United States House Ways and Means Committee Hearing on the Health Care Law’s Impact on Jobs, Employers

January 26, 2011

The Campaign to End Obesity Action Fund is dedicated to reversing one of America’s costliest diseases. Today, two-thirds of U.S. adults and nearly one in three children struggle with overweight or obesity. Taxpayers, governments and businesses spend billions on obesity-related conditions, including an estimated $168 billion in medical costs every year.  The trends for obesity – and the costs associated with it – are ominous: as recently as 1990 not a single state had an obesity rate greater than 15 percent; today 49 states have obesity rates greater than 20 percent, with 9 of those topping 30 percent.          

Ending the epidemic requires change – in individuals, institutions and communities. The Campaign convenes leaders from industry, academia, public health and associations to speak with one voice for federal policies to reverse the obesity epidemic and promote healthy weight in children and adults. From changes to nutrition policy, education policy, health policy, to environment and transportation policy, the Campaign promotes measures that support and facilitate obesity prevention and treatment for all Americans. 

Spending on Obesity and Chronic Diseases Linked to Obesity is Unsustainable

From a purely economic standpoint, the cost of addressing the obesity epidemic is staggering and will only become worse unless quick, aggressive action is taken to address obesity.  The fact is obesity is one of America’s costliest diseases: nearly one of every five dollars spent on healthcare in the United States will be attributable to obesity and obesity-related conditions within the next decade.

Without serious efforts to reverse this epidemic, American taxpayers will incur ever-increasing costs as obesity is linked to a number of chronic diseases, including diabetes, heart disease, hypertension and others that require expensive treatments.  Currently, Medicare pays out approximately $45 billion for Medicare patients suffering from diabetes and its complications.  However, given the dramatic projected growth in diabetes, Medicare’s spending on diabetes-related treatments is projected to skyrocket to $75 billion by 2019 and $170 billion by 2034 (www.nmqf.org/presentations/10HuangEJCP3.pdf).

According to the Centers for Disease Control and Prevention, “the cost of cardiovascular diseases in the United States, including health care expenditures and lost productivity … is estimated to be more than $503 billion in 2010” ( http://www.cdc.gov/chronicdisease/resources/publications/AAG/dhdsp.htm). Medicare spending in 2006 totaled $24 billion; Medicaid figures for that year were only slightly lower, and the projections for Medicare and Medicaid spending on heart disease are also expected to rise dramatically.     

These two examples illustrate that trends in spending for chronic conditions related to obesity are unsustainable. Taxpayers have a real stake in addressing – and combating – these chronic diseases before they occur.

The Obesity Epidemic Threatens our Economic Prosperity

Congress is rightly focused on the economy and jobs.  One of the most effective ways to increase the productivity of Americans and lower costs to U.S. businesses – both of which would contribute to job growth – would be to reverse the devastating economic impact obesity has on the nation’s economy.  Simply put, healthy workers are more productive workers and American workers are increasingly unhealthy.  The Centers for Disease Control estimates that medical expenses for obese employees are 42 percent higher than for a person with a healthy weight.

In 2005, the cost of the obesity epidemic was estimated to have cost American private sector businesses an estimated $142 billion, including $76 billion in medical costs and another $66 billion in lost productivity.  By way of comparison, in 1994, private sector medical costs associated with obesity were only $13 billion.   

Every year, American workers lose more and more time on the job due to obesity and related conditions: Obesity is associated with 39 million lost work days, 239 million restricted activity days, 90 million bed days and 63 million physical visits.  This dramatic level of lost productivity is a serious drag on the economy and negatively impacts America’s ability to compete in a highly competitive global marketplace.  It is vital to America’s economy that the obesity epidemic is reserved; our Nation’s future economic well-being is at stake. 

The Obesity Epidemic Threatens our Children’s Future and Military Readiness

For the first time in our nation’s history, the current generation of children faces the likelihood of living shorter life spans than their parents, due in significant part to the complications they face from overweight and obesity.

The obesity epidemic has brought other tolls for our children who suffer from a growing list of emotional disorders associated with obesity, such as depression, social stigmatization and poor academic performance.  We must work to curtail this troubling trend. Among minority and underserved populations, the data is even more dire: 23.4 percent of Hispanic children and 23.8 percent of black children have obesity, compared with 12.9 percent of Caucasian children.     (Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children’s Health, Data Resource Center for Child and Adolescent Health website. Retrieved 12-14-09 from www.nschdata.org)

The nation’s overweight and obesity epidemic even threatens our military readiness – a 2010 report   noted that nearly nine million potential recruits are too heavy to serve; becoming overweight is one of the leading causes of medical discharges of active duty personnel.  (http://www.missionreadiness.org)  

Health Care Reform Marked a Beginning

The Campaign to End Obesity supported enactment of the Patient Protection and Affordable Care Act, which made important strides in bolstering the array of available obesity prevention and treatment options for adults and children.  Broadly speaking, the Affordable Care Act created the first statutory imperative for measuring and tracking “body mass index” (BMI) as a way to prevent obesity.  More specifically, some of the most important anti-obesity provisions of the Affordable Care Act are:

·         Section 2713 – Coverage of Preventive Health Services. 

·         Section 4004 – Education and Outreach Campaign Regarding Preventive Benefits.

