Medicare and Obesity – HealthyWomen



For millions of people living with obesity, the class of weight-loss medications known as GLP-1 agonists have been game-changers (think Wegovy and Zepbound). Studies show that people on these medications can lose more weight than they can with just lifestyle changes alone.

But for one group of Americans — people on Medicare — at least some of these drugs have been off-limits because Medicare is not allowed to cover medications prescribed for the sole purpose of weight loss. With ample evidence that obesity itself increases numerous health risks and new indications that these drugs lower risks of heart disease and stroke, those limits may be changing.

A bipartisan bill, the Treat and Reduce Obesity Act (TROA), moving through Congress would allow Medicare to cover weight-loss medications for the first time.

Experts argue it’s about time.

“The passage of the Treat and Reduce Obesity Act (TROA) is crucial for protecting women’s access to obesity care as they transition to Medicare,” said Fatima Cody Stanford, M.D., M.P.H., M.P.A., associate professor of medicine and pediatrics at Harvard Medical School and obesity medicine physician-scientist in the Massachusetts General Hospital Weight Center.

Stanford explains that TROA improves comprehensive coverage while improving equitable access to care.

“The TROA aims to expand Medicare coverage to include a wider range of obesity treatments, including FDA-approved medications and intensive behavioral therapy. This ensures that women can continue their established treatment regimens without interruption,” she said. “The TROA addresses disparities in healthcare access, ensuring that all women, regardless of their financial situation, can receive the necessary treatments to manage their obesity effectively.”

The costs of obesity

For 31 million women over age 65 (and another 4 million younger women who qualify for Medicare because of long-term disabilities), Medicare’s lack of obesity care coverage creates risks. Approximately 10,000 Americans turn 65 every day, more than half of whom are women. With obesity rates reaching 43% in people over age 60, losing access to obesity treatments can be especially detrimental.

“When women transition from private insurance to Medicare at the age of 65, they often face a significant loss in coverage for obesity treatments,” Stanford said. “When women who have been receiving consistent obesity treatment, including medications, behavioral therapy and nutritional counseling, experience an abrupt halt in their care, this can lead to weight regain and worsening of obesity-related conditions.”

Experts recognize obesity as a chronic medical condition. According to the CDC, 2 out of every 5 American adults are living with obesity. Almost 6 out of 10 of them also have high blood pressure, which raises their risks for heart disease. Nearly 1 out of 4 also have diabetes. Obesity is also known to increase the risks of certain cancers, pregnancy and fertility problems, and mental health issues, among other conditions.

“Obesity is a chronic disease that requires ongoing management,” said Alicia Shelly, M.D., obesity medicine physician. “Without Medicare coverage for obesity treatment, women are at increased risk for serious health issues like heart disease, diabetes and cancer. Long-term support is essential to help prevent these life-threatening conditions.”

Obesity is also a serious economic issue. People with obesity have nearly $2,000 more in annual medical costs than people without obesity. Overall, those costs add up to nearly $173 billion in extra medical costs each year in the U.S.

And that’s just direct medical costs associated with obesity. Add to that lost productivity that results when employees miss work, are less productive at work due to obesity complications, or prematurely die or leave the workforce due to disability. The CDC estimates that obesity-related missed work alone costs between $3.38 and $6.38 billion each year.

TROA is one way to reduce these costs.

“By providing coverage for obesity treatments, the TROA supports preventive health measures, reducing the incidence of obesity-related diseases and lowering long-term healthcare costs,” Stanford said.

In women’s own voices

In a HealthyWomen survey of 1,000 women ages 35 to 64, nearly one-quarter reported having been diagnosed with obesity, and 79% said they were trying to lose weight or lower their BMI. Another 8% of respondents said they are caregiving for someone living with obesity.

Nearly two-thirds of women living with obesity reported dieting or considering doing so, and one in five said they’re taking or considering taking an anti-obesity medication (AOM).

The survey results show that 8 out of 10 women who consult a nutritionist said their insurance covers all or part of those costs, but only 6 out of 10 said the same about insurance coverage for AOMs.

