By Elena Rios, MD, MSPH, MACP
Obesity continues to drive health disparities across the state, yet California policymakers cut access to the most effective treatment available.
Latinos make up 40% of California’s population and more than half of Medi-Cal enrollees; this population is already facing a whirlwind of unintended consequences because of inconsistent approaches to obesity care. Every day I see how the chronic condition negatively impacts my patients’ health, livelihoods and futures. Many are trying to manage it while working demanding jobs, caring for family members and navigating everyday challenges. By cutting access to proven treatments like GLP-1s, the state didn’t just change a coverage policy; it removed a lifeline for communities that have spent generations fighting for equitable access to care.
Many Medi-Cal enrollees who were on GLP-1s before January 1 are already losing the cardiometabolic benefits associated with consistent treatment – blood pressure, cholesterol and glucose levels will return to previously higher levels. These resurging symptoms will exacerbate many of the disparate challenges our community consistently faces, including one of the highest obesity rates and “prescription gaps,” meaning Latinos are less likely to be prescribed medications than their white counterparts even when adjusting for socioeconomic factors, structural barriers or implicit bias in health care settings.
I grew up in a community where access to basic necessities, like healthy foods, modern medicine and Spanish-language resources, were limited not by a lack of effort but because of systemic barriers built into the system. When people cannot access information in a language they understand, health care becomes harder to access, and trust becomes harder to build.
For patients with obesity, that concern is often compounded by stigma. Often, people will experience a “white coat shock” once they reach their doctor’s office. The stress of being in a clinical environment and fear of being misunderstood by a provider leave patients mired with anxiety. Too often, their symptoms and conditions are reduced to a matter of willpower, overlooking many of the biological, environmental, cultura, and socioeconomic factors that shape health. Patients deserve support and evidence-based treatment, not blame.
Breaking down barriers and improving communication between doctors and patients are the driving forces behind my entire career. We’ve made progress, but it is a shame that decades of work to build trust and improve access could become undone by a hasty, ill-informed decision to revoke access to a cost-effective treatment that helps people become healthier. Now, instead of refilling prescriptions, I am forced to give a Policy 101 spiel explaining how this reversal happened. I would much rather be discussing my patients’ health and needs.
Some argue that patients can simply restart GLP-1 treatment down the line and pick up right where they left off, but emerging research indicates that is not always the case. A recent analysis by Penn Medicine found that consistent usage yields the most effective results. Cycling GLP-1s on-and-off makes the medication less effective with each new round of treatment, slowing down weight loss and halting progress. Treatment adherence is just as important as access – it also makes financial sense.
Even modest weight loss is associated with meaningful reductions in health care spending, while greater weight loss can reduce costs by 30% or more. Patients who achieve approximately 25% weight loss can see annual health care costs fall by more than $5,000. When scaled across California’s population, the impact is substantial: $40.7 billion to $176.5 billion in cumulative medical cost savings over the next decade.
On the other hand, lack of action could lead to $4 billion in higher Medi-Cal spending and $6.9 billion in higher health care costs for employers as a result of health-related absenteeism and workers’ compensation and disability.
California’s decision to eliminate GLP-1 coverage sent the message that Medi-Cal beneficiaries don’t deserve modern health care, and that obesity is not worthy of sustained treatment, despite overwhelming evidence to the contrary. If state policymakers would like the advice from a Latino physician, the most patient-forward policies are typically the most fiscally-sound. Reinstating GLP-1 coverage within Medi-Cal is how we can save money and, more importantly, keep Californians healthy.
Elena Rios, MD, MSPH, MACP is the President of the National Hispanic Health Foundation. From 1994-1998, Dr. Rios served as the Advisor for Regional & Minority Women’s Health in the U.S. Department of Health and Human Services.