CHARLESTON, S.C. — When Page Campbell’s doctor recommended she try an injectable prescription drug called Wegovy to lose weight before scheduling bariatric surgery, she readily agreed.

“I’ve struggled with my weight for so long,” said Campbell, 40, a single mother of two. “I’m not opposed to trying anything.”

In early April, about four weeks after she’d started taking Wegovy, Campbell said she hadn’t experienced any side effects, such as nausea or bowel irritation. But she doesn’t use a scale at home, she said, so she didn’t know whether she’d lost any weight since her most recent medical appointment earlier this year, when she weighed 314 pounds. Still, she was confident about achieving weight loss.

“It’s going to work because I’m putting in the work. I’m changing my eating habits. I’m exercising,” said Campbell, a shipping manager at a Michaels store. “I’m not going to second-guess myself.”

Wegovy belongs to a pricey class of drugs called GLP-1s (short for glucagon-like peptide-1 agonists) that have upended the treatment of obesity in recent years, offering hope to patients who have tried and failed to lose weight in myriad other ways.

Campbell gained access to Wegovy through South Carolina Medicaid’s decision in late 2024 to cover these weight loss drugs. But the medications remain out of reach for millions of patients across the country who could benefit from them, because many public and private health insurers have deemed the drugs too expensive.

A report published in November by KFF, a health information nonprofit that includes KFF Health News, found only 13 states were covering GLP-1s for the treatment of obesity for Medicaid beneficiaries as of August. South Carolina became the 14th in November.

Liz Williams, one of the report’s authors and a senior policy manager for the Program on Medicaid and the Uninsured at KFF, said she was not aware of any other state Medicaid programs joining the list since then. Looking ahead, the remaining states may be reluctant to add a new, expensive drug benefit while they brace for potential federal cuts coming from Congress, she said.

“As the budget debate, federally, is developing, that may impact how states are thinking about this,” Williams said.

The federal government won’t be helping anytime soon, either. Medicare covers GLP-1s to treat diabetes and some other health conditions, including obstructive sleep apnea and cardiovascular disease, but not obesity. In early April, the Trump administration announced it will not finalize a rule proposed by the Biden administration that would have allowed an estimated 7.4 million people covered by Medicare and Medicaid to access GLP-1s for weight loss. Meanwhile, the FDA is poised to force less expensive, compounded versions of these drugs off the market.

And the barrier to entry remains high, even for Medicaid patients in those few states that have agreed to cover the drugs without a federal mandate.

Case in point: In South Carolina, where more than one-third of all adults, and nearly half of the African American population, qualify as obese, the state Medicaid agency estimates only 1,300 beneficiaries will meet the stringent prerequisites for GLP-1 coverage.

Under one of those requirements, Medicaid beneficiaries who wish to access these drugs to lose weight must attest to “increased exercise activity,” said Jeff Leieritz, a spokesperson for the South Carolina Department of Health and Human Services.

Campbell, who is insured by Medicaid, was granted coverage for Wegovy based on her body mass index. First, though, she was required to submit six months’ worth of documentation proving that she’d tried and failed to lose weight after receiving nutrition counseling and going on a 1,200-calorie-a day diet, said Kenneth Mitchell, one of Campbell’s doctors and the medical director for bariatric surgery and obesity medicine at Roper St. Francis Healthcare.

Campbell’s Wegovy prescription was approved for six months, Mitchell said. When that authorization expires, Campbell and her health care team will need to submit more documentation, including proof that she has lost at least 5% of her body weight and has kept up with nutrition counseling.

“It’s not just, ‘Send a prescription in and they cover it.’ It’s rather arduous,” Mitchell said. “Not a lot of folks are going to do this.”

Mitchell said South Carolina Medicaid’s decision to cover these drugs was met with excitement among those working in his medical specialty. But he wasn’t surprised that the state anticipates relatively few people will access this benefit annually, since the approval process is so rigorous and the cost high. “The problem is the medicines are so expensive,” Mitchell said.

