Expanding Medicare coverage to more providers and treatment types for obesity?
H.R. 4231 seeks to improve obesity treatment by expanding Medicare coverage to include FDA-approved chronic weight-management medications and intensive behavioral therapy. Obesity is the second leading cause of preventable death in the United States (National Library of Medicine). The bill also expands access to treatment by covering a wider range of health care providers. Currently, this type of therapy is covered under Medicare if administered by a primary care physician. In addition, the bill requires biannual reporting from the Secretary of Health and Human Services detailing the program’s progress and recommendations for improvement.
Sponsor: Rep. Mike Kelly (Republican, Pennsylvania, District 16)
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Opponents say
• "Medicare Part D coverage of GLP-1RAs to treat obesity would lead to a substantial net increase in future Medicare spending, and policymakers should leverage a comprehensive range of strategies, including further price reductions resulting from Medicare’s drug price negotiation under the Inflation Reduction Act, lower cost strategies to prevent weight regain, and reductions in spending on unnecessary care." Source: JAMA Health Forum, a peer-reviewed medical and health policy journal
• "CBO analyzed an illustrative policy that would authorize Medicare to cover AOMs for weight management beginning in January 2026. The policy, which is broadly similar to TROA, would apply to Medicare beneficiaries with obesity (in other words, those having a BMI equal to or greater than 30), as well as certain beneficiaries who are classified as overweight (having a BMI of 27 to 30) and with a weight-related chronic condition. The policy would increase federal spending by $35.5 billion, on net, from 2026 to 2034, in CBO’s estimation (see Table 3). Spending on AOMs would amount to $38.8 billion over that period but would be partially offset by reductions of $3.4 billion in other health care spending because of beneficiaries’ improved health. Beyond 2034, the policy’s net federal costs to the Medicare program would probably be lower on a per-user basis than in the first decade, CBO estimates, but the policy would still increase federal spending between 2035 and 2044." Source: Congressional Budget Office, nonpartisan analysis for the U.S. Congress
Proponents say
• "Obesity poses a growing health risk to millions of Americans, especially older adults. TROA would support critical medical interventions that can help those struggling with obesity, improving the overall health and well-being of Medicare beneficiaries," Source: Representative Gwen Moore (Democrat, Wisconsin, District 4)
• "As a physician and former director of the Iowa Department of Public Health, I have seen firsthand how obesity contributes to serious and preventable health conditions. The Treat and Reduce Obesity Act allows Medicare beneficiaries to access life-changing treatments, including behavioral therapy and FDA-approved medications. This bipartisan legislation improves health outcomes, lowers long-term costs, and helps Americans live longer and healthier lives," Source: Representative Mariannette Miller-Meeks (Republican, Iowa, District 1)
• "The Centers for Medicare & Medicaid Services (CMS) still prohibits Medicare prescription drug coverage of obesity medications, citing an outdated federal statute that excludes agents used for weight loss or weight gain. Additionally, the National Coverage Determination (NCD) for intensive behavioral therapy (IBT) for obesity is overly restrictive to the types of health professionals and settings of care, significantly limiting and even undermining patient access to comprehensive services. Congress must pass the Treat and Reduce Obesity Act (TROA) and align Medicare policies with our current understanding of how to effectively treat and care for patients living with obesity in the same way treatments are covered for other chronic diseases." Source: Obesity Action Coalition, a nonprofit organization focused on improving access to the treatment of obesity
- Rep. Kelly introduces the Treat and Reduce Obesity Act to combat the Medicare coverage gap (Press Release)
- How Would Authorizing Medicare to Cover Anti-Obestity Medications Affect the Federal Budget? (Congressional Budget Office)
- National Council on Ageing discusses the temporary Medicare GLP-1 Bridge program (NCOA)
- The Impact of Obesity on Health Care Utilization and Expenditures in a Medicare Supplement Population (National Library of Medicine)
- Rep. Mike Kelly’s Largest Donors (OpenSecrets)