Women living with obesity said that achieving their desired weight would have the biggest positive impact on their physical and mental health, self-confidence, and daily activities. But 11% of survey respondents who reported that they will turn 65 in the next six months (or are caregiving for someone who will) will not have access to AOMs under the current rules. Seven percent of women said they have a plan that will no longer cover their AOM next year or that they’re caring for someone in that situation.

The survey also revealed racial and ethnic health disparities. Nearly one-third of respondents said they have been diagnosed with obesity or would be if they went to a healthcare provider (HCP) who would assess their weight. And Black respondents were twice as likely than Hispanic/Latina respondents to categorize themselves this way.

Insurance status also showed important differences. People on Medicaid, the public insurance program for Americans with lower incomes, were more likely to say they had been diagnosed with obesity (31%) compared with 20% of those with job-based insurance and 17% with other private coverage. Among survey respondents with Medicare coverage, 13% said they care for someone with obesity and 26% are living with obesity.

Fighting for coverage

“The sudden lack of support and resources can have a detrimental effect on mental health, leading to feelings of helplessness, frustration and depression,” Stanford said. “This can further exacerbate the challenges associated with managing obesity.”

Stanford recommends that women transitioning onto Medicare be proactive about their care, such as reviewing various Medicare plan options to find the most comprehensive obesity coverage available and/or adding supplemental coverage (known as Medigap). She also recommends consulting HCPs to plan for the transition in advance and get their help navigating coverage or finding alternative treatments.

“I recommend developing a plan that outlines the available and affordable obesity treatments,” Shelly said. “Currently, Medicare does not cover weight loss medications, so it’s important to prioritize optimizing your nutrition and physical activity to support weight maintenance.”

More broadly, anyone who is or may someday be covered by Medicare can use their voice to advocate for coverage. Write letters to elected officials, call or visit their offices, or even request meetings to express support for TROA.

“Stay informed about legislative changes like the Treat and Reduce Obesity Act and advocate for their passage,” Stanford said. “Engaging with patient advocacy groups can amplify your voice and help drive policy changes.”

This educational resource was created with support from NovoNordisk, a HealthyWomen Corporate Advisory Council member.

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Where Do Kamala Harris and Donald Trump Stand on Women’s Health Issues?



There’s a lot at stake in this presidential election, and women’s health policy will be impacted by our new commander in chief and their administration, no matter who wins. So, as the 2024 presidential election fast approaches, make sure you know where Kamala Harris and Donald Trump stand on important issues related to women’s health and healthcare.

You can do a deep dive on each candidate’s stances on their websites (do your research at
KamalaHarris.com and DonaldJTrump.com) but here’s a quick snapshot of some of the key issues affecting the health of women and people assigned female at birth.

Health Insurance

Affordable Care Act (ACA)

Trump

Donald Trump wants to replace the ACA with “much better healthcare.” During the debate, he mentioned that he has a “concept of a plan” for healthcare reform but has not issued specifics.

Trump campaigned in 2016 on repealing and replacing the ACA. Though that effort failed, his administration made other changes, including zeroing out the penalty for not having insurance, ending certain subsidies, and reducing funding for outreach and enrollment support.

Medicaid

Medicare

Harris

Harris has said she will protect Medicare by taxing millionaires and billionaires and closing tax loopholes.

As vice president, Harris cast the tie-breaking vote for the Inflation Reduction Act, which contained provisions to lower Medicare prescription prices.

The Harris-Biden administration expanded coverage for mental health services and extended coverage for telehealth through December 2024.

Trump

Trump has said he will make no cuts to Medicare and will not change the retirement age, although no specific policies have been shared.

As president, Trump enacted tax reductions that sped up the depletion of the Medicare Part A Trust Fund and repealed a federal board that was intended to slow Medicare spending. He increased Medicare premiums for higher-income beneficiaries. He also relaxed Medicare telehealth rules to make remote care more accessible during the Covid pandemic.

