Alan Lyles and Ann Cotten American social life, in and out of the house, is often built around eating. J.E. Tillotson (2004) OVERVIEW Given the critical function that employment-based health insurance has on the provision of health care in the USA, this chapter focuses on employers in their role as primary providers of private health insurance, the public sector’s role as regulator of insurers and employers, and the options available to both groups for preventing and treating obesity. To understand how public policy can inﬂuence obesity prevention and treatment through the health care system, the factors that shaped the evolution of the current private insurance system will also be discussed. While the public policies that inﬂuence the availability and content of private health insurance are considered, the public programs that provide health beneﬁts to poor, disadvantaged and elderly populations, such as the Medicare and Medicaid programs, are beyond the scope of this chapter. Obesity represents a major cost to insurers and to the public. Fiftythree percent of adults in private insurance plans are overweight or obese – a level comparable to that of other insurance categories (Finkelstein et al., 2003). Medicaid, however, has the largest percentage of obese enrollees, at 27.4 percent (versus a range of 17.0–18.8 percent for others). The aggregate ﬁnancial impact of excess weight varied by insurer – costing private insurers 8.2 percent of their spending – for obesity alone was recently estimated at $9.5–16.1 billion. Public payors had a similar experience: Medicaid at 8.8...
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