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Terry Senty

State worker Terrie Senty, 59, talks about her obesity-related health problems at her home in Evansville, Wis.

MADISON — As Wisconsin considers self-insuring state employees, some want officials to take another step that could save money: covering weight-loss surgery for state workers who are severely obese.

Forty states pay for the surgery for state workers who qualify, five states are experimenting with coverage and four states provide no coverage, according to the American Society for Metabolic and Bariatric Surgery.

Wisconsin is in another category, covering less than 5 percent of workers through its most expensive health plan.

UW Health surgeons, who have pressed for coverage for all state workers, say the move could save $60 million over 10 years by reducing costs from diabetes, heart disease, sleep apnea and other conditions related to obesity.

“Obesity is a massive public health problem, and many citizens in Wisconsin do not have access to the most effective — cost effective — treatment options,” said Dr. Luke Funk, a bariatric surgeon at UW Health.

The Group Insurance Board, which oversees benefits for nearly 250,000 state and local government workers and their family members, in May considered covering weight-loss surgery for all employees this year but decided against it. The program would have cost $1.5 million the first year and $2.25 million over two years, the state estimated.

Mark Lamkins, spokesman for the state Department of Employee Trust Funds, which administers benefits for state workers, said the evidence on long-term savings is “inconclusive.” But, he said, “this benefit will be considered again in the future.”

Terrie Senty, an obese state worker, said she developed diabetes and heart disease — for which she has had three heart procedures since October — after looking into weight-loss surgery years ago. She said she couldn’t afford the more expensive health plan that does cover it or pay out of pocket for the surgery, which costs $30,000 or more.

If she had received weight-loss surgery years ago, “the state wouldn’t be paying for my heart procedures and my lancets because I never would have gone on insulin” for diabetes, said Senty, 59, of Evansville.

Coverage is available only through the state’s standard plan, administered by Monona-based WPS Health Insurance. Workers pay $250 a month for individuals and $624 a month for families for that plan, compared to $83 a month for individuals and $209 a month for families for any of 17 HMOs that don’t cover the surgery.

Medicare and nearly all Medicaid programs, including Wisconsin’s, cover weight-loss surgery. Most national insurers cover it for large employer groups.

In Dane County, Dean Health Plan covers the surgery for large groups. Unity Health Insurance and Group Health Cooperative of South Central Wisconsin allow coverage as an add-on if employers pay more. Physicians Plus doesn’t provide any coverage.

The Group Insurance Board is looking at self-insuring state workers, which could save $42 million a year or cost $100 million more, consultants have said. The state would pay benefits directly and assume the risk for large claims in the $1.4 billion program instead of buying insurance from the 17 HMOs.

The board is also considering another proposal to reduce the number of HMOs from 17 to no more than six, plus a statewide plan. That could save $45 million to $70 million a year, according to Segal Consulting.

Gov. Scott Walker said he would apply any savings from state worker benefit changes to public education.

Nearly 19,000 severely obese

Weight-loss, or bariatric, surgery, is approved for people who have a body mass index, or BMI, of more than 40 — or more than 35 if they have a health problem related to obesity, such as diabetes.

For someone 5 feet 8 inches tall, that is about 265 pounds — or 230 pounds with an obesity-related condition.

One type of surgery is gastric bypass, which shrinks the stomach and reroutes food, making the body absorb fewer calories. Another is sleeve gastrectomy, which results in a banana-shaped stomach that makes people feel full faster. A third option, the lap-band, puts a band around the top of the stomach, limiting intake.

The surgeries typically result in considerable, durable weight loss, studies say. But they carry risks, such as bowel obstruction, stomach perforation, hernias, malnutrition and, rarely, death.

If the state offered weight-loss surgery for all state workers, it would pay about $25,000 per surgery at the discounted rate offered to large groups, less than the $30,000 or more people typically pay on their own, UW Health surgeons said.

A 2014 actuarial study prepared for the Wisconsin Obesity Coalition and funded by Ethicon Endo-Surgery, a bariatric surgery equipment maker, said covering the surgery for all state workers could save taxpayers $60 million over 10 years.