Child Tax Credits and Childcare

Harris

Harris supports a $6,000 tax credit for parents of newborns and enhanced child tax credits ($3,600 for children under 6 and $3,000 for older children).

Harris supports creating federal paid family and medical leave (the current Family and Medical Leave Act guarantees unpaid leave) and enhanced funding for childcare providers. She proposes a cap on childcare costs to no more than 7% of a family’s income.

Trump

Trump has not issued specific policy proposals, but at a New York Economic Club event, Trump stated that his proposals to increase tariffs on foreign imports would reduce the costs of childcare. He also said of childcare, “You have to have it.” Trump’s running mate, JD Vance, has said he supports a $5,000 child tax credit. A more modest proposal failed to pass in the Senate due to Republican opposition.

LGBTQ Health

Harris

Harris has made a campaign commitment to pass the Equality Act, which protects LGBTQ+ people from discrimination.

The Biden-Harris administration reinstated Section 1557 of the ACA, which provides the broadest protections to date for healthcare based on gender identity and sexual orientation, for transgender people, and for gender-affirming care.

Trump

Trump has pledged to prohibit gender-affirming care for young people and block the use of federal funds for gender-affirming care.

Trump has also pledged to “Keep men out of women’s sports” as part of the 2024 Republican pledge to “end left-wing gender insanity.”

As president, Trump created the Division of Conscience and Religious Freedom at HHS and issued final conscience regulation expanded religious protections, which created opportunities for LGBTQ-based discrimination in certain circumstances.

Prescription Drug Prices

Harris

Harris supports expanding the number of drugs that the government can negotiate and extending the $35 insulin cap for Medicare recipients to all Americans.

Harris cast the tie-breaking vote to pass the Inflation Reduction Act (IRA), which requires the government to negotiate drug prices on certain drugs, caps out-of-pocket drug costs and limits insulin costs to $35 per month for Medicare enrollees.

Trump

The Trump administration created a voluntary model for Medicare prescription plans to limit insulin costs to $35 per month and allowed states to import medicines from Canada; however that was later rescinded. Trump initially supported creating a “Most Favored Nation” status for Medicare to limit government spending on certain drugs but has since backed away from that position.

Reproductive Health

Abortion access

Trump

Trump has taken credit for the Supreme Court’s decision to overturn Roe v. Wade, which removed the constitutional right to abortion. He favors letting states decide their own abortion laws, and he personally supports exceptions to abortion bans in cases of rape, incest, and threats to the mother’s life.

Although Trump has held a variety of positions on abortion rights over the years. Recently, he said that laws banning abortion after six weeks go too far, but later stated that he plans to vote for such a measure in Florida, his home state. Trump previously would not commit to vetoing a federal abortion ban if Congress passes one, but more recently posted on social media that he would veto such a ban.

Medication abortion

Harris

Harris supports the FDA decision to improve access to medication abortion pills by allowing them to be mailed.

The Biden-Harris administration opposes the interpretation and enforcement of the Comstock Act to prevent sending abortion medication through the mail.

Trump

Trump has suggested he would block availability of medication abortion pills at times and suggested that he would not block them at other times. Support for leaving abortion policy to the states allows states to block access to all abortion, including medication abortion pills.

Trump has not publicly spoken on his position on the Comstock Act, but many Republican leaders, including his running mate JD Vance, have called for the enforcement of the Comstock Act to prohibit the mailing of medication abortion pills.

Access to contraception

Harris

Harris supports the proposed Right to Contraception Act, which protects the right to contraceptives.

The Biden-Harris administration is fighting a federal lawsuit that challenges ACA requirements to cover preventive services (including contraceptives). The administration has issued executive orders in support of contraception.

Trump

Earlier in the 2024 campaign, Trump said he was open to restrictions on contraceptives but later promised never to ban birth control.

Trump administration policies paved the way for employers with religious objections to exclude birth control from employee health plans. Most Republican members of Congress, including Vance, opposed the Right to Contraception Act.

