of the following three options:

  1. Selecting the EHB benchmark plan that another state used for the 2017 plan year;
  2. Replacing one or more EHB categories of benefits in its EHB benchmark plan used for the 2017 plan year with the same categories of benefits from another state’s EHB benchmark plan used for the 2017 plan year; or
  3. Otherwise selecting a set of benefits that would become the state’s EHB-benchmark plan.

While this greater state flexibility could be seen as a threat to coverage gains made for bariatric surgery and other obesity treatment services in a number of state health exchanges around the country, these changes also mean that obesity advocates will have more opportunities to advocate for full coverage of all treatment avenues across the obesity care continuum.

At the time of this report, OCC member groups were shoring up their respective State Advocacy Representative (STAR) programs to ensure that OCC will have scouts and foot soldiers on the ground in every state to either protect current obesity coverage gains or lead the charge for broader coverage. If you would like to learn more about the STAR program, or be considered to serve as the STAR in your state, please contact OCC Coordinator Chris Gallagher at chris@potomaccurrents.com.

Update on Treat and Reduce Obesity Act

Co-sponsorship of the Treat and Reduce Obesity Act (TROA) continues to grow, with 147 House co-sponsors and 9 Senate co-sponsors. At the time of this report, OCAN leadership was working on a special congressional briefing for key healthcare committee staff to educate policymakers regarding the potential Medicare cost savings associated with implementation of TROA. Additionally, OCAN will be reaching out to the Government Accountability Office (GAO) to engage GAO staff regarding the agency’s pending study on obesity drugs — to better inform and steer GAO regarding best data sources and obesity  experts, which should be accessed to ensure a fair and balanced study.

Roundtable on Obesity Solutions Hosts Workshop on Obesity in the Armed Services

On May 7, the National Academies Roundtable on Obesity Solutions hosted a special workshop on “Understanding and Overcoming the Challenge of Obesity and Overweight in the Armed Forces.” The overall goals of the workshop were to examine the challenges posed by overweight and obesity in the armed forces and explore opportunities to overcome these challenges. The workshop examined these issues as they affect service members (including active duty, guard, and reserve components), veterans, retirees, and their families and communities. Several OCAN leaders who participated in the day-long workshop are also active members of the Roundtable on Obesity Solutions. For more information about the speakers and topics that were included in the workshop, please click here.

State Employee Coverage of Bariatric Surgery in Wisconsin

On May 16, the Wisconsin Department of Employee Trust Funds’ Group Insurance Board will hold a public meeting to discuss changes in the state employee health insurance program. This Board sets policy and oversees administration of the group health, life insurance, and Income Continuation Insurance plans for state employees and retirees, and the group health and life insurance plans for local employers who choose to offer them.

At the time of this report, leadership from the ASMBS Wisconsin State Chapter was working with a patient advocate to present public comments during the meeting regarding her denial of coverage for bariatric surgery under the state employee health plan.

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