Novo Nordisk, which manufactures Wegovy, announced in March that it was cutting the monthly price for the drug from $650 to $499 for cash-paying customers. The price that health insurance plans and beneficiaries pay for these drugs varies, but some GLP-1s cost more than $1,000 per patient per month, Mitchell said, and many people will need to take them for the rest of their lives to maintain weight loss.

“That is a tremendous price tag that someone has to foot the bill for,” Mitchell said.

That’s the reason California Gov. Gavin Newsom on May 14 proposed eliminating Medicaid coverage of GLP-1s for weight loss starting Jan. 1, to save an estimated $680 million a year by 2028.

And the North Carolina State Health Plan Board of Trustees voted last year to end coverage of GLP-1s for state employees, after then-North Carolina Treasurer Dale Folwell’s office estimated in 2023 that the drugs were projected to cost the State Health Plan $1 billion over the next six years. The decision came only a few months after a separate North Carolina agency announced it would start covering these drugs for Medicaid beneficiaries. North Carolina Medicaid has estimated it will spend $16 million a year on GLP-1s.

South Carolina Medicaid, which insures fewer than half the number of people enrolled in North Carolina Medicaid, anticipates spending less. Leieritz estimated GLP-1s and nutrition counseling offered to Medicaid beneficiaries in South Carolina will cost $10 million a year. State funding will cover $3.3 million of the expense; the remainder will be paid for by matching Medicaid funds from the federal government.

In a recent interview, Health and Human Services Secretary Robert F. Kennedy Jr. didn’t rule out the possibility that Medicare and Medicaid might cover GLP-1s for obesity treatment in the future as costs come down.

They’re “extraordinary drugs” and “we’re going to reduce the cost,” Kennedy told CBS News in early April. He said he would like GLP-1s to eventually be made available to Medicare and Medicaid patients who are seeking obesity treatment after they have tried other ways to lose weight. “That is the framework that we’re now debating.”

Meanwhile, public health experts have applauded South Carolina Medicaid’s decision to cover GLP-1s. Yet the new benefit won’t help the vast majority of the 1.5 million adults in South Carolina who are classified as obese, according to data published by the South Carolina Department of Public Health.

“We still have some work to do,” acknowledged Brannon Traxler, the public health department’s chief medical officer.

But the state’s new “Action Plan for Healthy Eating and Active Living,” written by a coalition of groups in South Carolina, including the Department of Public Health, makes no mention of GLP-1s or the role they might play in lowering obesity rates in the state.

The action plan, underwritten by a $1.5 million federal grant, isn’t meant to lay out an overarching approach for lowering obesity in South Carolina, Traxler said. Instead, it promotes physical activity in schools, nutrition, and the expansion of outdoor walking trails, among other strategies. A more comprehensive obesity plan might address the benefits of surgical intervention and GLP-1s, but those also carry risk, expense, and side effects, Traxler said.

“Certainly, I think, there is a need to bring it all together,” she said.

Campbell, for one, is taking the comprehensive approach. On top of injecting Wegovy once weekly, she said, she is prioritizing protein intake and moving her body. She also underwent weight loss surgery in late April.

“Weight loss is my biggest goal,” said Campbell, who expressed appreciation for Medicaid’s coverage of Wegovy. “It’s one more thing that’s going to help me get to my goal.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

The post Trump Won’t Force Medicaid to Cover GLP-1s for Obesity. A Few States Are Doing It Anyway. appeared first on kffhealthnews.org

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

This article presents a generally factual and empathetic perspective on access to weight loss drugs through Medicaid, highlighting the challenges and policy decisions affecting coverage. It critiques cost barriers and political decisions from the Trump administration and some state governments, which aligns with a viewpoint that supports increased healthcare access and government intervention in health coverage. The tone is balanced but leans slightly left by emphasizing the importance of public health and expanded coverage via Medicaid while pointing out the budget cuts and coverage restrictions primarily associated with conservative or right-wing policy positions.

