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In Wisconsin, where, according to ASMBS, bariatric surgery isn’t covered for state employees or Obamacare enrollees, Jon Gould, a surgeon at the Medical College of Wisconsin, tells his obese patients there’s not a lot he can do for them. Obamacare enrollees in Arkansas, the third most obese state, also can’t get bariatric surgery. “Keeping the plan affordable for everyone is one of our biggest challenges and, unfortunately, it results in certain services not being a covered benefit of the plan,” a spokesperson for PEBA, South Carolina’s state employee health plan, told me via email. The state also doesn’t cover the procedure for state employees and their spouses and children, another half a million people. (Ethicon / ASMBS)īlue Cross Blue Shield, the only Obamacare insurer in South Carolina, does not cover bariatric surgery for the more than 200,000 enrollees in that state. Obamacare plan coverage of bariatric surgery, as of January 2018. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), many states don’t cover the procedure in their state employee, Obamacare, or Medicaid plans: To put it most starkly, the surgery cuts obese peoples’ risk of death in half.īut experts and surgeons say the procedure is treated by insurance companies less like a life-saving treatment and more like a nose job: frivolous and optional. Still, studies show bariatric surgery is more effective long-term than diet and exercise for people who are more than 100 pounds overweight, especially if they have other medical problems like diabetes. People who get bariatric surgery have to change their eating habits dramatically, and it comes with the risk of complications like bleeding or digestive issues.
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(People who lost hundreds of pounds sweating it out on the TV show The Biggest Loser, for example, tended to gain it all back.) For the morbidly obese, diet and exercise don’t usually have this same effect on their own. It shrinks the stomach to about the size of a banana, changing the body’s hunger hormones and reducing a person’s natural weight-one they don’t have to starve themselves to stick to. One popular type of bariatric surgery, the gastric sleeve, costs between $20,000 and $35,000 without insurance, experts told me. But Mississippi is also one of two states, along with Montana, that doesn’t cover bariatric surgery in its Medicaid program, which serves 760,000 people. In Mississippi, more than 37 percent of adults are obese, making it the second-most obese state in the nation.