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Committee passes bill expanding bariatric surgery coverage for commercial plans; injectables excluded
Summary
The committee approved House Bill 1424 to require commercial insurers to cover bariatric surgery under specified criteria. Testimony emphasized long-term cost savings, while insurers warned of short-term premium impacts. The bill does not require commercial plans to cover newer weight-loss injectables and does not expand Medicaid coverage.
The Arkansas House Insurance & Commerce Committee voted to pass House Bill 1424 on Tuesday, a measure that would require commercial health plans to cover bariatric surgery for qualifying patients under defined clinical criteria.
Representative Lee Johnson, sponsor of the bill, introduced the measure and brought bariatric surgeons to testify, including Dr. Sam Bledsoe of Arkansas Heart Hospital and Dr. Eric Paul of Baptist Health Medical Center's bariatric surgery program. Dr. Bledsoe said the bill would expand coverage "to virtually every Arkansan" who meets clinical criteria and estimated the eligible population at roughly 250,000 to 500,000 people, with an expectation that about 1'2 percent of eligible people would seek surgery.
Dr. Bledsoe cited prior state analysis and said Act 109 (2022) supports the bill's rationale. "Act 109 says this, quote, payers can rely on bariatric surgery paying for itself through decreased comorbidities within 2 to 4 years," he told the committee, and he referenced Arkansas Employee Benefits Division (EBD) data that showed a 45% reduction in medical cost per member per month for participants in an earlier program.
Insurer witnesses, including David Mans, senior vice president for policy at Arkansas Blue Cross, and Dr. Mark Jansen, its chief medical officer, told the committee they had been negotiating language with the sponsor and were not formally opposing the bill. Mans said the carrier is still studying the fiscal impact and balancing short-term costs against possible long-term savings. Jansen emphasized clinical selection and program quality, noting Blue Cross has covered bariatric surgery in commercial plans since 1998 and that outcomes depend on selecting appropriate patients and providing comprehensive pre- and post-operative support.
Committee members sought details on fiscal impacts and Medicaid coverage. Deputy DHS Secretary Janet Mann told the panel that the Arkansas Medicaid program already covers bariatric surgery under its current clinical criteria and that the bill's language was intended not to change Medicaid practice. Sponsors and witnesses said the measure is focused on commercial payers, and that a separate bill or process would be needed to extend coverage of obesity-related injectable medications.
Representative Johnson closed and moved the bill. The committee approved HB 1424 by voice vote; the chair declared the motion passed. Sponsors said they will continue to work with payers and stakeholders on implementation details as the measure moves forward.