Health care has proved a vulnerable target for the firehose of cuts and policy changes President Donald Trump ordered in the name of reducing waste and improving efficiency. But most of the impact isn’t as tangible as, say, higher egg prices at the grocery store.

One thing experts from a wide range of fields, from basic science to public health, agree on: The damage will be varied and immense. “It’s exceedingly foolish to cut funding in this way,” said Harold Varmus, a Nobel Prize-winning scientist and former director of both the National Institutes of Health and the National Cancer Institute.

The blaze of cuts have yielded nonsensical and perhaps unintended consequences. Consider instances in which grant funding gets canceled after two years of a three-year project. That means, for example, that $2 million has already been spent but there will be no return on that investment.

Some of the targeted areas are not administration priorities. That includes the abrupt termination of studies on long covid, which afflicts more than 100,000 Americans, and the interruption of work on mRNA vaccines, which hold promise not just in infectious disease but also in treating cancer.

While charitable dollars have flowed in to plug some gaps, “philanthropy cannot replace federal funding,” said Dustin Sposato, communications manager for the Science Philanthropy Alliance, a group that works to boost support from charities for basic science research.

Here are critical ways in which Trump administration cuts — proposed and actual — could affect American health care and, more important, the health of American patients.

Cuts to the National Institutes of Health: The Trump administration has cut $2.3 billion in new grant funding since its term began, as well as terminated existing grants on a wide range of topics — vaccine hesitancy, HIV/AIDS, and covid-19 — that do not align with its priorities. National Institutes of Health grants do have yearly renewal clauses, but it is rare for them to be terminated, experts say. The administration has also cut “training grants” for young scientists to join the NIH.

Why It Matters: The NIH has long been a crucible of basic science research — the kind of work that industry generally does not do. Most pharmaceutical patents have their roots in work done or supported by the NIH, and many scientists at pharmaceutical manufacturers learned their craft at institutions supported by the NIH or at the NIH itself. The termination of some grants will directly affect patients since they involved ongoing clinical studies on a range of conditions, including pediatric cancer, diabetes, and long covid. And, more broadly, cuts in public funding for research could be costly in the longer term as a paucity of new discoveries will mean fewer new products: A 25% cut to public research and development spending would reduce the nation’s economic output by an amount comparable to the decline in gross domestic product during the Great Recession, a new study found.

Cuts to Universities: The Trump administration also tried to deal a harrowing blow — currently blocked by the courts — to scientific research at universities by slashing extra money that accompanies research grants for “indirect costs,” like libraries, lab animal care, support staff, and computer systems.

Why It Matters: Wealthier universities may find the funds to make up for draconian indirect cost cuts. But poorer ones — and many state schools, many of them in red states — will simply stop doing research. A good number of crucial discoveries emerge from these labs. “Medical research is a money-losing proposition,” said one state school dean with former ties to the Ivies. (The dean requested anonymity because his current employer told him he could not speak on the record.) “If you want to shut down research, this will do it, and it will go first at places like the University of Tennessee and the University of Arkansas.” That also means fewer opportunities for students at state universities to become scientists.

Cuts to Public Health: These hits came in many forms. The administration has cut or threatened to cut long-standing block grants from the Centers for Disease Control and Prevention; covid-related grants; and grants related to diversity, equity, and inclusion activities — which often translated into grants to improve health care for the underserved. Though the covid pandemic has faded, those grants were being used by states to enhance lab capacity to improve detection and surveillance. And they were used to formally train the nation’s public health workforce, many of whom learn on the job.

Why It Matters: Public health officials and researchers were working hard to facilitate a quicker, more thoughtful response to future pandemics, of particular concern as bird flu looms and measles is having a resurgence. Mati Hlatshwayo Davis, the St. Louis health director, had four grants canceled, three in one day. One grant that fell under the covid rubric included programs to help community members make lifestyle changes to reduce the risk of hypertension and diabetes — the kind of chronic diseases that Health and Human Services Secretary Robert F. Kennedy Jr. has said he will focus on fighting. Others paid the salaries of support staff for a wide variety of public health initiatives. “What has been disappointing is that decisions have been made without due diligence,” she said.

