It's a good day for anyone who suffers from obesity
In the final weeks of his presidency, Joe Biden has proposed extending Medicare and Medicaid coverage to a new generation of weight-loss drugs, framing obesity itself as a treatable disease worthy of public investment. The move would open access to medications like Wegovy and Zepbound for potentially millions of Americans who cannot afford their steep monthly costs — yet it arrives on the threshold of a new administration philosophically opposed to both the spending and the pharmaceutical approach. Like many proposals born at the edge of one era and the beginning of another, its fate will be decided not by the hand that wrote it, but by those who inherit the pen.
- Roughly 7.5 million Medicare and Medicaid beneficiaries could gain access to weight-loss injections costing up to $1,300 a month — drugs that have already reshaped how medicine thinks about obesity.
- The $35 billion decade-long price tag lands like a provocation inside an incoming administration that has made cutting federal spending a cornerstone of its identity.
- Robert F. Kennedy Jr., tapped to lead Health and Human Services, has publicly rejected pharmaceutical coverage in favor of food subsidies and gym memberships — putting him on a direct collision course with the rule before he is even confirmed.
- The legal mechanism is as consequential as the policy: by reclassifying obesity as a treatable disease, the Biden administration attempts to dismantle a decades-old statutory barrier that blocked Medicare from covering weight-loss drugs at all.
- The rule cannot be finalized until January, days after the presidential transition — leaving its survival entirely in the hands of an administration that may see it as both fiscally reckless and philosophically misguided.
The Biden administration announced Tuesday a proposed rule that would allow Medicare and Medicaid to cover expensive weight-loss medications for millions of obese Americans — a sweeping health policy move that immediately ran into the ideological headwinds of the incoming Trump administration.
Under the proposal, Americans with a body mass index of 30 or higher would qualify for coverage of weekly injectable drugs like Wegovy and Zepbound, which can help patients lose 15 to 25 percent of their body weight by mimicking appetite-regulating hormones. An estimated 3.5 million Medicare beneficiaries and 4 million Medicaid recipients could gain access, though the eligible pool may be far larger — CMS estimates some 28 million Medicaid enrollees meet the clinical definition of obesity. The cost to taxpayers could reach $35 billion over a decade, as the drugs run between $1,000 and $1,300 per month.
HHS Secretary Xavier Becerra called it a transformative moment for Americans priced out of treatments that wealthier patients have long been able to access. The rule rests on a legal reinterpretation: Medicare has historically been barred from covering weight-loss products, but by classifying obesity itself as a treatable disease, the administration believes it can sidestep that restriction.
The proposal faces a direct challenge from Robert F. Kennedy Jr., Trump's nominee to lead HHS, who has argued that the government's money would be better spent subsidizing healthy food and gym memberships rather than pharmaceuticals. His position reflects a broader skepticism toward drug-based solutions that sits uneasily alongside the incoming administration's commitment to reducing federal expenditure.
Because the rule will not be finalized until January — after Trump takes office — its future is deeply uncertain. A bipartisan coalition in Congress has pushed for Medicare coverage, contending that preventing obesity-related conditions could save far more than the drugs cost. But with fiscal hawks and a Kennedy-led HHS poised to shape the decision, the proposal may not survive its own transition.
The Biden administration moved Tuesday to open the door for millions of Americans struggling with obesity to access expensive weight-loss drugs through Medicare and Medicaid—a proposal that immediately collides with the incoming Trump administration's stated commitment to cutting government spending and the ideological opposition of Robert F. Kennedy Jr., Trump's pick to lead the Department of Health and Human Services.
Under the new rule, people with a body mass index of 30 or higher would qualify for coverage of medications like Wegovy and Zepbound, the injectable drugs that have captured public attention for their ability to help people shed 15 to 25 percent of their body weight. The Department of Health and Human Services estimates that roughly 3.5 million Medicare beneficiaries and 4 million Medicaid recipients could newly gain access to these treatments. Yet the actual pool of eligible people may be far larger—the Centers for Medicare and Medicaid Services suggests approximately 28 million Medicaid enrollees meet the clinical definition of obesity. The price tag is substantial: taxpayers could spend as much as $35 billion over the next decade to cover these drugs, which cost between $1,000 and $1,300 per month.
Health and Human Services Secretary Xavier Becerra framed the proposal as a breakthrough for people who cannot otherwise afford the medications. "It's a good day for anyone who suffers from obesity," he said, calling the move a transformative step for Americans locked out of treatments by cost alone. The rule hinges on a legal reframing: Medicare has been prohibited for decades from covering weight-loss products, but the administration's proposal would classify obesity itself as a treatable disease, thereby circumventing that restriction. Some people already receive coverage through these programs if they have diabetes or cardiovascular risk factors, but this rule would expand eligibility based on obesity alone.
The pharmaceutical landscape has shifted dramatically in recent years. Novo Nordisk's Wegovy and Eli Lilly's Zepbound represent a new class of weekly injectables that work by mimicking hormones regulating appetite, signaling fullness to the brain during eating. Before these drugs became widely available, weight-loss medications were largely inaccessible to ordinary Americans—the high cost meant they remained the province of the wealthy and celebrities willing to publicize their use. Supply shortages have further constrained access.
But the proposal faces a formidable obstacle. Kennedy, awaiting Senate confirmation as HHS secretary, has been vocal in his opposition to covering these drugs through government insurance programs. He has argued instead for redirecting that money toward subsidizing healthier food and gym memberships for obese Americans. "For half the price of Ozempic, we could purchase regeneratively raised, organic food for every American, three meals a day and a gym membership, for every obese American," he told federal lawmakers earlier this year, invoking the diabetes drug that can produce weight loss as a point of comparison. His position reflects a broader skepticism about pharmaceutical solutions and a preference for what he frames as preventive lifestyle interventions.
The timing creates a political trap. The rule will not be finalized until January, days after Trump takes office. A bipartisan group of congressional members has lobbied for Medicare coverage, arguing that preventing obesity-related diseases like diabetes and heart disease could ultimately save the government billions in treatment costs. Yet Trump's incoming administration, populated by officials committed to reducing federal spending, may view the upfront cost as prohibitive. Trump's own position on the drugs remains unclear, but the ideological alignment between Kennedy and the administration's fiscal priorities suggests the proposal faces an uncertain future.
Citas Notables
For half the price of Ozempic, we could purchase regeneratively raised, organic food for every American, three meals a day and a gym membership, for every obese American— Robert F. Kennedy Jr., Trump's HHS nominee
La Conversación del Hearth Otra perspectiva de la historia
Why does Kennedy oppose covering these drugs when they clearly work for weight loss?
He sees it as treating a symptom rather than the root cause. He believes the money would be better spent on food access and fitness infrastructure—addressing what he views as the actual problem: the food system and sedentary living.
But wouldn't that take longer to show results?
Absolutely. His approach is preventive and systemic; the drugs are immediate and individual. That's the fundamental disagreement—whether you solve obesity through personal pharmaceutical intervention or through reshaping the environment people live in.
What happens to the people who need these drugs right now?
That's the tension no one's quite resolved. The drugs work. People lose significant weight. But they're expensive, and once you stop taking them, the weight often returns. Kennedy's argument is that we're treating the symptom while ignoring why so many Americans became obese in the first place.
So this rule dying in January would mean what, exactly?
It means millions of people who can't afford $1,300 a month stay locked out. Some might get coverage through other programs if they have diabetes or heart disease, but obesity alone wouldn't qualify them. The drugs remain a luxury good.