Fertility treatment/in vitro fertilization (IVF)

Harris

Harris supports guaranteed rights to IVF and supports the ACA, which includes access to coverage before, during and after childbirth. She advocated against a ruling from the Alabama Supreme Court that embryos are children, and therefore cannot be destroyed.

She took a stand against Republicans blocking a bill that would have protected IVF.

Trump

Trump supports access to IVF and said he would require insurance companies to cover the costs but did not detail how he would implement such a requirement.

The Republican platform opposes research using embryonic stem cells (which can be derived from the IVF process).

Maternal health/maternity care

Paid family and medical leave

Harris

In the past, Harris supported 12 weeks of paid leave for most workers, including new parents, caregivers and victims of intimate partner violence. During her presidential run, she has expressed support for paid family and medical leave but has not shared details.



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Coping with the Cost of Cancer Treatment



Finances are not always the first thing people think of when they get diagnosed with cancer. Top questions may be, What’s the prognosis? What are the treatment options? And who are the best specialists?

But more and more, you also have to grapple with the cost of cancer alongside the physical and emotional aspects of cancer. Those costs can truly add up, often catching people by surprise.

Different types of cancer-related costs

Unfortunately, cancer costs come in many forms.

If you have health insurance, you might expect it to cover all your cancer care costs — and it should cover a lot of them. Direct medical costs include tests, medications, procedures, surgeries and some medical supplies. Insurance is likely to cover these costs if they’re considered “medically necessary.” In other words, if your treatment is in line with standard guidelines for your particular cancer and your healthcare providers (HCPs) believe you need it, it’s more likely your insurance will pay for it.

Yet even if your insurance covers direct medical costs, you may have to get their approval in advance (called “prior authorization”). Getting that approval can be its own headache. If your treatment plan is less common or you want to see an HCP who isn’t in your insurance network, you may not get approval.

Beyond the direct medical costs of your cancer treatment, you may come across many other types of expenses. For example, special foods or nutrition supplements may be important, but insurance doesn’t typically pay for them. Or, while medical care may be covered, home health may not be.

If you have to travel to get your care, across town or far away, you need to factor those costs in, too. Whether you have to pay for parking at a downtown hospital or travel to get specialized care away from home, travel costs can be challenging.

If you’re living with cancer, you may need extra help caring for your children, your parents or your pets. You may need more help in your home or doing errands that you may not be able to do yourself for a time. Caregiver costs can be substantial, and for many, may be out of reach.

Cancer costs may be even harder to manage thanks to “opportunity costs,” the missed opportunities to earn money. If you’re in treatment, you may not be able to work or you may have to scale back your hours. Lost wages or the loss of job-based health benefits can turn financial strain into a crisis. In a 2022 Cost of Cancer study conducted by HealthyWomen and CancerCare, nearly half of people in active treatment experienced some financial setback, and 6% lost their job altogether.

Coping with the stress of cancer-related financial challenges

The first step in managing the very real stress of cancer-related costs is to recognize that you are not alone. HealthyWomen’s Cost of Cancer report showed that paying for cancer costs was stressful for 6 out of 10 people surveyed. Nearly 1 of 2 patients with cancer reported feeling stress, worry and a sense of being overwhelmed because of the direct and indirect costs of cancer care.

It’s also important to ask for help — or allow people to help when they offer. The people in your life very likely want to help, but they may need you to tell them what would be most helpful. Perhaps a neighbor can run errands for you, or a close friend can help you with household chores. These gestures can spare you the cost of hiring someone and give you the comfort of knowing you’re not alone.

The emotional strain of a cancer diagnosis is real. The financial parts of cancer only add to those challenges. If you feel anxious, depressed or generally overwhelmed, seeking therapy or other mental health care may also help.

Easing cancer-related financial burdens

Without health insurance, the direct costs of cancer can be crushing. But if you are uninsured, there are ways to get coverage.

If you don’t have health insurance from your job, is there someone in your household who may be able to add you to their coverage? If not, visit the federal Marketplace (Healthcare.gov) or the Marketplace in your state. If you’ve lost your benefits recently, you may be able to sign up even if it’s not during open enrollment. If you have low or no income, you may qualify for generous subsidies.