An estimated 18,772 workers and family members are severely obese, with an average annual health care cost of $15,600, the study said. About 188 of them would be expected to have the surgery per year.

UW Health performs 130 to 150 weight-loss surgeries a year, surgeons said. Coverage for state workers likely would increase the total by 20 to 50 surgeries, they said.

Dean Clinic/St. Mary’s Hospital also does weight loss surgery.

Dr. Michael Garren, a bariatric surgeon at UW Health, said severe obesity is often misunderstood as primarily a behavioral issue. Even then, he said, it is singled out while other conditions linked to behavior are paid for.

“Are we going to stop treating lung cancer from smoking?” Garren asked. “Are we going to stop treating melanoma because people don’t wear sunscreen and a hat?”

Lamkins, of the Department of Employee Trust Funds, said that when the Group Insurance board considered weight-loss surgery coverage in May, “we did not have strong support of the health plans or overwhelming feedback from members.”

Hard to keep off the pounds

Senty, who was heavy as a child, put on pounds when she had three children between 1976 and 1980.

After she quit smoking in 1996, she gained 60 pounds, tipping the scales at 300. She is 5 foot 6 inches tall.

Last year, through a program at a gym, she got down to 230 pounds, which she weighs today. Her BMI is 37.

In addition to diabetes and heart disease, she has gastric reflux, a thyroid condition and anxiety.

After a mild heart attack in October, she had two procedures to put stents in her arteries and one to correct a heart rhythm problem. The total charges for the procedures exceeded $160,000, Senty said, though the cost to the state likely will be less after insurance discounts.

Senty has tried Weight Watchers and TOPS, or Take Off Pounds Sensibly, but said she has a hard time controlling her diet.

“It isn’t that I don’t know how to eat. It isn’t that I don’t know how to exercise,” she said. “Food is an addiction. Bad food is a really bad addiction.”

Ruth Williams, 48, of Madison, said she would pursue weight-loss surgery if it was covered for all state workers. Like Senty, she works at UW Hospital, where employees are covered by state worker benefits.

Williams, whose BMI is 40, has high cholesterol, high blood pressure and pre-diabetes. She assumes she will develop full diabetes and heart disease, which run in her family.

She has tried weight-loss programs, aerobics and counseling but said she can’t keep weight off.

“Wouldn’t it make more sense for insurance to cover this, at least in part, than pay the long-term price of heart disease and diabetes?” she asked.

“Obesity is a massive public health problem, and many citizens in Wisconsin do not have access to the most effective — cost effective — treatment options.” Dr. Luke Funk, a bariatric surgeon at UW Health.
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(15) comments

MarineJim

Once again,over eating, indulging in donuts, sodas, etc, become the taxpayers responsibility. Has anyone ever considered you are WHAT you eat? Don't tell me that there is a 'glandular' problem. There is the problem of an over active fork in 99% of the cases. There is a problem with self control. There is a problem with 'justification' of eating habits.
How about the state employees lobby for healthy food in the cafeterias, of NO sodas or chips in the vending machines... of educating those whose job involves sitting all day to get up off the buttski and walk some?
How about a class on personal responsibility?
How about leaving the sodas, chips, dips, donuts alone? What's wrong with celery or raw carrots?

union conservative

Right on but fat chance. Can you say entitlement.

Vangel

I have worked at a hospital treating patients pre and post stomach weight loss surgery. 80% that apply for surgery have no knowledge of the world health medical weight loss guidelines for obese and overweight. Summary Eat less and exercise 60 - 90 minutes or more each day till for over 30 days till a deficit of energy in and energy out is achieved each day. 30% that apply need it due to a high risk of obesity related health issues and 50% of these 30% are not denied the surgery due to the high risk of further complications and death due to the surgery. The other 70% that request the surgery do it purely for cosmetic reasons. 25-35 years old and finished having their 2 children and want to look sexy to be attractive to their partner or find a new partner they feel ugly. Its the hardest & worst alternative Only 30% of these people succeed the other 70% it dosent work or they look worst. then they want it reversed. Some surgeries are irreversible and becomes a death sentence. $ 4 Drs

