Linda Reese is 5 feet 4 and weighs 327 pounds.
“I can’t move around, and when I do dishes, I can’t stand at the sink, … so I sit down to do the dishes on a kitchen chair,” she says in court documents.
Reese, who is on Medicaid, wants taxpayers to foot the approximately $12,000 bill for stomach-stapling surgery she and her doctor believe may help her.
But the Idaho Department of Health and Welfare, which runs the public health insurance program, will not pay for obesity treatment.
The department faces four lawsuits, including three pending in the Idaho Supreme Court, involving extremely obese women who want the department to change its mind. The women say their extremely overweight bodies cause or aggravate a variety of health problems, including diabetes, back trouble and high blood pressure.
Most private insurers do not cover surgery intended to treat obesity.
But that does not make any difference to the Idaho Legal Aid attorneys representing the women.
“I would be fighting Blue Cross or Blue Shield with the same zeal,” said Mike McCarthy, Legal Aid attorney in Twin Falls.
McCarthy represents Elizabeth Hoffman, who lives in the Magic Valley.
The women pursuing their cases meet the medical definition of morbid obesity, which is at least 100 pounds over ideal body weight or at least 200 percent of ideal body weight. Reese’s ideal body weight is about 125 to 130 pounds.
For years, Medicaid rules specifically have excluded coverage for obesity treatment.
Department spokeswoman Ann Kirkwood said the reasons include:
The treatment’s effects often don’t last.
Some treatments have serious side effects. Vitamin deficiencies may result from obesity surgery.
Treatments may be medically unnecessary. For example, very heavy people are prone to diabetes, but stomach stapling is not diabetes’ only treatment.
The surgery can have expensive complications that would have to be fixed at taxpayer expense.
Stomach-stapling surgery involves using staples to make patients’ stomachs much smaller. Then, when patients eat, they feel full much sooner. Some studies report patients have managed to keep off half their excess weight as long as 10 years after surgery. However, there are potentially dangerous side effects.
Patients may be prone to developing gallstones. They may develop vitamin or mineral deficiencies and be unable to easily digest the sugar in dairy products.At an administrative hearing in Dec. 1993, Reese said she understood the risks.
Reese’s case has been dragging on since 1992, when the Health and Welfare Department first denied her request.
Reese lives on disability benefits because of her health problems, which include congestive heart failure, diabetes and a degenerative spinal condition.