For over a decade, bipartisan legislation aimed at providing Medicare coverage for obesity treatments has circulated in Congress, but a key obstacle remains. The Medicare system, by law, continues to exclude coverage for obesity medications, a policy rooted in outdated perceptions of obesity and its treatment. The time has come to update this policy and treat obesity as the chronic disease it is, rather than a cosmetic issue, and ensure that older Americans have access to necessary medications.
Recent developments have shed light on the importance of this issue. In October, the Congressional Budget Office (CBO) provided its first budgetary estimate regarding the potential impact of extending Medicare coverage to obesity treatments starting in 2026. While this marks a significant step forward, experts agree there is much work to be done. The current prohibition on Medicare coverage for obesity drugs, set in motion by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, reflects a bygone era when obesity was wrongly classified as a matter of appearance rather than a serious, chronic health condition. As a result, millions of Americans have been denied effective treatments that could prevent obesity-related complications and ultimately reduce the need for costly hospitalizations and interventions.
Fortunately, change is on the horizon. Last month, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would update this outdated interpretation and allow Medicare to cover medications used for weight loss or chronic weight management. If this rule is finalized, it would treat obesity like any other chronic disease, expanding access to medications that can significantly improve health outcomes.
Despite this positive development, there are still many uncertainties ahead. The final decision on whether the proposed rule will take effect rests with the next administration, which could influence the direction of this policy. Key figures, including those within former President Trump’s circle, have mixed opinions on the efficacy of GLP-1 medications, which are among the most promising weight-loss drugs. While tech mogul Elon Musk has vocally supported the idea of making GLP inhibitors more affordable, others, such as potential Health and Human Services Secretary Robert F. Kennedy Jr., have expressed reservations.
This ongoing debate highlights the need for continued bipartisan efforts in Congress to pass a legislative solution. One such proposal, the Treat and Reduce Obesity Act (TROA), enjoys broad support across party lines and aims to allow Medicare Part D to cover FDA-approved obesity medications while also expanding access to evidence-based intensive behavioral therapy (IBT). Although the CBO report did not address IBT in detail, it is clear that expanding access to this therapy, provided by a range of healthcare professionals, could significantly enhance the effectiveness of weight loss interventions at a reduced cost.
The CBO’s findings provide a crucial perspective on the economic implications of expanding Medicare coverage. The projected increase in federal spending from covering obesity medications is $35 billion over nine years, a figure that is notably lower than previous estimates. This amount represents a small fraction of the $115 billion spent annually on Medicare Part D, and it pales in comparison to the nearly $5 trillion in expiring tax cuts that will be debated in the coming year. In the face of rising budget deficits, some lawmakers may be hesitant to approve additional spending. However, maintaining the status quo is not a sustainable option. The Joint Economic Committee estimates that individuals with severe obesity incur over $9,500 in additional healthcare costs each year, a number that could climb to $14,000 per person by 2033. Without intervention, government spending on obesity is expected to surpass $4 trillion over the same period.
The government will inevitably bear the financial burden of obesity-related healthcare costs. Ensuring comprehensive access to obesity care—including medications under Medicare Part D and expanded IBT under Part B—would not only improve health outcomes but also generate long-term savings by reducing more expensive treatments down the line.
Anything short of full coverage for obesity medications under Medicare would be unjust for the millions of individuals affected by this condition. Acknowledging obesity as a chronic disease and providing the necessary treatments would improve individual health outcomes and strengthen the overall healthcare system, ultimately benefitting both patients and taxpayers. The time to act is now.
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