Impact of Statewide Essential Health Benefits on Utilization of Bariatric Surgery



In response to concerns about inadequate insurance coverage, bariatric surgery was included in the Affordable Care Act’s essential health benefits program—requiring individual and small-group insurance plans in 23 states to cover bariatric surgery. We evaluated the impact of this policy on bariatric surgery utilization.


Multiple-group interrupted time series analyses of IBM MarketScan commercial claims data from 2009 to 2016.


Bariatric surgery utilization increased in all states after ACA implementation, but this increase was no greater in states with a bariatric surgery essential health benefit.


Our findings suggest that the essential health benefits program may have been too narrow in scope to meaningfully increase bariatric surgery utilization at the population level.

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The authors acknowledge the Institute for Healthcare Policy & Innovation Data and Methods Hub for analytic support on an earlier version of this manuscript.


Dr. Chhabra receives funding from the University of Michigan Institute for Healthcare Policy and Innovation Clinician Scholars Program, Agency for Healthcare Research and Quality grant T32HS000053, and the National Institutes of Health’s Division of Loan Repayment. Dr. Chao receives funding from the Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System; this work does not represent the views of the US government nor the Veterans Affairs. Dr. Dimick receives grant funding from the NIH, AHRQ, and BlueCross BlueShield of Michigan Foundation. Dr. Telem receives funding from AHRQ K08 HS025778-01A1.

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Correspondence to Karan R. Chhabra.

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Conflict of Interest

Dr. Dimick is a cofounder of ArborMetrix, Inc., a company that makes software for profiling hospital quality and efficiency, which had no role in the work herein. Dr. Telem receives consulting fees from Medtronic. All other authors declare that they have no conflict of interest.

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Chhabra, K.R., Fan, Z., Chao, G.F. et al. Impact of Statewide Essential Health Benefits on Utilization of Bariatric Surgery. OBES SURG 30, 374–377 (2020) doi:10.1007/s11695-019-04092-z

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  • Health policy
  • Health insurance
  • Essential health benefits
  • Bariatric surgery
  • Utilization