March 11, 2025
On February 22, 2025, a federal court in the District of Maine dismissed a proposed class action lawsuit which sought to characterize obesity as a disability under Section 1557 of the ACA.
The plaintiff brought the case against the insurance carrier that administered the health plan the plaintiff participated in. The plan does not provide prescription drug coverage for weight loss. The plaintiff claimed that this was discrimination based on a disability and a violation of Section 1557 of the ACA. Section 1557 prohibits discrimination in certain health programs and activities on the basis of race, color, national origin, sex, age, or disability in any health program or activity that receives federal financial assistance and other covered entities. The plaintiff was diagnosed with obesity and was prescribed drugs to treat it. Although the plan provided access to the same drugs for the treatment of other conditions, it does not do so for the purpose of treating obesity.
The court agreed with the defendant that the plaintiff failed to articulate a legal claim based on Section 1557. Specifically, the court found that the plaintiff’s allegations did not support a finding that they are disabled as a matter of law merely because of a high body mass index. In addition, the court found that the plaintiff did not allege any facts to establish that the defendant regarded them as disabled, which would be necessary to support a discrimination claim under the ACA. The court dismissed the case based on those findings.
Employer Takeaway
The case turned on the plaintiff’s inability to make a case based on Section 1557, rather than a challenge to Section 1557 itself. Although rules promulgated by federal agencies to enforce and administer that section have been challenged, the section itself is still valid law and may be the basis for more challenges like this one. Employers considering changes to their plans in reaction to the popularity of expensive weight loss drugs should consult with counsel.
Whittemore v. Cigna Health and Life Ins. Co.
PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.
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