Bariatric surgery is out of reach in the heaviest states

In red states, Obamacare plans don't cover bariatric surgery.
(Bariatric surgery society map; click  the image to enlarge it.)

The reasons for obesity, which hits rural areas hardest, are many: lack of nutrition education, inability to afford or otherwise access healthy foods, cultural preferences, or an inactive lifestyle. And it can lead to a host of health problems, from diabetes and heart disease to early death. A combination of diet and exercise is theoretically the best way to take the weight off, but the morbidly obese who use only that strategy tend to gain it all back. Bariatric surgery is the most effective approach for such patients because it shrinks the stomach and changes the body's level of hunger hormones, but hundreds of thousands of patients in the nation's most obesity-prone areas can't access it because it isn't covered on their health-care plans.

In red states, state-employee plans don't cover the surgery.
(Bariatric surgery society map; click the image to enlarge it.)

Though the surgery cuts obese people's risk of death in half, "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. According to the American Society for Metabolic and Bariatric Surgery, many states don’t cover the procedure in their state-employee, Obamacare, or Medicaid plans," Olga Khazan reports for Route Fifty.

Jon Gould, a surgeon at the Medical College of Wisconsin, notes that insurance companies could save money in the long term by covering bariatric surgery, since it often fixes expensive chronic health conditions like diabetes. "But state budgets, which help fund Medicaid, are often pinched and need immediate returns on investment, not savings on insulin and doctors’ visits that may not add up until five or 10 years later," Khazan reports.

Plans that do cover bariatric surgery often impose high barriers to qualify for it, such as requiring patients to quit smoking, not gain any weight for three months before the surgery, or fail at following a structured diet program for six months.

Outdated ideas about obesity as a personal failure may also be a factor. In Mississippi, where more than 37 percent of adults are obese, a bill to help bariatric patients pay for surgery in Mississippi stalled out in 2015 after it became known locally as the "belly-band bill."

"Adding a bariatric benefit in a conservative state where there is a prejudice or bias against morbidly obese people . . . so many people think you're enabling them," said David Dzielak, Mississippi's former Medicaid director.