The Biden administration is proposing to make “miracle” weight loss drugs free for low-income people and retirees, in a move aimed at tackling America’s chronic obesity problem but which throws down a gauntlet to the incoming president, Donald Trump.
The proposal, unveiled on Tuesday, would see expensive drugs such as Ozempic, Wegovy and Zepbound covered by Medicaid and Medicare, the federal government programs for the poor and the elderly.
It would come at a hefty cost to the public purse. The drugs would be covered for anyone qualifying as obese, a definition that currently fits 40% of the US population. Currently, coverage is only given when patients have other conditions that is caused by obesity, such as diabetes, heart disease and cancer.
Xavier Becerra, the US Health and Human Services secretary, called the move a “game changer”.
“It helps us recognize that obesity is with us,” he told the Washington Post. “It’s severe. It’s damaging our country’s health. It’s damaging our economy.”
But the proposed reform amounted to a challenge to Trump’s incoming administration, which would have to decide whether to implement the change a few days after taking office in January. Trump has sworn to slash the federal budget.
It also paved the way for a likely conflict between two of Trump’s health sector nominees: Robert F Kennedy Jr, who has been proposed as the health and human services secretary, and Mehmet Oz, the celebrity physician who has been nominated to run Medicare and Medicaid.
Kennedy has vowed to promote healthy eating and improve fitness in the battle against obesity, and has fiercely criticised weight loss drugs, blaming them for obscuring the causes of ill health.
He recently claimed to Fox News that covering a drug like Ozempic for every overweight American would cost $3tn a year.
“If we spend about one-fifth of that, giving good food, three meals a day, to every man, woman and child in our country, we could solve the obesity and diabetes epidemic overnight for a tiny fraction of the cost,” he said.
“There’s a huge push to sell this to the American public. They’re counting on selling to Americans because we’re so stupid and so addicted to drugs.”
Oz has taken a different tack, praising Ozempic on social media last year. “[F]or those who want to lose a few pounds, Ozempic and other semaglutide medications can be a big help,” he wrote. “We need to make it as easy as possible for people to meet their health goals, period.”
Beccera estimated that 3.4 million people on Medicare and 4 million on Medicaid would become eligible for the drugs under the new rule.
But other research suggests that far more people may qualify. The Centers for Medicare and Medicaid Services (CMS), the agency Oz has been nominated to head, has estimated that 28 million recipients suffer from obesity.
A recent Congressional Budget Office analysis estimated that federal spending would rise by $35bn between 2026 and 2034 by allowing Medicare alone to cover weight-loss medications.
People can lose between 15% and 25% of their body weight thanks to the drugs, which imitate the hormones that regulate appetites. A month’s supply can cost around $1,000.
