The assault on healthcare for America’s most vulnerable is not only coming from Washington. It’s creeping into statehouses across the nation — even here in the commonwealth.
In Pennsylvania, Medicaid beneficiaries rang in the New Year without the obesity treatments they previously had access to, thanks to the actions of policymakers who moved to prohibit Medicaid coverage to meet tighter state budget benchmarks.
As a cardiologist who has spent my career treating many Black and brown patients, I have witnessed the consequences of unmanaged obesity play out in the most brutal and preventable ways: men in their 40s having heart attacks, women with decades of life ahead of them receiving stroke diagnoses, and heart failure caught too late for treatment to make a real difference. I have sat with families and explained that the disease that took their loved one was manageable — if caught earlier, with the right treatment. It’s devastating.
That’s why Pennsylvania’s decision to strip Medicaid coverage for obesity medications, effective Jan. 1 of this year, is a sign of further catastrophe that may be coming.
Pennsylvania has long been heralded as a champion of health equity, but our legislature is unintentionally sending a message that advances in medicine should be reserved for the privileged, the justification being cost. However, this rationale suffers from tunnel vision — the cost of untreated obesity and its complications is far greater. Treating obesity prevents its complications and saves money.
Obesity is not a lifestyle failure. It is a chronic disease that exacerbates cardiovascular conditions, already killing Black and brown Pennsylvanians at disproportionate rates. Obesity costs the U.S. nearly $173 billion annually in direct medical costs and more than $1.4 trillion in total economic impact. Cutting access to treatment will only worsen the obesity epidemic and continue to drive up costs.
Nearly 60% of Black women live with obesity, along with half of all Black and Latino adults. Pennsylvania is home to approximately 3.5 million adults living with obesity — one in three residents, irrespective of race or ethnicity. That number is projected to reach one in two by 2030. But for Black and brown communities, already burdened by decades of systemic underinvestment in preventive care and access to healthy food, the cardiovascular consequences of untreated obesity are the daily reality of emergency rooms and cardiac units across Philadelphia, Pittsburgh, Harrisburg, and everywhere in between.
Gaps in state budgets shouldn’t be closed by compromising the health of the underserved, communities of color, those with disabilities, and millions of others who depend on public healthcare coverage. Access to healthcare should be more than just a budget debate — it’s both a civil rights and a human rights issue.
At the same time, when patients cannot access FDA-approved obesity medications through Medicaid, they resort to whatever fills the void. Right now, that means a predatory market of unregulated, potentially unsafe, compounded GLP-1 drugs aggressively marketed to low-income communities.
Attorney General Dave Sunday has already warned Pennsylvanians about the dangers of these products. The Shapiro administration itself fined a Chester County pharmacy $1 million for producing unauthorized injectable weight-loss drugs. The state knows this market exists, but fails to see how cutting Medicaid coverage for FDA-approved treatments drives patients straight into it.
State Rep. Justin Fleming (D., Dauphin) has introduced the GLP-1 Safety Act, which would crack down on illegal compounders and protect Pennsylvanians from dangerous counterfeit medications. His bill deserves passage.
However, enforcement without access is not a health policy. It forces patients to choose between nothing and something dangerous. For Black and brown patients in Pennsylvania, this is not hypothetical, but their current reality.
Pennsylvania once led the nation by expanding Medicaid to cover chronic conditions like obesity. But now, with Washington dismantling Medicaid at the federal level — 310,000 Pennsylvanians are projected to lose coverage under federal cuts beginning this year — it’s important that the state moves in the right direction at the state level.
Choosing exclusion and shortsighted cuts is weak policy and will not achieve future healthcare savings. Pennsylvania can once again lead in equitable access to obesity treatment. Our shared progress in the fight against obesity is not negotiable.
Marietta Ambrose is a cardiologist in Philadelphia and is affiliated with the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center. She is a member of the Association of Black Cardiologists.