Health-Related Impact of Tariffs: Though Trump has exempted prescription drugs from his sweeping tariffs on most imports thus far, he has not ruled out the possibility of imposing such tariffs. “It’s a moving target,” said Michael Strain, an economist at the American Enterprise Institute, noting that since high drug prices are already a burden, adding any tax to them is problematic.

Why It Matters: That supposed exemption doesn’t fully insulate American patients from higher costs. About two-thirds of prescription drugs are already manufactured in the U.S. But their raw materials are often imported from China — and those enjoy no tariff exemption. Many basic supplies used in hospitals and doctors’ offices — syringes, surgical drapes, and personal protective equipment — are imported, too. Finally, even if the tariffs somehow don’t themselves magnify the price to purchase ingredients and medical supplies, Americans may suffer: Across-the-board tariffs on such a wide range of products, from steel to clothing, means fewer ships will be crossing the Pacific to make deliveries — and that means delays. “I think there’s an uncomfortably high probability that something breaks in the supply chain and we end up with shortages,” Strain said.

Changes to Medicaid: Trump has vowed to protect Medicaid, the state-federal health insurance program for Americans with low incomes and disabilities. But House Republicans have eyed the program as a possible source of offsets to help pay for what Trump calls “the big, beautiful bill” — a sweeping piece of budget legislation to extend his 2017 tax cuts. The amount of money GOP leaders have indicated they could squeeze from Medicaid, which now covers about 20% of Americans, has been in the hundreds of billions of dollars. But deep cuts are politically fraught.

To generate some savings, administration officials have at times indicated they are open to at least some tweaks to Medicaid. One idea on the table — work requirements — would require adults on Medicaid to be working or in some kind of job training. (Nearly two-thirds of Medicaid recipients ages 19-64 already work.)

Why It Matters: In 2024 the uninsured rate was 8.2%, near the all-time low, in large part because of the Medicaid expansion under the 2010 Affordable Care Act. Critics say work requirements are a backhanded way to slim down the Medicaid rolls, since the paperwork requirements of such programs have proved so onerous that eligible people drop out, causing the uninsured rate to rise. A Congressional Budget Office report estimates that the proposed change would reduce coverage by at least 7.7 million in a decade. This leads to higher rates of uncompensated care, putting vulnerable health care facilities — think rural hospitals — at risk.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The post How Trump Aims To Slash Federal Support for Research, Public Health, and Medicaid  appeared first on kffhealthnews.org

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

This content offers a critical perspective on the Trump administration’s health care policies, particularly emphasizing the negative impact of funding cuts to scientific research, public health programs, and Medicaid. It highlights concerns about the potential long-term consequences of these cuts and frames the administration’s actions as misguided or harmful. While the piece largely presents factual information and expert opinions, it adopts a tone that is skeptical of the administration’s priorities and decisions, reflecting a center-left viewpoint that values robust public health funding and social safety nets.

During his first administration, President Donald Trump’s top health officials gave North Carolina permission to use Medicaid money for social services not traditionally covered by health insurance. It was a first-in-the-nation experiment to funnel health care money into housing, nutrition, and other social services.

Some poor and disabled Medicaid patients became eligible for benefits, including security deposits and first month’s rent for housing, rides to medical appointments, wheelchair ramps, and even prescriptions for fresh fruits and vegetables.

Such experimental initiatives to improve the health of vulnerable Americans while saving taxpayers on costly medical procedures and expensive emergency room care are booming nationally. Without homes or healthy food, people risk getting sicker, becoming homeless, and experiencing even more trouble controlling chronic conditions such as diabetes and heart disease.

