Gov. Nathan Deal, in a decision this week, overrode state lawmakers’ direction to restore a benefit to state employee health plans that seeks to treat obesity.
The decision puts into question whether bariatric surgery will be covered in state employees’ health plans next year.
The benefit was eliminated last year as a cost-saving measure for the Department of Community Health, which faced a deficit reaching into the tens of millions of dollars. But lobbying from bariatric surgeon groups convinced lawmakers to restore the benefit in the eleventh hour of this year’s legislative session.
But when Deal signed the 2013 budget Monday, he instructed the Department of Community Health to disregard the legislature’s suggestion that the state health benefit plan reinstate coverage for bariatric surgery, leaving the decision up to the Department of Community Health’s board of directors.
“Putting in mandates handcuffs the board’s ability to provide the most comprehensive coverage at a reasonable cost,” Brian Robinson, the governor’s chief spokesman, said of Deal’s decision.
The Department of Community Health’s board of directors meets today to discuss legislative issues, but a spokeswoman for the department said its board won’t likely make a final decision on state employees’ benefits until August.
The original decision to cut the benefit came as lawmakers in Gov. Sonny Perdue’s administration, who had used the state health plan’s reserve funds to make up for deficits elsewhere in the state budget, sought to restore money to the plan.
Bariatric surgery seemed an easy target for removal, because compared with the more than 668,000 state employees covered, the number of employees who took advantage of the benefit were few.
According to numbers provided by the state, 1,577 employees had the surgery between 2009 and 2011.
Pamela Keene, a spokeswoman for the Department of Community Health, did not rule out the
possibility that bariatric surgery will return as a covered treatment next year, but Keene said that keeping it out of the state plan could save a department that faces a $62 million deficit about $3.5 million in 2013.
Restoring the benefit next year only adds to the deficit.
Proponents of the surgery, however, say it cuts down on other costly health problems related to obesity. Annual costs for treating diabetes are estimated at between $8,000 and $12,000 per patient.
And Dr. Robert Richard, a bariatric surgeon at the Longstreet Clinic’s Obesity Solutions clinic, calls the governor’s decision one that seems to save immediate money but likely will be more costly in the long run.
Of the 311 state employees who had weight-loss surgery covered by the state plan in 2011, the Longstreet Clinic was responsible for at least 40.
News that the General Assembly had restored the benefit earlier this year, Richard said, had already brought some state employees back to the clinic, in hopes that they could begin some of the state-required prerequisites that would prepare them for the surgery next year.
“I think the reason why it’s so politically OK to just restrict this coverage is that people feel ... ’Oh, these patients decided to do this to themselves.’ But the reality is that obesity causes the diabetes that we’re treating. Obesity causes the hypertension that we’re treating. Obesity is going to cause the renal failure ...” Richard said. “And if we don’t treat the root cause, which is the obesity, we’re going to be paying for all these other medical problems whether we like it or not.”
Currently, the state health plan has no other benefits specifically related to treating obesity, Keene said. State officials do hope, however, that the state’s wellness plan — which requires employees to take health assessments and perform tests on blood pressure, body mass index, glucose and cholesterol — will cause state employees to be more conscious of their health-related decisions.
The Longstreet Clinic is attempting a letter-writing campaign to members of the Board of Community Health who plan to decide the final benefit package for state employees this summer.
And despite the governor’s decision this week, Richard said he is hopeful that the board sees that weight-loss surgery is beneficial.
“We know the cost savings of patients who have had this surgery over time well outweighs the up-front costs, and I think it’s very short-sighted to remove this benefit for our teachers and beneficiaries,” Richard said.