A significant portion of the state will get access to bariatric surgery for weight loss after Gov. Jeff Landry signed a new bill requiring commercial insurance to cover the procedure last week.
Without insurance coverage, patients looking to treat obesity with surgery could expect to pay between $15,000 to $25,000, an amount that is impossible or off-putting for many who might otherwise pursue it.
“Our estimate is that over a million people who didn't have coverage who have commercial insurance in Louisiana will get access to bariatric surgery coverage,” said Dr. Phillip Schauer, an obesity specialist and director of the Metamor Metabolic Institute at Pennington Biomedical Research Center in Baton Rouge. “So that could be a big, big deal.”
State Rep. Regina Barrow, D-Baton Rouge,
The bill, authored by Sen. Regina Barrow, D-Baton Rouge, has been brought before the legislature before without success. When Schauer transferred to Pennington from The Cleveland Clinic four years ago, Louisiana was one of the most difficult places to get coverage for bariatric surgery, despite having one of the most significant rates of obesity, at around 40%, according to the Centers for Disease Control and Prevention. Only two other states rank over 40% for obesity.
“Louisiana, frankly, was kind of in last place in terms of covering bariatric surgery for patients with severe obesity,” said Schauer.
But slowly, progress has been made. In 2021, Louisiana passed a bill that required coverage for state workers. Medicaid also now covers the procedure.
Patients with commercial insurance were mostly uncovered. Blue Cross Blue Shield, the state’s largest commercial insurer, did not previously cover it in the company's standard fully-insured plan.
“About half the patients that knock on our door at Metamor we have to turn down because they don't have insurance coverage,” said Schauer. “Many of them have insurance, they have a good job, but their insurance doesn't provide it as a benefit.”
Citing data that shows the safety and cost effectiveness of the procedure seemed to convince the legislature, said Schauer.
Weight loss surgery safety, effectiveness
Though weight loss drugs like Ozempic have skyrocketed in popularity, weight loss surgery remains a more effective treatment for those with a BMI of at least 35, at least for now. The procedure has about 30 years of long-term data behind it, while the drugs are new and lack that evidence. The surgery is also a one-time procedure. Most patients need to take the drugs indefinitely to keep the weight off.
Ideally, patients would be able to access both, said Dr. Michael Cook, a bariatric surgeon at University Medical Center. A bill requiring coverage for GLP-1 weight loss drugs like Ozempic did not pass.
There are limitations within the new law, however. While it covers the procedure for people with a BMI over 40, which is considered severe obesity, it will only cover those with a BMI of 35 and up if they have another disease, such as sleep apnea or high blood pressure. And companies with self insurance will not be required to provide coverage for bariatric surgery to employees.
The law does not change anything for state employees, who have access to coverage under the Office of Group Benefits. The state caps coverage for workers at 300 patients per year. As a result, about 1200 to 1500 patients are on the waiting list, said Schauer. There is also a long waiting list for Medicaid patients, said Dr. Michael Cook, a bariatric surgeon at University Medical Center. Cook estimated the wait list at UMC, one of the only hospitals in the region that accepts Medicaid for bariatric surgery, is up to 1,000 patients.
The procedure itself comes with risks, though it is considered generally safe and can result in loss of 60% to 80% of excess body weight. The surgery changes how food affects a person’s body in profound ways. Patients can become malnourished if they are not educated on how to get the right nutrients with a smaller appetite. Some become clinically depressed because their relationship with food changes so much.
Changing the brain
Diet and exercise, long the advice given to people with obesity, simply is not enough, said Dr. Shauna Levy, bariatric surgeon and medical director of the Tulane Weight Loss Center.
Lifestyle modifications should be part of obesity treatment, but it typically is only effective for early obesity. That’s because the brain has a mechanism to maintain a certain body weight, said Levy, “like a thermostat in our brain of what our weight range should be.”
In obese people, the thermostat gets thrown off. Once they start to lose weight, the brain goes into overdrive to increase hunger and slow metabolism, making it very difficult to maintain weight loss.
Bariatric surgery can change that set point on the brain’s thermostat.
The coverage will go into effect Jan. 1, 2025.