Depending on your income and the rules in your state, you may qualify for Medicaid, the state-operated health insurance for people with very low incomes. Similarly, depending on your age and condition, you may be able to sign up for Medicare. These programs offer good coverage and a lot of consumer protections, often for free or with very low costs.

With or without insurance, if you’re struggling to pay for medical care, you may qualify for financial assistance from your hospital or clinic. Hospital financial counselors can often help you navigate the hospital’s financial aid process, which may include a formal application. If your application is denied, you may be able to appeal. Medical facilities will also usually set up a payment plan that lets you pay small amounts over time, sometimes without interest. Be honest about what you can comfortably afford.

If you can’t get financial relief from the hospital or medical center itself, the financial counselor may still be able to help. They might help you get support from local community or religious organizations, or from drug maker co-payment relief programs. Some nonprofits will also help you advocate for yourself or negotiate bills on your behalf.

Finally, many people turn to crowdfunding campaigns to raise the money they need. Whether you launch a formal campaign or seek financial help informally, there’s no denying the power of your community to help you cope with the emotional and financial challenges of cancer.

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Lidiar con el costo del tratamiento contra el cáncer



Las finanzas no siempre son lo primero en lo que piensan las personas cuando reciben un diagnóstico de cáncer. Las preguntas principales podrían incluir, ¿cuál es la prognosis? ¿Cuáles son las opciones de tratamiento? Y ¿quiénes son los mejores especialistas?

Pero cada vez más, también deben considerarse los costos del cáncer además de sus aspectos físicos y emocionales. Esos costos pueden sumar montos importantes y frecuentemente las cuentas suelen sorprender a los pacientes.

Varios tipos de costos relacionados con el cáncer

Desafortunadamente, los costos del cáncer son de varios tipos.

Si tienes un seguro médico, podría esperarse que cubra todos tus costos relacionados con el cáncer, y muchos de ellos deberían estar cubiertos. Los costos médicos directos incluyen pruebas, medicamentos, procedimientos, cirugías y algunos suministros médicos. El seguro médico probablemente cubre estos costos si se considera que son “necesarios desde el punto de vista médico”. Es decir, si tu tratamiento concuerda con las pautas estándar de tu cáncer específico y tus proveedores de atención médica (HCP, por sus siglas en inglés) creen que los necesitas, es más posible que tu seguro los pague.

Sin embargo, incluso si tu seguro cubre los costos médicos directos, puede que tengas que obtener su aprobación de antemano (denominada “autorización previa”). Obtener esa aprobación puede ser un dolor de cabeza. Si tu plan de tratamiento es menos común o si deseas mantener consultas con un proveedor de atención médica que no es miembro de la red de tu seguro, es probable que no obtengas la aprobación.

Aparte de los costos médicos directos de tu tratamiento contra el cáncer, podrías tener muchos otros tipos de gastos. Por ejemplo, alimentos o suplementos nutricionales especiales podrían ser importantes, pero los seguros comúnmente no los cubren. O, aunque la atención médica esté cubierta, servicios médicos proporcionados en el hogar podrían no estarlo.

Si debes viajar para obtener tu atención médica, al otro lado de la ciudad o a una gran distancia, también debes considerar estos costos. Ya sea que debas pagar por el parqueadero de un hospital en el centro de la ciudad o que tengas que viajar para obtener atención especializada lejos de tu hogar, los costos de viajes pueden ser un desafío.

Si vives con cáncer, podrías necesitar ayuda adicional para el cuidado de tus hijos, de tus padres o de tus mascotas. Podrías necesitar más ayuda en tu hogar o con mandados que tú no podrías hacer durante algún tiempo. Los costos de cuidadores podrían ser considerables y, para muchos, impagables.

