James H Mehaffey, MD, Eric J Charles, MD, Irving L Kron, MD, Bruce Schirmer, MD, Peter T Hallowell, MD. University of Virginia
Background: Bariatric surgery leads to dramatic weight loss and improved overall health, which may affect insurance status for certain patients. Traditional Medicaid only provides coverage for children, pregnant women, and disabled adults, while expanded Medicaid provides insurance coverage to all adults with incomes up to 138% of the federal poverty level. The objective of this study was to evaluate our 30-year bariatric surgery experience in a non-expansion state and determine the impact of resolving obesity and its associated comorbidites on postoperative insurance status. We hypothesized that successful bariatric surgery would lead to improved health status but an unintended loss of Medicaid coverage.
Methods: All patients who underwent bariatric surgery at a single institution in a non-expansion state from 1985 through 2015 were identified using a prospectively collected database, which was merged with administrative billing data to identify payor status at the time of surgery, one-year postoperatively, and at the last encounter with our health system. All patients under the age of 65 with Medicaid payor status at the time of surgery qualified for that coverage due to disability. Univariate and multivariate analyses were used to identify differences in patients who no longer qualified for disability and Medicaid insurance after bariatric surgery.
Results: Over the 30-year study period, 3,487 patients underwent bariatric surgery, with 373 (10.7%) having Medicaid coverage at the time of surgery. This cohort of patients had a median age of 37 years and preoperative Body Mass Index (BMI) of 54 kg/m2. At one-year follow-up, 155 (41.6%) of patients no longer qualified for Medicaid, leaving 76 (49.0%) of those with no insurance coverage. The preoperative prevalence of diabetes (32.3 vs. 44.0%, p=0.02), age (36 vs. 38 years, p=0.01) and BMI (53 vs. 55 kg/m2, p=0.04) were significantly lower in patients who no longer qualified for Medicaid after bariatric surgery. Multivariate regression demonstrated that every point increase in preoperative BMI (OR 0.91, p=0.01) predicted a 9% decrease in the likelihood of losing Medicaid coverage postoperatively.
Conclusions: Not expanding Medicaid has lead to a major disparity in insurance coverage for patients undergoing bariatric surgery. Successful surgery in a non-expansion state results in over 40% of patients losing Medicaid coverage postoperatively, with half of those patients returning for follow-up with no insurance coverage at all. This barrier to care has major implications in patients undergoing bariatric surgery, which requires life long follow-up and nutrition screening.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79037
Program Number: P554
Presentation Session: Poster (Non CME)
Presentation Type: Poster
