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Weight loss surgery funding cut

By Aaron Cooper, CNN
updated 7:04 AM EDT, Wed November 2, 2011
STORY HIGHLIGHTS
  • Georgia says cut was essential to help balance the budget
  • Self-funded health care program had projected deficit of $815 million
  • 1,577 workers have had the surgery in the 2 1/2 years it has been covered

(CNN) -- Alice McCormack thought she had the answer to her decades-long battle with her weight: bariatric surgery. That was until the state health insurance's budget shortfall got in the way.

McCormack, 61, estimates she's been on 10 to 20 weight loss regimens in her life. "I have been to LA Weight Loss, Weight Watchers," she says. "At one point in time I actually did human growth hormone shots. I did Fen-Phen. I did Meridia."

She says she lost a little bit of weight, but it always came back, plus a little more.

Now, the soft-spoken 5 foot 2 woman weighs 305 pounds and has a body mass index of more than 56.

Why it's so hard to keep weight off

McCormack retired in 2003 after 31 years working in the Walker County, Georgia, school system and now gets her insurance from the state. This summer she found out her plan would cover weight loss surgery. "I thought that was probably an answer," she says. "As I get older it gets more and more imperative that I find an answer, or else I'm going to end up with some major health problems."

McCormack already has asthma, arthritis, sleep apnea, high blood pressure and gastric reflux, all conditions caused or made worse by obesity. "This is the one surgery that seems to fix all of the problems, or at least the majority of them," she says.

McCormack was set. She was at a pre-surgery doctor's appointment when she found out her insurance was eliminating the surgical weight loss benefit for 2012. Patients are required to go on a special diet for six months before being eligible for the surgery, so it was too late for her to complete the diet and have the surgery before January.

"You get your hopes up and think everything is OK because you think you've done your homework and think you've checked things out ahead of time and gotten the low-down and then all of a sudden you don't," she says.

Georgia says cutting surgical weight loss from the state's plan was essential to help balance the budget. Their self-funded health care program had a projected deficit of $815 million for the 2012 and 2013 fiscal years.

Calculate your BMI

The state says 1,577 members have had the surgery in the 2 1/2 years it has been covered for a total cost of $30.8 million. That works out to a little less than $20,000 per person.

In a statement to CNN, a spokeswoman for the state's health plan says, "We examined a number of options to address the projected deficits. It was imperative that these options be fiscally responsible, fair to the membership, and feature wellness and choice." The cuts eliminated the 2012 shortfall and reduced the 2013 shortfall.

The state also points to a wellness plan that it is adding to its coverage this year, saying "the wellness plan options, while voluntary, are designed to educate and engage members in adopting healthy lifestyles through positive behavioral changes."

Bariatric surgery facts
The American Society for Metabolic and Bariatric Surgery estimates that there are 15 million people in the United States who suffer from morbid obesity. It says only about 1% get the surgery.

To be eligible for most of the surgeries you have to have a body mass index of 40 or greater, or a BMI of 35 or greater with an obesity related health condition. Lap Band surgery is approved for people with a BMI of 30 and contributing condition.

CNN legal contributor Holly Hughes says she owes her life to getting obesity surgery while working as a Georgia county prosecutor. "I was able to consult with a surgeon ... and get it taken care of before it got to the point it was going to kill me, literally kill me," she says.

Hughes weighed nearly 300 pounds before the operation and now is at 151.

"It's frightening to me that you are going to stop all of these state employees from having access to this surgery," she says. "In the long run it's going to cost the state more. These are folks that are going to develop diabetes, if they don't already have it. ... things that can kill you."

For now, the initial cost of the surgeries was too much. The state says it is "aware of numerous studies projecting long-term savings over a five- to 10-year period following bariatric surgery but has not had the program in place long enough to realize any significant savings." It will continue to monitor to see whether the patients who had the surgery as state employees will end up saving them money.

"National data is very clear this is life-saving and money-saving," says Dr. Robin Blackstone, the president of the American Society for Metabolic and Bariatric Surgery. "When people understand the data, we believe they will say we didn't know." She says private companies have been increasing coverage at about 8% a year and Medicaid has covered the procedure since 2006. The society's data also show that 44 states cover the operation for state employees. Montana, Idaho, Kansas, Oklahoma, Louisiana and Pennsylvania do not currently have the benefit.

Missouri's state Consolidated Health Care Plan cut coverage for weight loss surgery in 2011 but is bringing it back in 2012. Emily Kampeter, a spokeswoman for the plan, says, "They did realize some short-term savings, but in the long-term decided that the benefits of offering bariatric surgery outweighed the short-term costs."

McCormack takes seven or eight medicines each day. She says if she got the surgery it would not only help her stop taking the expensive prescriptions, but also live a better life.

In her retirement, McCormack works three jobs. With her home still in need of repair after this spring's tornadoes she doesn't think she can afford to pay for the $25,000 operation on her own. She still wants the surgery. "Once I get my house finished I can take out a loan or, you know, see what turns out." Medicare pays for the operation, and she says she may have to wait four years until she is eligible for that program to get the surgery.

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