Opinion: Removing GLP-1s From Medi-Cal Will Lead to Higher Long-Term Costs

By Wayne Ho

Gov. Gavin Newsom often talks about the importance of preventative care. However, his decision to eliminate Medi-Cal coverage of GLP-1 medications is moving California in the opposite direction.

As a primary care physician who specializes in obesity medicine, practicing in California, I can already tell you what happens next.

Patients who were finally getting healthier will regain weight. Diabetes will worsen. Blood pressure will climb. Sleep apnea, fatty liver disease, chronic pain, heart disease and disability will become far more common and more expensive to treat. And many of the people hit the hardest will be those with the fewest resources.

I will watch patients lose progress they have fought incredibly hard to achieve.

Obesity is still widely misunderstood. It is not a cosmetic issue or a failure of willpower. It is a chronic disease driven by biology, environment, genetics, stress, sleep medications and socioeconomic conditions.

With nearly 1 in 3 Californian adults living with obesity, we cannot ignore the impact of this disease on our state both medically and financially. Nearly 27 percent of Californians have been diagnosed with high blood pressure, and an additional 10 percent with diabetes. These numbers are even higher among Californians living below the poverty line, the very population Medi-Cal is designed to serve, who are 1.5 times more likely to be obese than those living above the poverty line.

The mistake behind this decision is assuming that refusing to cover obesity treatment saves money. It does not. It simply delays costs until patients come sicker. We do not save money when someone develops diabetes instead of receiving preventative treatment. We do not save money when a patient needs dialysis, heart surgery, repeated hospitalizations or disability benefits years later.

As physicians, we are trained to prevent disease before it spirals into irreversible complications. That is exactly what these medications can help us do.

Study after study has shown that GLP-1 medications produce significantly greater clinical benefits than lifestyle modifications alone and generate long-term savings by reducing downstream costs related to obesity. In fact, these medications reduced the risk of progression to diabetes by up to 93 percent. Another GLP-1 use study showed reduction of major adverse cardiovascular events (like heart attacks, strokes and heart failure) by 20 percent, first-time hospitalizations for any reason by 17 percent and cardiovascular hospitalizations by 11 percent. These are precisely the types of events that drive Medi-Cal expenses.

GLP-1 use not only improves patient outcomes but also reduces medical costs over time. A recent workforce analysis revealed that GLP-1 users experienced a seven-percentage-point slower growth in medical spending in their second year of use. If these trends continue, they imply meaningful long-term savings. Not only in health care costs but also through less absenteeism, disability and lost productivity. Additionally, economic research indicates that Medi-Cal patients can save between $760 to $960 for people without diabetes and $1,770 to $1,970 for people with diabetes.

I see the results every day in my clinic.

For the first time, I am routinely able to reduce or stop medications for hypertension and cholesterol. GLP-1s are one of the most effective preventative tools I have ever had. I have patients who no longer need CPAP machines for sleep apnea, patients with knee osteoarthritis whose pain has improved enough to avoid surgery, and patients with chronic autoimmune disorders experiencing fewer flares and needing less medication and fewer specialist visits.

I met a patient with obesity just one month before his scheduled metabolic bariatric surgery and started him on a GLP-1 medication. Two years later, he had lost over 200 pounds, avoided surgery altogether and now takes less than half the medications he once needed.

That transformation was not cosmetic. It was lifesaving.

I often wonder how many similar patients lack access to this care. With the end of GLP-1 medication coverage for Medi-Cal, I fear I will find out soon.

Newsom himself has referenced Texas hospital spending to highlight that not covering care does not eliminate costs, it merely shifts them. In other words, treating chronic diseases early is a form of preventive care. The same applies to obesity. We either treat obesity now or pay for the treatment of diabetes, organ failure, cancer and disability later. Unlike nearly any other chronic disease, obesity treatment is repeatedly asked to justify itself, despite overwhelming evidence. Yet, the numbers support coverage. The science supports coverage. The economics support coverage. And the experiences of patients and physicians support coverage.

If California wants to lead on health care, prevention and equity, we cannot afford to move backward on obesity treatment now. The cost of inaction will not just be measured in dollars. It will be measured in worsening health, preventable suffering and lives cut shorter than they should have been.

Dr. Wayne Ho is an internal medicine and obesity specialist and a professor in medical education at the USC Keck School of Medicine.

This article first appeared on California Health Report and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Previously Published on calhealthreport.org with Creative Commons License

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