Frangel45

Early in my career as an employee I was rather stunned with all the donuts, cookies, sodas that were being eaten throughout the day by fellow employees. Needless to say it was tempting and I started to put on a few pounds each year. Amazing thing happened when I started my own business - I lost quite a bit of weight and I just didn't nosh throughout the day - amazing isn't it? Pretty simple really. Instead of this weight loss surgery which is expensive and then requires the patient to eat small amounts much more often through the day perhaps employers should just stop the endless grazing. I know several people that have had this surgery and it is definitely not the panacea that the surgeons make it out to be. Most wish they had not done it.
When legislators stop meddling in all other women's family planning issues then perhaps you can revisit this stupid idea. Which surgeons made political donations for this?

Vangel

Its surgeons taking advantage of uneducated vulnerably fat people. These fat people dont even complain when it goes wrong and the health insurance company ( your premiums ) have to pay for the errors and problems. Because they sign a waiver. With this surgery available as an easy do it for me option, many uneducated people will try it. It is marketed aggressively with the aid of the health insurance companies and the only ones who wins is the Surgeons. I have had a friend of mine die from it 3 month after having it from mistakenly eating the wrong food. Its a death sentence.

Bullflap

Educate yourself on what a proper diet consists of, exercise moderately (walking, biking, etc.), quit (or reduce) the alcohol and sugar drinks...become active instead of sedentary...it's about changing habits. It really isn't rocket science. I think the weight loss challenge is more psychological than anything else...get mentally tough. Good luck.

Vangel

I have found most doctors and nurses are not up to date with the weight loss medical guidelines for overweight and obese. so the patient can be educated better. Its like the weight loss Bariatric surgeons have silenced them.

Machiavelli

Sometimes weight management isn't just about diet and exercise: depression, thyroid problems, digestive issues, heart conditions and all that make it a medical matter. Once you've lost the weight, you might need skin surgery too.

Everybody is different: get advice from a doctor before embarking on any weight-loss program. If you're medically able, exercise. Quit drinking sodas. Walk at the mall. Do housework. Cut out fatty and sugary foods. Learn to cook healthy foods that also taste good (it's possible!). These things will be hard on you for a while, but the cravings and pains will go away over time. Exercise, too, will become easy and fun if you stick with it.

“She may have a weight problem but you have an ugly problem.”
― Donna Lynn Hope

“God, I hate judgmental people. They're so mean...and fat.”
― John Raptor

“Fat people are funny … until obesity pays your loved one a visit.”
― Mokokoma Mokhonoana

Vangel

you dont believe millions of dollars of research conducted over 40 years in most countries of the world? that states its a mathematical equation, ( 2 less 3 = minus 1. ) so if every day you eat 2000 calories and exercise 3000 calories you will have a deficit of 1000 calories thus weight loss. no one is immune to this theory. (sure if you have a thyroide problem but 99% of weight loss surgery patients dont) a deficit is a deficit. do this every day and you have cured yourself. free. the best exercise is dancing. and you can dance sitting down if your legs dont work. stupid lazy English speaking world that still believe kwaks and marketing.

CJ

Personal responsibility is dead isn't it?

Vangel

No its just that a well marketed product like weight loss surgery that has millions put into it and human laziness is alive. We have more money then cents. Cosmetic surgery paid for by the health insurance policy holders.

LaCrosseTaxPayer

Maybe if government employees would spend a little more working and less time on coffee breaks or just wasting our tax dollar paid time they would burn a few calories at work instead of adding calories on our dime!!!!

Clarification

My compliments, at least time you kept you dumb comment short. A broken mouse cures copying and pasting?

LSE tax-payer

“My compliments, at least time you kept you dumb comment short.”
Look who’s calling someone dumb, what are you trying to say, a 2nd grader can write a sentence better than that.
“My compliments, at least time you kept you dumb comment short.”

Vangel

Weight loss surgery is a failure, only 30% success rate long term. for all that torture. However its not just the governments, they are only in for a 3 or 4 year term. they get influenced by the experts especially scientists and doctors. ( who try and make work for them self) The governments don't really care about the population long term. Move to an insurance company that does not allow weight loss surgery. The insurance companies are the main problem, how ever they do what the government experts say.

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