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Aetna Foundation Contribution May Signal a Change in the Approach to Obesity for Insurers

MedSave Admin | January 26, 2010

In January 2010, the Aetna Foundation announced its plans for community grants for the year 2010 and beyond. Grants from the Aetna Foundation will now be focused on three issues, with a priority given to the rising incidence of obesity in the US.

Aetna and the Aetna Foundation give millions of dollars in grants every year, but the 2010 announcement is of particular interest because it may signal a change of direction for the health insurance industry with regard to obesity.

The Health Insurance Industry and Obesity

The health insurance industry's interest in obesity is hardly surprising--the financial stakes are huge. According to the Associated Press, one in three Americans is obese, and the number is rising at an alarming pace.

Not only are more Americans obese, but the US now spends $147 billion annually to treat obesity. To put this into perspective, MSNBC points out that obesity treatment costs 60% more than the treatment for all types of cancer combined.

A much cited 2004 report, issued by the USDA, says that lifetime health care costs are $10,000 more for obese people, compared to those who are not obese. The same report also states that health care costs could be reduced by as much as $5,000 per obese person by helping those with obesity reduce body weight by 10%.

A more recent report indicates that, as a group, each person with obesity needs $1,600 more in medical care than those who are not obese.

Government Stance on Health Insurance and Obesity

In response, a number of federal tax regulations issued from 2002 to 2009 liberalized tax treatment for obesity-related treatments. Yet, under group health plans, which cover more than 60% of all Americans, insurance companies are generally prohibited from offering financial incentives based on weight.

The Health Insurance Portability and Accountability Act (HIPAA) considers weight-based pricing to be a type of discrimination. While this was a common practice a decade ago, weight-based pricing now exists only in non-group health insurance.

In 2008, the Department of Labor further reinforced the government's restrictive position with additional regulations for insurance companies that offer discounted rates based on weight or body mass index.

Employers and Weight Reduction Programs

Many large company employee heath plans now include some type of healthy lifestyle benefits that typically include weight reduction programs. These benefits are almost always paid by employers and not through insurance coverage.

Health Insurance Coverage for Obesity Treatment

Meanwhile, insurance companies openly admit that medical coverage for obesity treatment is extremely limited under most health insurance plans. While coverage guidelines have improved in recent years, most obese individuals do not qualify for coverage for weight reduction programs or surgery under today's benefit guidelines.

Over the past few year. UnitedHealthcare, Cigna, and other commercial insurance companies have made grants to community-based programs that address obesity. The message seems to be that while insurance companies recognize the importance and impact of obesity, they also know that payment through insurance is not the most effective approach.

Community-Based Programs May Be the Best Treatment Option

Comprehensive reports, on dozens of aspects of obesity, published by the Centers for Disease Control (CDC) in 2009, barely mention health insurance. Again the focus is on community-based programs and support systems.

While it is clear that reducing obesity is a good goal for employers, insurance companies, and individuals, there is no clear indication on whether these benefits may be included in future health insurance policies.

Source:

Aetna • weight reduction coverage guidelines • http://www.aetna.com/cpb/medical/data/1_99/0039.html
The Atlantic • Health Care Reform And Obesity Prevention • http://politics.theatlantic.com/2009/07/in_a_keynote_address_to.php
http://www.cigna.com/about_us/community/targeted_grant.html • Cigna's former grant, primary source removed
Associated Press • Nearly 10 percent of health spending for obesity • MSNBC • http://www.msnbc.msn.com/id/32170526/ns/health-health_care/
The Economics of Obesity • USDA
Dept. of Treasury • Notice 2008-23 • http://www.irs.gov/irb/2008-07_IRB/ar09.html

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