Insurance and Real Estate Committee
SENATE FAVORABLE REPORT
Bill No.: SB-204
AN ACT REQUIRING HEALTH INSURANCE COVERAGE FOR CERTAIN
Title: SURGICAL PROCEDURES PERFORMED TO TREAT SEVERE OBESITY.
Vote Date: 3/10/2020
Vote Action: Joint Favorable
PH Date: 2/25/2020
File No.:
Disclaimer: The following SENATE FAVORABLE Report is prepared for the benefit of the
members of the General Assembly, solely for purposes of information, summarization and
explanation and does not represent the intent of the General Assembly or either chamber
thereof for any purpose.
SPONSORS OF BILL:
Insurance and Real Estate Committee
REASONS FOR BILL:
This bill will require health insurance coverage for certain surgical procedures performed to treat
severe obesity.
RESPONSE FROM ADMINISTRATION/AGENCY:
None Expressed
NATURE AND SOURCES OF SUPPORT:
Senator Eric Berthel, 32nd District testified saying as a recipient of bariatric and metabolic
surgery, I can attest that it is an effective and lifesaving procedure. Obesity is a health crisis
that is facing our nation and state, and this surgery has a proven track record of improving
many conditions that are associated with an individual being overweight. These health related
conditions include, type 2 diabetes, heart diseases, and high blood pressure. Currently, most
insurance plans in the state do not provide coverage for bariatric and metabolic surgery. The
coverage is currently available to Connecticut residents who are covered by our state's Husky
Plans. All healthcare insurance should provide coverage for metabolic and bariatric surgeries.
I respectfully ask the committee to look beyond the initial expense today and to look instead
at the tremendous change in quality of life for these patients, and the overall savings that will
come from reducing and eliminating the co-morbidities associated with obesity.
Jonathan Aranow, MD, FACS e Connecticut Chapters of the American Society for
Metabolic and Bariatric Surgery (CT-ASMBS) and American College of Surgeon (CT-
ACSPA) and the Connecticut State Medical Society (CSMS)
Alan K. Meinke, MD, FACS President CT Chapter of American College of Surgeons
Professional Associations, INC both stated there is more than ample evidence to
demonstrate that bariatric surgery improves and extends lives. The literature presented
strongly supports obesity as a major drain on healthcare costs. The literature also
demonstrates that State healthcare costs will diminish over time if obesity can be reversed.
Bariatric surgery is both cost-effective and cost-saving. With approval of SB317, Connecticut
could potentially see approximately 3000 additional operations. The initial cost of this
mandate would likely range in the $0.3-$1.5 PMPM range but cost savings due to reduced
healthcare costs will likely yield a return on investment under 5 years. If improved workforce
productivity is calculated then the ROI would be sooner. Based on the reported reductions in
healthcare costs per patient per year (estimated at $3000-4000/year) and an additional 3,000
operations per year after adoption of SB317, Connecticut could see $9 million- $12 million
dollar/year savings in healthcare expenditures. We must also think beyond the numbers and
consider the individuals affected by the disease of obesity. Not only is this population
stigmatized and marginalized, they are being denied lifesaving care.
Haley Duscha, Registered Dietitian,CT Children's Medical Center At Connecticut
Childrens Pediatric Obesity Center testified that they see a countless number of patients
experiencing the side effects of obesity as early as 2 years old. Additionally, some of these
childrens weight may be contributed to by factors outside of their control, like life-saving
medications, syndromic obesity, or social stressors. Connecticut Childrens has been
performing bariatric surgery on children for 10+ years now with the goal of helping young
people attain healthy weight loss. A reduction of 10% current body weight can greatly reduce
the risk of serious illnesses, such as hypertension, diabetes, metabolic syndrome and many
more. The American Academy of Pediatrics even published data showing that the average
weight reduction after bariatric surgery is 27% for the pediatric population. Bariatric surgery is
a research and results driven tool that can be used to help many people, including children,
meet their health goals. By treating or preventing complications of severe obesity at a young
age we provide these children with the hope of living happy, healthy, and full lives. I ask you
to look at the young people in your life and around you when considering SB 204, as this will
allow providers to offer effective treatment and the care they deserve.
Christine Finck, MD, FACS Surgeon-in-Chief, CT Children's Medical Center Bariatric
and metabolic surgery is currently not an essential health benefit in Connecticut. It is a
covered benefit in New York, Massachusetts, Rhode Island, Vermont, Maine, and New
Hampshire. Although this important life-saving treatment is available through Medicaid, many
private insurance policies, including those offered to small businesses, specifically exclude
these procedures. I support this bill in my role as Surgeon-in-Chief at Connecticut Childrens
and also as a mother. No child should have life-saving treatment withheld due to
misconceptions and social prejudice. Obesity is a chronic disease that has the potential to be
cured by surgery. Weight management programs that encompass the appropriate support,
education, nutritional intervention and surgery work hard to treat these children. This bill
needs to be supported so that these children can all receive the care they deserve.
James Healy MD Pediatric Surgeon, CT Children's Medical Center
The perception that bariatric surgery is the easy way out is inaccurate for many of these
patients a significant surgical metabolic disruption is by no means simple. The results are not
immediate, there is no cosmetic surgery or liposuction involved (which has the potential to
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add additional complications) and there is temporary post-operative pain and nausea
associated with the procedure. It is not easy, but for severely obese patients it may be the
only current way to effectively induce durable weight loss. Complications from the procedure
are uncommon, and frequently minor, however they tend to be more frequent in patients with
more severe obesity. For this reason, it is important not to delay the procedure for years as a
child is gaining more and more weight. The decision for surgery is never taken lightly, and
requires a thoughtful, shared decision making process between the patient, family or
guardian, and medical and surgical providers across multiple specialties. Denial of coverage
for these procedures denies our patients a critical opportunity to reverse the significant health
impacts of their obesity, correcting diabetes in 95%, high blood pressure in 74%, cholesterol
levels in 66%, and reversing fatty liver disease (which is becoming a common reason for
requiring liver transplant later in life.) By operating, we can save these children from decades
of medical problems.