Former President Joe Biden encouraged states to go big on new benefits, and the availability of social services exploded in states red and blue. Since North Carolina’s launch, at least 24 other states have followed by expanding social service benefits covered by Medicaid, the health care program for low-income and disabled Americans — a national shift that’s turning a system focused on sick care into one that prioritizes prevention. And though Trump was pivotal to the expansion, he’s now reversing course regardless of whether evidence shows it works.

In Trump’s second term, his administration is throwing participating states from California to Arkansas into disarray, arguing that social services should not be paid for by government health insurance. Officials at the Centers for Medicare & Medicaid Services, which grants states permission to experiment, have rescinded its previous broad directive, arguing that the Biden administration went too far.

“This administration believes that the health-related social needs guidance distracted the Medicaid program from its core mission: providing excellent health outcomes for vulnerable Americans,” CMS spokesperson Catherine Howden said in a statement.

“This decision prevents the draining of resources from Medicaid for potentially duplicative services that are already provided by other well-established federal programs, including those that have historically focused on food insecurity and affordable housing,” Howden added, referring to food stamps and low-income housing vouchers provided through other government agencies.

Trump, however, has also proposed axing funding for low-income housing and food programs administered by agencies including the departments of Housing and Urban Development and Agriculture — on top of Republican proposals for broader Medicaid cuts.

The pullback has led to chaos and confusion in states that have expanded their Medicaid programs, with both liberal and conservative leaders worried that the shift will upend multibillion-dollar investments already underway. Social problems such as homelessness and food insecurity can cause — or worsen — physical and behavioral health conditions, leading to sky-high health care spending. Medical care delivered in hospitals and clinics, for instance, accounts for only roughly 15% of a person’s overall health, while a staggering 85% is influenced by social factors such as access to healthy food and shelter for sleep, said Anthony Iton, a policy expert on social determinants of health.

Health care experts warn the disinvestment will come at a price.

“It will just lead to more death, more suffering, and higher health care costs,” said Margot Kushel, a primary care doctor in San Francisco and a leading researcher on homelessness and health care.

The Trump administration announced in a March 4 memo that it was rescinding Biden-era guidance dramatically expanding experimental benefits known as health-related social needs. Federal waivers are required for states to use Medicaid funds for most nontraditional social services outside of hospitals and clinics.

Last month, the administration told states that these services, which can also include high-speed internet and storage units, should not be part of Medicaid.

Future waiver requests allowing Medicaid to provide social services — a liberal philosophy — will be considered on a “case-by-case basis,” the administration said. Rather, it has signaled a conservative shift toward requiring most Medicaid beneficiaries to prove that they’re working or trying to find jobs, which puts an estimated 36 million Americans at risk of losing their health coverage.

“What they’re arguing is Medicaid has been expanded far beyond basic health care and it needs to be cut back to provide only basic coverage to those most desperately in need,” said Mark Peterson, a health policy expert at UCLA. “They’re making the case, which is not widely shared by specialists in the health care field, that it’s not the job of taxpayers and Medicaid to pay for all this stuff outside the traditional heath care system.”

Although states have not received formal guidance to end their social experiments, Peterson and other health policy researchers expect the administration not to renew waivers, which typically run in five-year intervals. Worse, legal experts say programs underway could be halted early.

Evidence supporting social investments by Medicaid is still nascent. An expansion in Massachusetts that provided food benefits reduced ER visits and hospitalizations, for instance. But often, it’s a mixed bag.

California is going the biggest, investing $12 billion over five years to provide a slew of new services, from intensive case management to help people with severe behavioral health conditions to housing and food assistance through a pair of federal waivers. The most popular benefits provided by health insurers are those that help homeless people on Medicaid by placing them in apartments or securing beds in recovery homes, covering up to $5,000 for security deposits, and preventing eviction.

Since the CalAIM program launched in 2022, it has served only a small fraction of the state’s nearly 15 million Medicaid beneficiaries, with roughly 577,000 referrals for benefits. Yet it has improved and even saved the lives of some of those lucky enough to get help, including Eric Jones, a 65-year-old Los Angeles resident.