·         Section 4103 – Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan, including BMI Screening. 

·         Section 4106 – Improving Access to Preventive Services, including BMI Screening, for Eligible Adults in Medicaid.

·         Section 4306 – Funding for Childhood Obesity Demonstration Project

More is Needed

Given the alarming trends in taxpayer-provided funding of obesity related chronic diseases and in order to optimize the benefits of the new policies of the Affordable Care Act, the Campaign urges Members of the Committee to advance a number of additional policy changes, including:

1.       Recognize Obesity as a Disease

One of the most important steps that federal policymakers – both in Congress and at the Centers for Medicare and Medicaid Services (“CMS”) – can take is to recognize obesity as the disease that it is.  Doing so will facilitate needed prevention and treatment options for children and adults with obesity or at risk of having obesity.  Not only is obesity a disease, but it is in fact one of America’s costliest medical condition.  Until our policies reflect this fact, clinicians will be discouraged from diagnosing cases in children and adults that must be recognized in the doctor/patient/family dialogue before the disease prompts the onset of other, dangerous conditions.  In fact, today there is a perverse disincentive for doctors to address obesity with their patients since there is no reimbursement for such services/treatment.  Thus, many doctors wait until their patients become very sick – often with devastating and costly diseases like diabetes, heart disease, etc. – because there is no reimbursement for treating a major contributing factor: the patients’ obesity.       

2.       Expand Medicaid’s EPSDT to Cover BMI Screening for Children

As noted above, the Campaign is pleased by the inclusion of BMI screening in Medicare Annual Wellness visits and for eligible adults under Medicaid.  Coupled with Section 4004’s language, that should provide improvement in one vital area: education about being overweight or obese.  The fact is most Americans do not know whether they or their children are at a healthy weight, and thus many do little or nothing to fight the disease they have or may soon have.  The more information parents and children have early on, the better their chances of making improvements.  That is why every opportunity to conduct a simple BMI screening should be supported by federal programs.   As noted, minority children are most at risk when it comes to being overweight or obese.  Thus, the Campaign would encourage Medicaid to also cover BMI screenings for children because the tragic fact is obese children typically grow into obese adults.  This could be done by adding a BMI screening to the Early Periodic Screening, Diagnosis and Treatment guidelines issued by HHS.     

3.       Expand Coverage for Treatment Options

While the Affordable Care Act made solid progress in authorizing new obesity education, prevention and treatment options, the Campaign would urge coverage for a greater number of treatment options.  Obesity is a complex disease that is caused by many different factors.  Given that, there is no “one-size-fits-all” treatment solution for obesity. The Campaign urges Congress to direct Medicare and Medicaid to cover a broad range of accepted treatment options.  Specifically, upon a diagnosis of a BMI level of 30 (obese) or a level of 25 (overweight), when accompanied by other chronic conditions, coverage would be triggered for treatment benefits.  Treatment would include services in medical nutrition therapy services, physical therapy or exercise training, behavioral health counseling as determined by a National Coverage Determination Process and CMS-deemed appropriate medical interventions, including both pharmacological and surgical options.

4.       Improve CMS Communication to States Concerning Obesity Prevention and Treatment Options

Currently, CMS issues guidelines to States to inform them of the existing opportunities for covering child obesity prevention and treatment services under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) guidelines and offering them model guidance to State providers.  As noted above, the Campaign believes adding a BMI screening for all children under the EPSDT would be beneficial.  CMS has, up to now, insufficiently communicated to States that the screening and treatment services proposed in the standard benefit package can already be provided and reimbursed under EPSDT services.  There is wide variation between States as to the degree to which they have offered specific guidance to providers on the coverage and how to bill for these services.  The most successful States have issued provider guidance specifically on pediatric obesity services. 

The Campaign strongly recommends that CMS issue national guidance clarifying that obesity prevention and treatment services are currently covered for pediatric populations under Medicaid.  CMS should also issue model guidelines that State Medicaid programs can issue to providers.  Finally within two years of issuance of the CMS national guidance, CMS should release a list of those States that have and have not issued their own guidelines to practitioners.  These critical actions can be achieved by CMS without any legislative action by Congress.

5.       Fully Fund Anti-Obesity Initiatives Included in the Affordable Care Act

While Congress is under pressure to cut spending and reduce costs in the coming months, there is no denying that the cost of America’s obesity epidemic is extremely high and some predict that it will become much worse.  Just a year ago, a comprehensive the UnitedHealth Foundation, the American Public Health Association and the Partnership for Prevention (“America’s Healthy Rankings”) predicted that if current trends continue, the nation will spend an estimated $344 billion in obesity-related health care costs by 2018.  More needs to be done in the area of obesity education, prevention and treatment if this alarming figure is to be rolled back in any meaningful way.  Thus, the Campaign strongly urges Congress to fully fund the key obesity related programs included in the Affordable Care Act.  

The Campaign to End Obesity Action Fund stands ready to work with the Committee and Congress to advance these and similar efforts that are designed to help more Americans achieve and remain at a healthy weight, but also to help reduce the enormous economic, social and physical toll obesity currently takes on our nation and our communities.  We appreciate the opportunity to share our views and welcome the opportunity to engage further on this important subject.