This week, the Missoula City Council approved a lifetime benefit of up to $40,000 for morbid obesity surgeries – an addition to the city's employee health plan.
Members of the public soon speculated, and complained, on social media sites that the request had been made by the mayor.
Mayor John Engen has struggled with his weight and previously discussed the possibility of one such procedure.
On Thursday, however, Engen declined to address whether he made the request to add the bariatric benefit.
He said medical information is sensitive, and he cited the federal HIPAA law. The Health Insurance Portability and Accountability Act is designed in part to protect confidential health care information.
"HIPAA, and I'm not going to talk about it," Engen said. "For any employee. I'm just not going to put anyone in that position at City Hall."
A city memo discussing the benefit noted a health plan participant had requested the change.
The memo said the benefit would apply to participants who have been obese for two years and have a related condition, such as diabetes. The surgery, such as a gastric band or bypass, must be deemed medically necessary and the patient must be trying to lose weight.
"Bariatric surgery is a last resort for those folks who are morbidly obese and are struggling with other health issues," the memo said. "Providing the opportunity for plan members to get the procedure has potential to drastically improve that member's quality of life and maybe even save it."
The memo also noted the annual costs to the city's health plan of conditions generally occurring with obesity, citing insurance statistics:
• Diabetes: $10,832.09.
• Sleep apnea: $7,343.92.
• Esophageal reflux: $13,483.39.
It estimated the average cost of one heart attack at $23,450.53.
After the council approved the benefit, John Velk, a lawyer in Missoula, sent out a couple of tweets noting the amendment. He used the hashtags #corruption and #goodtobetheking.
On Thursday, he said the tweets referred to Mayor Engen. He said he wanted to know how many other rare procedures the council has adopted to benefit "a few select, targeted individuals."
"I've heard a lot of people talking about it. This has to have come from the top," Velk said.
He questioned the city's decision to spend as much as $40,000 on a couple of individuals while it fails to fix sidewalks people have tripped on multiple times.
"I don't understand how you can come up with those kinds of priorities and say that you're acting in the betterment of the entire community," Velk said. "I guess I question the prioritization of that."
Members of the mayor's administration referred the matter to a council committee. Chief administrative officer Bruce Bender sponsored the request and central services director Dale Bickell prepared it.
The plan has $4.8 million in health claims annually, the memo said. It said one bariatric surgery at $40,000 represents 0.8 percent of the annual claims, and it noted the plan pays 70 percent or 50 percent of the cost of the procedure, depending on the provider.
"This could result in an increase in the short term," the referral said. "In the long run, there is a chance that the benefit could actually reduce medical inflation by lowering the number of high-risk members on the plan."
At this week's City Council meeting, Councilman Adam Hertz tried to cut the benefit from $40,000 to $20,000 to reduce the risk to the health plan. He said it was unusual for a health plan to include such surgeries.
Other council members, though, voted to keep the cap at $40,000 as recommended by the benefits committee. A couple of council members pointed to potential savings down the road as a result of the coverage.
The mayor said he would not discuss his health, when contacted about the new benefit.
"I've just gotten so tired of this line of questioning," Engen said. "If I were anybody else, if I were a woman, would you be asking these questions? If I were a city council member? I think it's unfair all the way around."
During the 2013 mayoral election, Engen said he knew constituents worried about his weight, but said his blood pressure and cholesterol were good. At the time, he said he had received a letter from a woman telling him lap-band surgery had changed her son's life.
“I think about my weight every day,” Engen said in October 2013. “It is a tremendous personal struggle. It is a small public struggle.”