“When I got diabetes, I didn’t know what to do and I had a hard time getting to my medical appointments,” said Jones, who lost his housing this year when his mom died but received services through his Medi-Cal insurer, L.A. Care. “My case manager got me rides to my appointments and also helped me get into an apartment.”

California is considering making some of its social services permanent after the CalAIM waivers expire at the end of 2026. Gov. Gavin Newsom’s administration is adding more housing services, including up to six months of free rent under a third waiver approved by the Biden administration. Medi-Cal officials contended early evidence shows CalAIM has led to better care coordination and fewer hospital and ER visits.

“We are fully committed,” said Susan Philip, a deputy director for the state Department of Health Care Services, which administers the program. “We have invested so much.”

Health insurers, which deliver Medicaid coverage and receive greater funding to cover these additional benefits, say they’re worried the Trump administration will end or curtail the programs. “If we do things the same old way, we’re just going to generate the same old results — people getting sicker and health care costs continuing to rise,” said Charles Bacchi, president and CEO of the California Association of Health Plans, which represents insurers.

Industry leaders say the expansion is already changing lives.

“We believe wholeheartedly that housing is health, food is health, so seeing these programs disappear would be devastating,” said Kelly Bruno-Nelson, executive director of Medi-Cal for CalOptima Health, a health insurance provider in Orange County.

Oregon is also providing low-income Medicaid patients with a range of new services, including home-delivered healthy meals and rental payment assistance. Residents can even qualify for air conditioners, heaters, air filters, power generators, and mini fridges. State Medicaid officials say they remain committed to providing the benefits but worry about federal cuts.

“Climate change and housing instability are huge indicators of poor health,” said Josh Balloch, vice president of health policy and communications at AllCare Health, a Medicaid insurer in Oregon. “We hope to prove to the federal government that this is a good return on their investment.”

But even as the Trump administration curtails waivers, it is retaining discretion to provide social services in Medicaid, just on a smaller scale. Supporters say it’s fair to scrutinize where to draw the line on taxpayer spending, arguing that there isn’t always a direct health connection.

“We’re seeing these things increase, with the free rent, and we’re seeing some states pay for free internet, paying for furniture,” said Kody Kinsley, who previously served as North Carolina’s top health official. “We know there’s evidence for food and housing, but with all of these new benefits, we need to look closely at the evidence and the linkage to what actually drives health.”

Current North Carolina officials say they’re confident the new social services Medicaid provides in their state have resulted in better health and lower overall spending on expensive and acute care. Medicaid recipients there can even use the program to buy farm-fresh produce.

While it’s too soon to know whether these experiments have been effective elsewhere in the United States, early evidence in North Carolina shows promise: The state had saved $1,020 per participant a year into its experiment — operating in mostly rural counties — by reducing ER trips and hospitalizations.

State health officials also touted the economic benefits of driving business to family farms, home improvement contractors, and community-based organizations providing housing and social services.

“I welcome the challenge of demonstrating the effectiveness of our programs. It’s making for healthier people and healthier budgets,” said Jay Ludlam, deputy secretary for North Carolina’s Medicaid program. “Family farms that were on the verge of collapse after Hurricane Helene are now benefiting from a steady income while they also serve their community.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

The post Housing, Nutrition in Peril as Trump Pulls Back Medicaid Social Services appeared first on kffhealthnews.org

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

The article presents a relatively balanced view of the Medicaid expansion efforts under both the Trump and Biden administrations, highlighting the shift in policy and the effects on states. While it notes the positive impact of social service initiatives introduced by Trump and expanded under Biden, it also criticizes Trump’s subsequent withdrawal from these programs. The focus on evidence from states like California and North Carolina, along with the discussion on the social determinants of health, suggests a lean toward more progressive policies on health care. However, the article still presents opposing views from conservative health policy experts, maintaining some balance in tone.