Although bipartisan legislation to provide Medicare coverage for obesity treatments has circulated in Congress for more than a decade, the Congressional Budget Office (CBO) ventured to estimate the budgetary effects of such a policy for older Americans starting in 2026 for the very first time in a report published in October.
The CBO should be commended for conducting this comprehensive analysis. But we are the first to admit that there’s still a long way to go before this change happens. Medicare, by statute, is still prohibited from paying for the use of obesity medications — a policy that is discriminatory and a reflection of the stigmatization of obesity. The popular focus on the costs of obesity medications to Medicare distracts from the need to treat obesity like every other chronic disease.
The Medicare prohibition on covering obesity medicines began when the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was implemented — at a time when obesity was still viewed as a cosmetic condition, not the complex, chronic disease that we recognize today. This interpretation of the act has prevented people from receiving treatments that effectively reduce and prevent obesity-associated complications, thereby reducing the need for expensive treatments and hospitalization.
However, just last month, the Center for Medicare and Medicaid (CMS) proposed a new rule that would update the interpretation and include coverage for medications used for weight loss or chronic weight management for the treatment of obesity. If made final, this rule would expand access to obesity medications and treat obesity like every other chronic disease.
While CMS’s proposal is welcome news, it’s unclear what will happen next, as the next administration will have the final say as to whether the rule is promulgated. Those in Trump’s inner circle have mixed opinions about GLP-1s. Elon Musk has touted them, saying recently, “Nothing would do more to improve the health, lifespan and quality of life for Americans than making GLP inhibitors super low cost to the public.” But the Make America Healthy Again folks, including potential Health and Human Services secretary Robert F. Kennedy Jr., are less enamored.
Therefore, it behooves Congress to continue its bipartisan deliberations on a legislative solution.
CBO’s report is particularly timely given that Congress has been considering the Treat and Reduce Obesity Act (TROA), which has the bipartisan support of more than 130 members of Congress across both chambers. The bill would allow Medicare Part D to cover FDA-approved obesity medications and expand Medicare beneficiary access to evidence-based intensive behavioral therapy (IBT), which helps people improve habits that can lead to persistent weight loss. While the CBO report did not focus on the latter policy in its report, IBT provided by a broader array of providers, such as registered dietitians, specialty physicians, and clinical psychologists, could increase the effectiveness of care at a lower cost.
While we can quibble with some of the modeling assumptions CBO used, the “good” news is that covering obesity medications would increase federal spending by only $35 billion over 9 years — yes, “only,” because it’s significantly less than what some researchers and politicians have estimated, and a drop in the bucket compared with total Medicare Part D spending of $115 billion this year alone. It’s even smaller compared with the nearly $5 trillion in expiring tax cuts up for debate next year.
In an era of soaring budget deficits, it is understandable that some lawmakers are weary of additional spending. But the status quo is also not an option. The Joint Economic Committee estimates that people with severe obesity generate more than $9,500 per year in additional health care costs. This figure could be as much as $14,000 per person by 2033; government spending on obesity is projected to exceed $4 trillion over the same time frame.
The government will foot the health care bill for older Americans in one form or another. Ensuring access to the full continuum of obesity care — including obesity medications under Medicare Part D and expansion of IBT under Part B — can yield significant long-term savings and successful long-term outcomes for individuals.
Anything short of complete coverage is unfair to the millions of people with obesity who could benefit from safe and effective obesity medications. Recognizing obesity as a chronic disease will ease the burden on individual patients by providing them with the critical care they deserve while strengthening the health care system by improving outcomes as people age.
You can’t put a price tag on that.
Anand Parekh, M.D., M.P.H., is chief medical adviser at the Bipartisan Policy Center. William H. Dietz, M.D., Ph.D., is professor of exercise and nutritional sciences at the Milken Institute School of Public Health, George Washington University, and director of the STOP Obesity Alliance. Joseph Nadglowski is president and CEO of the Obesity Action Coalition.
Disclosure: The STOP Obesity Alliance and the Obesity Action Coalition receive financial support from companies that produce GLP-1 medications. The views expressed in this piece are solely those of the authors and do not necessarily speak for their organizational affiliations.