John Morton, MD,MPH,FACS, FASMBS Bariatric surgery is a life-saving procedure yet,
currently, bariatric surgery is not a covered benefit on all health insurance plans offered in the
State of Connecticut. It is covered by the State Medicaid Plan (Husky), Federal Medicare
Program and major payors. The incremental cost of adding this needed benefit will be
modest, estimated to be less than 50 cents per member per month. Most importantly, this is
the right act for Connecticut that will provide care and add productivity to our great state.
Joseph Nadglowski, OAC, President/CEO, Obesity Action Coalition feels the citizens of
Connecticut affected by obesity often find themselves targeted by weight bias and stigma in
all areas of life, such as employment, education, healthcare and more. These individuals
deserve access to these critical chronic disease treatment services. We urge you and your
colleagues on the committee to support SB 204 and stand up for coverage of all medically
necessary obesity treatment avenues and help these individuals improve their quality of life
and health.
Pavlos Papasavas, MD, FACS, FASMBS ,President CT Chapter of American Society for
Metabolic and Bariatric Surgery The CT Department of Public Health puts emphasis on
the Centers for Disease Control and Prevention's 6118 initiative, which targets six major
health conditions - asthma, high blood pressure, tobacco use, hospital-acquired infections,
teen pregnancy, and diabetes. Type 2 diabetes is the disease with the closest association
with Obesity. Epidemiologists call the epidemic of diabetes and obesity the twin epidemic! It
would only make sense that a state like ours that targets a chronic disease like diabetes to
also provide the most effective treatment for obesity: bariatric surgery.
Priya Phulwani MD CT Children's Medical Center
As someone who practices both pediatric and adult endocrinology, I see first-hand the health
consequences of obesity, and the tremendous negative burden from obesity related diseases
on quality of life from childhood into adulthood, not to mention the cost on our healthcare
system in the long run. There are clear national guidelines that recommend surgical weight
loss procedures for patients who meet specific criteria and are in the setting of weight
management programs such as the program at Connecticut Childrens Medical Center.
Darren S. Tishler, MD, FACS, FASMBS< Chief, Metabolic and Bariatric Surgery,
Hartford HealthCare stated as a physician, I have a responsibility to act in a fiscally
responsible manner but at the same time, do what is right for my patients and offer them the
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most effective treatments available. For me, one of the greatest satisfactions of practicing
medicine is the fact that we do things because they are the compassionate thing to do for our
patients. I urge you to support SB 204, An Act Requiring Health Insurance Coverage for
Certain Surgical Procedures Performed to Treat Severe Obesity. I sincerely hope that this is
the year that we join our neighboring states of New York, New Jersey, Massachusetts, Rhode
Island, Vermont, New Hampshire, and Maine in improving the access to bariatric surgery and
the treatment of morbid obesity.
Burt Zaretsky, Marketing Director, Fairfield County Bariatrics stated bariatric surgery
presents the severely obese with the opportunity to regain their health and recapture their
lives, and as a result of it, they do. Bariatric surgery has, and continues to, save lives! When I
meet the prospective patients at bariatric seminars and hear their pleas for help, I know that
they can be helped. However, under the current climate, so many of them are unable to get
the help that bariatric surgery can provide them, and they so desperately need. Unfortunately,
so many insurance plans, here in Connecticut, have exclusions, preventing them from
achieving the necessary surgery to help save their lives. Now, you have the opportunity to
reverse the discriminatory practice that permits insurance companies to practice against the
severely obese. Their lives are now in your hands and you can save them. I want to thank
you for affording me the opportunity of presenting my plea and evidence to help save the
lives of your fellow Connecticut residents.
The following individuals submitted testimony in support of this bill:
Dana Cantiello
Grace Chao
Natalie Cunningham
Paul Davidson
Amy Dumont
Neil Floch
Heidi Galliccio
Henry Hoefelt
Madhuvanti Joshi
Susan Millerick
Bethany Mulone
Violet Pasorkova-Jaouren
Cindy Ressier
Kerry Roy
Kate Salerni
Melissa Santos
Alicia Smith
Jane Sweeney
Barbara Whelan
Violet Wolf
NATURE AND SOURCES OF OPPOSITION:
CT Association of Health Plans stated the ACA requires strict adherence to a particular
timeline that would be undermined by the various mandates. CT Exchange is right now
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preparing their standard benefit designs and carriers are right now preparing their non-
standard plan design.
Michelle Rakebrand, Asst Counsel for CBIA stated mandates drive up costs because with
each new requirement, insurers must expand coverage to include additional services or
devices. This in turn increases the cost of health insurance premiums, and those increases
are passed directly onto enrollees. Each year, Connecticut residents pay an additional
$2,086.12 in premium costs because of the 68 health benefit mandates that are codified in
our states statutes. These increases are especially detrimental to small employers (defined
as under 50 FTE), who are not required to offer health insurance pursuant to the Affordable
Care Act, but choose to do so.
Reported by: Diane Kubeck Date: April 16, 2020
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