Medicare redefines obesity as an illness

After 40 years, Medicare has reversed its long-standing position that obesity is not illness.

HHS Secretary Tommy G. Thompson last week announced a new Medicare coverage policy that would remove barriers to covering anti-obesity interventions if scientific and medical evidence demonstrate their effectiveness in improving Medicare beneficiaries’ health outcomes.

“Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely,” Secretary Thompson said during testimony before the Senate Appropriations Subcommittee on Labor, Health and Human Services Education. “With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese and its many associated medical conditions.”

Thompson added, “Treating obesity-related illnesses and complications adds billions of dollars to the nation’s health care costs.”

The new policy removes language in the Medicare Coverage Issues Manual stating that obesity is not an illness. This change allows the public to request that Medicare review medical evidence to determine whether it Medicare would cover specific treatments related to obesity.

“From the standpoint of Medicare coverage and the health of our beneficiaries, the question isn’t whether obesity is a disease or a risk factor. What matters is whether there’s scientific evidence that an obesity-related medical treatment improves health,” said CMS Administrator Mark McClellan, M.D., Ph.D. “This change in Medicare’s coverage policy puts the focus on public health. The medical science will now determine whether we provide coverage for the treatments that reduce complications and improve quality of life for the millions of Medicare beneficiaries who are obese.”

The new policy is not expected to have an immediate impact on Medicare coverage. It does not affect the existing Medicare coverage of treatments of diseases resulting in or made worse by obesity, in particular currently covered surgical treatments for morbidly obese individuals.

However, as requests for coverage for obesity treatments are made by the public, Medicare will implement timely review of the scientific evidence, using the coverage determination procedures established in 1999 and modified by the Medicare Modernization Act of 2003.

(via U.S. Department of Health and Human Services)