Health care was on the ballot in last week's midterm elections. Not only were rising medical costs tied with high gasoline prices as the top concern for many voters, but Medicaid funding was a decisive issue in the election of 36 state governors. According to pre-election polling, seven in ten voters (71 percent) prioritized access to care for Medicaid recipients as the top concern for state officials.
One access issue on voters’ minds is already playing out at the state level with significant ramifications for the health of millions of Americans. Even as national polling reveals that nearly 70 percent of both Republicans and Democrats support expanding Medicare and Medicaid access to GLP-1 medications, Medicaid coverage of anti-obesity medicines (AOMs) is shrinking. KFF reported that just 13 state Medicaid programs covered AOMs as of January 2026, down from 16 in October 2025. Since then, Utah let its coverage pilot expire on June 30, Massachusetts ended coverage in July, and Rhode Island followed on October 1, 2026.
State officials cite budgetary constraints as the reason for dropping GLP-1 coverage, reflecting cuts in federal funding for Medicaid of between $911 billion to over $1.02 trillion due to the One Big Beautiful Bill Act (OBBBA). Yet health economists and obesity advocates caution that eliminating AOM coverage is a devil’s bargain - savings to the Medicaid budget will be short-term while the unintended consequences will be long-lasting, resulting in poorer health and medical expenditures much greater than what states spend on obesity care.
Take, for example, the case of a woman in Rhode Island whose obesity and high blood pressure had improved with a GLP-1 medication. On October 1, her coverage ended, and because she could not afford to pay out of pocket for the drug, she stopped treatment abruptly, and now she is experiencing weight regain and a metabolic rebound of her blood pressure.
Why this is the case is because obesity worsens the outcomes of over 230 chronic diseases. Thus, stopping treatment or not treating obesity at all will increase chronic disease rates, resulting in more costly knee and hip replacements, sleep apnea treatments, heart stents, hospitalizations, and other expenditures that will cost states hundreds of billions of dollars each year.
Adding to these concerns, ending Medicaid coverage for AOMs could create a two-tiered system: people who can afford private insurance would receive obesity treatment, while the medically underserved would just get sick. That is why the 4,000 obesity specialists gathering in Washington for ObesityWeek, November 14through 17, will unite in urging states to maintain or restore Medicaid coverage based on evidence that treatment improves lives and lowers states’ healthcare costs.
Starting with health improvements for patients, a 2018 study published in Current Obesity Reports, finds thateven a modest weight loss of 5-10 percent reduces LDL (“bad”) cholesterol and triglycerides in the blood. Additionally, a 15-20 percent weight loss produces remission of type 2 diabetes.
As to savings for state budgets, a large study of privately insured adults and Medicare beneficiaries published in JAMA Network Open showed that when a person with obesity who also has one or more chronic conditions achieved a 5 percent weight loss, there was a $1,262 reduction in healthcare spending. For a 25 percent weight loss, the reduction in health expenditures was $5,444 per person. Adding to the evidence, new research reported in the journal Diabetes, Obesity and CardioMetabolic CARE finds that treating obesity in adult Medicaid recipients could generate nearly $1 billion in medical cost savings nationally every year.
Experts attending ObesityWeek will also point to Medicare as a working model. The GLP-1 Bridge program, a temporary 18-month demonstration launched by the Centers for Medicare and Medicaid Services (CMS) on July 1, 2026, to provide weight-loss drugs for a $50 flat monthly copay, has shown strong early enrollment, high patient uptake, and is filling a critical coverage gap for Medicare beneficiaries who need GLP-1 medications for weight loss. Over 600,000 older Americans enrolled in the program within its first two months, showing that covering AOMs for Medicaid recipients is achievable.
In terms of dollars spent on medical care, lost wages, absenteeism, lost productivity and other expenditures, the cost of obesity is much too high. The latest estimate for the national cost of obesity in direct and indirect expenditures is $1.72 trillion a year, more than what Social Security paid in retirement benefits in 2022.
Voters told state leaders that access to care for Medicaid recipients is a priority. For patients with obesity, that includes treatment. Now is the time for governors and legislators to respond by adding or restoring obesity treatment coverage in their 2027 Medicaid programs, so patients who lost coverage can get back on the path to better health by resuming AOM treatment.
Nancy Glick is the Director of Food, Nutrition and Obesity Policy at the National Consumers League.
