Mandated Bariatric Coverage in NH - New Life on Senate Floor!
While the jokes were flying, with the senator smiling along, Clegg was also suffering the more serious repercussions of his size. Despite sessions with a personal trainer, repeated diet attempts and a seven-month stint under the guidance of a marathon runner, Clegg was unable to lose weight. He suffered from sleep apnea, acid reflux, high cholesterol, asthma and severe arthritis.
"I was 377.6 pounds when I decided if I was going to live any kind of life at all I needed to do something," he said.
After Clegg opted for weight-loss surgery in September, he has lost more than 100 pounds and seen his weight-related health problems recede. Now, the slimmer, healthier Clegg has become a persuasive champion of a bill that would require the state's health insurers to pay for surgeries like his in appropriate patients. A Senate committee that heard testimony from Clegg and his Boston surgeon voted unanimously to endorse the legislation. The full Senate will vote on the measure Thursday.
Clegg said that he's convinced that the reduction in his lifetime health care costs will more than compensate for the $20,000 surgery. His health insurer is saving on frequent doctors visits, prescription drug costs, sleep lab visits, his sleep apnea machine and possible esophageal cancer caused by his chronic reflux disease, he said. But despite those savings, his health insurer declined to cover the surgery and Clegg paid the entire $20,000 bill out of his pocket.
"I took my stomach to college," Clegg said, comparing the surgery's cost with the cost of a year's college tuition. Clegg could afford it, but he said that less wealthy residents should also have access to the surgery, which he even credits with improving his disposition and adding a "bounce" to his step.
Obesity surgeries, often called bariatric surgeries, are growing in popularity as medical evidence of their utility mounts. Recent studies have shown that the surgeries not only cause significant, lasting weight loss but can cure overweight patients of diabetes and other serious weight-related ailments. Medicaid, the federal-state health insurance program for the poor and Medicare, the federal health plan for adults over 65, both pay for bariatric surgeries in patients who meet certain qualifications. But not every commercial insurer covers the expensive procedures.
In New Hampshire, Cigna is the only insurer that does not cover the surgeries in every one of its plans. According to spokeswoman Lindsay Shearer, the majority of Cigna's New Hampshire customers choose plans without bariatric coverage.
Despite Clegg's dramatic testimonial, critics of insurance mandates say that the bill, which would require insurers to cover obesity surgeries and related therapies, will raise insurance premiums and reduce choice for employers. Under federal law, large employers who can afford to self-insure are not bound by state insurance mandates. Small employers and individual buyers are.
"Basically, our position has been that we get concerned any time there's a proposed mandate for coverage," said Adrienne Rupp, a spokeswoman for the Business and Industry Association, who testified against the bill. "Because generally, when a particular service or type of treatment or something is mandated, it results in higher health insurance rates."
A similar bill introduced in the House has been slated for interim study. Clegg said the House bill wasn't marketed to legislators the way his Senate version has, and he's optimistic that his story will help it pass.
"I think it has a great shot," Clegg said. "The bill has been in the House, but it didn't have the story behind it."
Sen. Jacalyn Cilley, a Barrington Democrat, became a cosponsor of the bill after hearing from Clegg. She said that she too was recently feeling the effects of excess weight--in her case, high blood pressure, high cholesterol, heartburn and a growing risk of diabetes. With diet and exercise, she was able to lose more than 25 pounds, and with that weight loss she said she's seen the scary numbers come down and her quality of life improve.
Feeling her own health gains and hearing about Clegg's difficulties persuaded her that the surgery should be an option for those with what's called morbid obesity.
"These are very debilitating, very costly illnesses," she said. "It seems absolutely silly that we're having this discussion about coverage."
When politicians lose weight, their colleagues generally wonder where their ambitions lie, as Cilley learned quickly.
"As soon as I started taking off weight, people said, 'What are you running for?' " she recalled.
Clegg has already made his plans clear, by announcing his candidacy for Rep. Paul Hodes' congressional seat last month.
The jokes at next week's St. Patrick's Day roast seem inevitable.
The reader comments about this story and the editorial in the Union Leader are pretty nasty and representative of just how little people understand about the mandate and the plight of people who are suffering because of morbid obesity. As you know, it is important to keep up the dialogue to raise awareness -- so please jump in! Best regards, Grant Sanborn Portsmouth Regional Hospital www.portsmouthhospital.com Parkland Medical Center www.parklandmedicalcenter.com *******************************************
N.H. Senate supports weight-loss surgery bill
CONCORD, N.H. --State Sen. Bob Clegg is on a personal crusade -- to lose 150 pounds and to make New Hampshire insurers pay for weight-loss surgery for morbidly obese people like him.
Clegg, a 53-year-old, 271-pound Republican from Hudson, is on his way on both counts.
He has lost 105 pounds since bariatric surgery in September where his stomach was reduced to the size of a cup. He has dropped from a 62 portly suit size to a 50 long. He can walk without hauling hard to draw a breath.
And on Thursday, the state Senate gave preliminary approval to his bill to require that New Hampshire insurers include bariatric surgery as an option in treating diseases and ailments caused by obesity.
Clegg weighed almost 378 pounds when he decided if he was going to live any kind of life he needed to act. Clegg, who is running for Congress instead of re-election, drew inspiration from the man he backed for president -- former Arkansas Gov. Mike Huckabee, who lost over 100 pounds through dieting and exercise.
But Clegg said his efforts to lose weight before surgery by dieting and exercise failed. His metabolism slowed to a rate where his body responded as if it was starving so he needed to keep eating.
Clegg said he paid $20,000 for his surgery out of his own pocket when his insurance company would not cover it -- not an affordable option for many people.
He points out that he had to go through a number of hoops before the surgeon would perform the operation. He had to diet, get counseling and meet with a psychologist, he said.
Now, he no longer is in constant pain from digestive problems that included acid reflux and diverticulitis.
"This is personal," he told his colleagues.
Clegg believes the long-term savings outweigh the initial costs to insurers. He points to studies that found the surgery can cure diabetes. Studies also show obesity affects fertility in women and may cause some cancers.
"I'm one of the people who has seen the benefits of bariatric surgery," Clegg told the Senate.
By July, he hopes to hit his goal of weighing 225 pounds.
Joseph Nadglowski, president and chief executive officer of the Obesity Action Coalition, said Maryland and Indiana have similar laws to the one Clegg is proposing. He said Maryland's law applies to companies with 50 or more employees. He said other states require states to offer the surgery as an option.
The state-federal Medicaid program for the poor and Medicare pay for the surgery for patients who meet certain qualifications. Nadglowski said many states also cover it, but not every commercial insurer does.
Large self-insured employers also may not provide coverage, he said.
The Florida-based coalition advocates on behalf of the obese.
The Senate sent Clegg's bill to the Finance Committee to review fiscal implications to the state before it takes a final vote.
At a Senate hearing last month, Portsmouth Regional Hospital and the Governor's Commission on Disability supported the bill while the New Hampshire Business and Industry Association and health insurers opposed it.
The House decided in January to study a similar bill. Clegg is optimistic the House will reconsider if the Senate passes his bill.
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