SC to cover surgery for obese workers under state health plan in pilot program next year

South Carolina to cover obesity surgery next year

COLUMBIA, S.C. — Obese government workers in South Carolina can get stomach-shrinking surgery through the state health plan under a pilot program that starts in January.

The state’s employee insurance plan will cover gastric-bypass or Lap-Band surgery costs for 100 people statewide on a first-come, first-serve basis, said Stephen VanCamp, director of the employee insurance program.

The surgeries - which involve either surgically creating a smaller stomach or shrinking intake with a belt-like, adjustable device - cost about $24,000 each. Lawmakers required the test program in the 2010-11 budget as a way to address the state’s growing obesity problem. The Budget and Control Board was directed to create it as part of workers’ benefits plan for 2011, which it approved Thursday.

The Legislature funded the program, as well as an additional $19 million in costs next year because of the new federal health care law - largely for extending coverage to dependents up to age 26 - so employees’ monthly health premiums will not change. Nearly 394,000 public workers, their dependents and retirees are covered under the state health plan.

Obesity rates in South Carolina have doubled since 1990, with 30 percent of adults meeting the definition. Nearly two of every three adults in the state are considered overweight or obese, according to the federal Centers for Disease Control and Prevention.

Obesity puts people at risk for a host of health problems, including diabetes, heart disease, certain cancers and sleep apnea. More than $1 billion annually is spent on obesity-related illnesses in South Carolina, according to the state’s health agency.

At least six states require insurance companies to cover morbid obesity treatment, including gastric bypass surgery: Georgia, Illinois, Indiana, Maryland, New Hampshire and Virginia, according to the National Conference of State Legislatures.

Under South Carolina’s pilot, the patients’ results will be tracked for 18 months to check for complications and see if the surgeries lead to overall health savings.

Comptroller General Richard Eckstrom, a board member, said the state should encourage workers to control their weight, but bariatric surgery seems extreme. While there’s hope the surgeries will result in savings, “as an accountant, you can’t measure hope,” he said. Eckstrom, who said he regularly works out, said the state should instead focus on preventing people from becoming so large that they qualify.

Qualifications for workers or their spouses to get their surgery covered include a body-mass index of at least 40, considered morbidly obese, which roughly translates to a 5-foot-7 adult weighing more than 255 pounds, a positive psychological exam, and post-surgical nutrition and support plans.

But a Republican state senator who has sought ways to encourage residents to live healthier said it makes no sense for the state to fund the costly operations during a recession. Sen. Greg Ryberg of Aiken also doubts they will save money long-term. Last year, he proposed charging obese public workers an extra $25 monthly in their health care premiums. But his colleagues balked at the idea, saying they supported the intent, but questioned how it would be enforced. The state already charges $25 extra for smokers on the health plan.

Next year, Ryberg said he will push for a bill that rewards people with healthy weights, instead of punishing overweight workers, by lowering their health premiums by $15 to $25 monthly.

“Those who are grossly obese probably incur greater costs to the health plan than those who smoke,” he said.