Opinion: Modernizing Medicare’s approach to obesity treatment is cost-effective and improves lives

Dr. Roxane Spitzer calls on Sen. Ron Johnson and his Republican colleagues to back the bipartisan initiative to expand Medicare coverage for anti-obesity medication. 

Obesity is one of the most pressing public health challenges facing the United States today. Nearly half of all adults are projected to have obesity by 2030, yet our healthcare system remains woefully unprepared to address this epidemic. Despite the availability of effective, FDA-approved anti-obesity medications (AOMs), Medicare still refuses to cover them, leaving millions of older Americans without access to vital treatment.

As a former hospital CEO and Medicare Commissioner who recommended mechanisms for updating hospital payment rates and who has worked closely with patients battling obesity, I know firsthand that this condition is not simply a matter of personal choice—it is a complex, chronic disease driven by a combination of genetic, biological, and environmental factors. Left untreated, obesity increases the risk of serious conditions like diabetes, heart disease, and stroke, placing a massive burden on both individuals and the healthcare system.

Medicare’s failure to cover AOMs is shortsighted and costly. Obesity-related illnesses cost Medicare approximately $50 billion each year, and studies show that a Medicare beneficiary with obesity incurs over $2,000 more in annual healthcare expenses compared to a beneficiary at a healthy weight. Investing in obesity treatment now would reduce long-term costs by preventing more expensive complications down the road.

The economic case for Medicare coverage of AOMs is compelling. A recent analysis estimated that expanding coverage could generate as much as $248 billion in savings over the next decade. These savings stem from fewer hospital admissions, reduced complications from chronic diseases, and improved overall health outcomes for beneficiaries.

Beyond financial considerations, expanding Medicare coverage for AOMs is also a matter of health equity. Obesity disproportionately affects communities of color and low-income populations, who often have less access to preventive care and fewer resources to manage chronic conditions, as well as lacking the financial means to obtain healthier food options. Black and Hispanic Americans, in particular, face higher rates of obesity-related illnesses. By denying coverage for AOMs, Medicare is perpetuating these disparities and limiting opportunities for these patients to lead healthier lives.

Another glaring issue is the inconsistency in coverage policies. Many individuals with private insurance have access to AOMs, yet they lose this coverage when they transition to Medicare. This abrupt loss of treatment can lead to weight regain and worsening health outcomes, making little sense from both a medical and policy perspective.

There is widespread bipartisan support for modernizing Medicare’s approach to obesity treatment. Medical organizations, advocacy groups, and the general public recognize the need for change. Surveys show that the majority of Americans believe Medicare should cover obesity medications, reflecting a growing awareness of the importance of comprehensive obesity care. With all of this in mind, I hope that Sen. Ron Johnson and his Republican colleagues who control the Senate will use their voices to push the Trump Administration to finalize this rule. 

The Centers for Medicare and Medicaid Services (CMS) must take decisive action to address this gap in coverage. Finalizing the proposed rule to include AOMs under Medicare Part D would align policy with current medical understanding, improve patient outcomes, and drive long-term cost savings. By acting now, CMS can ensure that older Americans receive the care they need to effectively manage obesity and its related health risks.

Medicare’s purpose is to provide comprehensive health care for older adults and individuals with disabilities. It must evolve to meet the realities of modern medicine. Covering anti-obesity medications is not just a policy change—it is a necessary step toward a healthier, more equitable future for millions of Americans.