Los costos del cáncer podrían ser incluso más difíciles de manejar debido a los “costos de oportunidad”, es decir, las oportunidades que se pierden para ganar dinero. Si estás teniendo un tratamiento, es posible que no puedas trabajar o que tengas que recortar tus horas laborales. La pérdida de salarios o de beneficios médicos de tu trabajo podría transformar una dificultad financiera en una crisis. En un estudio del costo del cáncer de 2022 realizado por HealthyWomen y CancerCare, casi la mitad de personas que recibían tratamiento activamente experimentaron algún tipo de pérdida financiera y el 6% incluso perdieron sus trabajos.

Lidiar con el estrés de las dificultades financieras relacionadas con el cáncer

El primer paso para manejar el estrés muy real de los costos relacionados con el cáncer es reconocer que no estás sola. El informe de los costos del cáncer de HealthyWomen mostró que pagar por los costos del cáncer era estresante para 6 de cada 10 personas encuestadas. Casi 1 de cada 2 pacientes con cáncer reportó sentir estrés, preocupación y presión debido a los costos directos e indirectos de la atención contra el cáncer.

También es importante pedir ayuda o permitir que personas ayuden cuando ofrecen hacerlo. Las personas en tu vida muy posiblemente desean ayudar, pero es posible que ellos necesiten que les digas que sería lo más útil para ti. Tal vez un vecino pueda encargarse de mandados o un amigo cercano podría ayudarte con quehaceres del hogar. Estos gestos podrían ahorrarte el costo de contratar a alguien y podrían darte una sensación de seguridad al saber que no estás sola.

El desgaste emocional de un diagnóstico de cáncer es real. Los aspectos financieros del cáncer solo dificultan más esos desafíos. Si te sientes angustiada, deprimida o generalmente abrumada, obtener terapia u otro tipo de atención de la salud mental también podría ser útil.

Mitigar las cargas financieras relacionadas con el cáncer

Sin un seguro médico, los costos directos del cáncer pueden ser devastadores. Pero si no tienes un seguro médico, hay formas en las que puedes obtener cobertura.

Si no tienes un seguro médico de tu trabajo, ¿hay alguien en tu hogar que pueda agregarte a su cobertura? Si no es así, visita el mercado virtual federal de seguros médicos(Healthcare.gov) o el de tu estado. Si perdiste tus beneficios recientemente, podrías inscribirte incluso si no es durante el período de inscripciones abiertas. Si tus ingresos son bajos o inexistentes, podrías cumplir con los requisitos para subsidios generosos.

Dependiendo de tus ingresos y de las regulaciones de tu estado, podrías cumplir con los requisitos de Medicaid, el seguro médico que maneja tu estado para personas con muy pocos ingresos. Asimismo, dependiendo de tu edad y de tu condición, podrías inscribirte en el programa de Medicare. Estos programas ofrecen buenas coberturas y muchas protecciones para los consumidores, frecuentemente gratis o a costos muy bajos.

Con o sin seguro, si tienes dificultades para pagar por atención médica, podrías cumplir con los requisitos para recibir asistencia financiera de tu hospital o clínica. Asesores financieros del hospital frecuentemente pueden orientarte en el proceso de asistencia financiera del hospital, la cual podría incluir una solicitud formal. Si rechazan tu solicitud, es posible que puedas apelar dicha decisión. Las intervenciones médicas usualmente también establecerán un plan de pagos que te permita pagar montos pequeños cada cierto tiempo, a veces sin intereses. Sé honesta acerca de lo que puedes pagar en forma cómoda.

Si no puedes obtener asistencia financiera del hospital o del centro médico, es posible que el asesor financiero pueda proporcionar otro tipo de asistencia. Podría ayudarte a que recibas apoyo de alguna comunidad local o de organizaciones religiosas, o incluso, de programas de asistencia de copagos del fabricante del medicamento. Algunas organizaciones sin fines de lucro también te ayudarán a defender tus derechos o a negociar cuentas por ti.

Finalmente, muchas personas recurren a campañas de financiamiento colectivo para recaudar el dinero que necesitan. Ya sea que simplemente sea una campaña formal o que trates de obtener asistencia financiera en forma informal, no se puede negar el poder de tu comunidad para ayudarte a lidiar con las dificultades emocionales y financieras relacionadas con el cáncer.

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