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There’s bad news and potentially good news for people living with obesity in California. The bad news is that California ended Medi-Cal coverage of GLP-1 drugs when used for weight loss earlier this year. The potentially good news is that Gov. Newsom has the opportunity to restore access to obesity medications for Medi-Cal patients.
Cutting treatment for one of the costly chronic diseases was a poor policy decision from the beginning, and one that could have wide repercussions if it’s not fixed – ultimately driving health spending higher by worsening outcomes for some of the state’s sickest patients and impacting patients far outside of Medi-Cal.
From the exam room, the consequences are already easy to see.
One of my patients, Paul Mack, a father in his 40s, could barely climb a flight of stairs without stopping to catch his breath.
When Paul first came to see me, he was a Medi-Cal patient living with severe obesity, uncontrolled blood pressure despite multiple medications, worsening prediabetes and heart failure. Paul was in the middle of a divorce, and his heart failure symptoms became so limiting that he could no longer work. He and his children moved in with his parents.
He felt shame about his weight and inability to provide for his family and blamed himself for an illness that was steadily worsening his heart failure, overall health, mobility and quality of life. He became depressed. More medications were added. And with every new setback, his confidence shrank further.
To turn Paul’s health around, we treated obesity as the chronic disease of weight dysregulation it is and provided comprehensive care. That included nutrition support, behavioral care and medication to address his underlying biology, including a GLP-1.
Paul lost 60 pounds. His heart failure improved and his blood pressure medications were reduced. He was eventually cleared for surgery to repair his aortic aneurysm and returned to work. He got his own place again. His depression lifted. His self-esteem came back. He got his life back.
The medication addressed underlying biological factors contributing to his obesity and helped him engage more fully in the lifestyle changes and overall care essential for long-term health. which meant lasting results.
But, under California’s obesity treatment policy, many patients have had to face a loss of access to the treatment that made that recovery possible. Without coverage, many patients simply cannot afford these medications.
Paul’s story is not unusual. Many of my Medi-Cal patients have severe obesity and serious related disease. When access disappears, they cannot simply “try harder” to overcome the biological factors that contribute to obesity and achieve better health outcomes. For some patients, weight returns and related conditions can worsen. The system ends up paying anyway – through heart attacks, strokes, dialysis and disability.
Obesity is a chronic disease that contributes to diabetes, heart disease, kidney disease, sleep apnea, many cancers and more. We have the ability to use medications that mimic hormones involved in appetite and treat obesity and improve related health conditions.
We would never tell patients living with asthma that inhalers are no longer covered. We would never treat blood-pressure medication as optional. Policies like this disproportionately harm Medi-Cal patients, who are least able to pay out of pocket.
And when a state as influential as California changes coverage policy, private insurers often follow.
California can do better. Cutting off evidence-based obesity treatment was bad policy, but the opportunity to fix it is in sight.
Paul’s recovery was not a miracle. It was good medicine, and the kind of care patients across California deserve.
Lydia Alexander, MD, DABOM, DABLM, MFOMA is the chief medical officer for Enara Health in San Mateo, and immediate past president of the Obesity Medicine Association.
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