Nebraska lawmaker seeks to expand Medicaid coverage to include obesity

Zach Wendling

Nebraska Examiner

LINCOLN — A Nebraska lawmaker looks to expand Medicaid coverage to include obesity, an effort he described Thursday as seeking to tackle the "root cause" of other ailments.

State Sen. Merv Riepe of Ralston, through Legislative Bill 907, seeks to expand coverage for intensive behavioral therapy and anti-obesity medications. The medications, prescribed in conjunction with diet and exercise changes, would be part of a tiered approach in addressing a chronic disease that affects more than 30% of Nebraskans.

"It's just one more tool in the toolbox," Riepe told the Health and Human Services Committee on Thursday.

Anti-obesity medications approved by the U.S. Food and Drug Administration are eligible for use by patients with obesity who have body mass indexes of 30 or greater, or those with a BMI of 27 or greater and at least one or more comorbidity.

A costly, chronic disease

Dr. Brianna Johnson-Rabbett, board certified in internal medicine, endocrinology, diabetes, metabolism and obesity medicine, was one of two representatives of the Nebraska Medical Association to testify in support.

Obesity-related diseases

Obesity has more than 200 comorbidities and is related to many other diseases, including:

1. Diabetes.

2. Heart disease, failure or hypertension.

3. More than 15 cancers, such as ovarian, thyroid and pancreatic.

4. Osteoarthritis or osteoporosis.

5. Hernias.

6. Yeast infections.

7. Carpal tunnel syndrome.

8. Depression or anxiety.

9. Asthma.

10. Recurrent miscarriage.

11. Preterm births.

12. Congenital abnormalities in newborns, such as spina bifida and neural tube defects.

13. Low birth weights or childhood obesity.

Source: Nebraska Obesity Society

She said excess weight is not due to a failure of will power for the chronic disease but due to "clear biological underpinnings."

Annual obesity-related medical costs nationwide were estimated at almost $173 billion in 2019. Johnson-Rabbett said this does not account for costly productivity losses, estimated at additional billions of dollars.

"Excluding anti-obesity medications for Medicaid coverage only serves to widen health care disparities that already exist," Johnson-Rabbett testified.

Long-run benefits

Samantha Pederson, a physician assistant whose patient population is almost exclusively adults with weight-related diseases, suggested LB 907 should be amended to clarify and define obesity as a documented BMI equal to or greater than 30.

She also encouraged lawmakers to work with economists to determine an appropriate value to negotiate with drug manufacturers for newer, more expensive therapies.

"I believe an investment in obesity treatment would benefit patients, taxpayers and society in the long run," Pederson said.

'Proactive and necessary step'

LB 907 includes a fiscal note from the Nebraska Department of Health and Human Services of about $300 million in the first two years, though a high-end estimate, without best practices in providing care or determining Medicaid eligibility, could cost up to $500 million annually.

Riepe, using federal mandated rebates and an "ambitious" estimate of 33% of eligible Nebraskans using the coverage, said he believes that his bill would cost $3.6 million annually.

The Nebraska Obesity Society "emphatically" endorsed LB 907 in a letter joined by 67 health care providers, including Pederson. It states expanded Medicaid coverage would be a "proactive and necessary step" in addressing obesity, a public health crisis.

"Not every patient needs every tool in the obesity treatment toolbox," the letter from the Nebraska Obesity Society states, "but when patients don't have access to them, our hands as providers are effectively tied, and we are left to watch as more health complications of obesity develop."

No one testified in opposition to LB 907. The committee took no immediate action.