Covering bariatric surgery has minimal effect on insurance premium costs within the Affordable Care Act.
BACKGROUND
Currently, of the 51 state health exchanges operating under the Affordable Care Act, only 23 include benchmark plans that cover bariatric surgery coverage. Bariatric surgery coverage is not considered an essential health benefit in 28 state exchanges, and this lack of coverage has a discriminatory and detrimental impact on millions of Americans participating in state exchanges that do not provide bariatric surgery coverage.


OBJECTIVE
We examined 3 state exchanges in which a portion of their plans provided coverage for bariatric surgery to determine if bariatric surgery coverage is correlated with premium costs.


METHODS
State health exchanges; United States.


METHODS
Data from the 2015 state exchange plans were analyzed using information from the Centers for Medicare & Medicaid Services' Individual Market Landscape file and Benefits and Cost Sharing public use files.


RESULTS
Only 3 states (Oklahoma, Oregon, and Virginia) in the analysis have 1 or more rating regions in which a portion of the plans cover bariatric surgery. In Oklahoma and Oregon, the average monthly premiums for all bronze, silver, and gold coverage levels are higher for plans covering bariatric surgery. Only 1 of these states included platinum plans that cover bariatric surgery. The average difference in premiums was between $1 to $45 higher in Oklahoma, and $18 to $32 higher in Oregon. Conversely, in Virginia, the average monthly premiums are between $2 and $21 lower for each level for plans covering bariatric surgery. Monthly premiums for plans covering versus not covering bariatric surgery ranged from 6% lower to 15% higher in the same geographic rating region.


CONCLUSIONS
Across all 3 states in the sample, the average monthly premiums do not differ consistently on the basis of whether the state exchange plans cover bariatric surgery.
Vanderbilt University, Nashville, Tennessee. Electronic address: wayne.english@vanderbilt.edu.
Wayne
W
English
Vanderbilt University, Nashville, Tennessee.
Brandon
B
Williams
Greenville Health System, University of South Carolina, Greenville, South Carolina.
John
J
Scott
Stanford University, Stanford, California.
John
J
Morton
D050110:Bariatric Surgery / Q000191:economics*; D017047:Cost Sharing; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007341:Insurance / Q000191:economics*; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D009765:Obesity / Q000191:economics / Q000601:surgery; D009825:Oklahoma; D009922:Oregon; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D014481:United States; D014768:Virginia
Affordable Care Act; Cost; Geographic rating region; Health exchange; Insurance premiums; Premiums