Taxpayer-funded weight loss bill deserves veto

Republican Gov. Jeff Landry, if he considers costs and outcomes, has good reason to veto SB 433.

The bill by Democrat state Sen. Gerald Boudreaux, after a few iterations, would have the state cover for Medicaid weight loss drugs for obesity, as prescribed. Louisiana Medicaid already covers it for clients where weight gain is a consequence of a chronic condition, which this expansion would not require. This has a five-year estimated cost of $72 million.

Here, the thinking is that obesity causes other maladies that eventually could fall under Medicaid treatment, hence needing state taxpayer support (although Louisiana typically has between 60-70 percent of costs covered by the federal government, so the bill has the Department of Health promulgate standards that would be consistent with federal regulations). By preventing obesity, the guess is that the use of semaglutide, the chemical in the drugs practically speaking that would have to be prescribed, would cost less than the eventual cost of treatment for other preventable conditions.

But not only is this fraught with danger for clients, it’s also swimming against the policy tide. People tend to look for silver bullets to cure what ails them rather than take natural measures as the latter requires more individual effort, which has led to a huge increase in prescribing such drugs meaning, by definition, people less and less obese take them, and by making it a free benefit that will provoke even more Louisianans to ask for such latitude.

The problem is, the known, shorter-term side effects increasingly are understood to be widespread and often severe, which include most prevalently nausea, fatigue, vomiting, constipation, and diarrhea. Neuroscientists and former child actress Mayim Bialik recently recounted her harrowing experience taking it, in the process highlighting just how severe and widespread these symptoms are among the public.

Perhaps enduring these – and the drug is taken for a lifetime, although the symptoms often diminish over time – might make sense for someone whose obesity is severe and itself could spawn other unfavorable medical conditions, but the economics of the situation and patient and doctor attitudes likely would provide incentives for those not very obese to take it when other and more interventions would avoid bad side effects. Should taxpayers foot the bill to cause a significant portion of recipients to stay prisoners in their own homes because their reactions are so bad that they can’t make it outside?

With some portion quitting use because reactions are so negative, that’s a waste of taxpayer funds. Further, these are only the known short-term effects; the drugs haven’t been on the market long enough to understand what the long-term impact would be. It makes little sense to plunge ahead when potential damage could be great but known only after collection of more data.

And, as the state contemplates on expanding free access, many other governments are pulling back, at least for populations to which Louisiana wants to expand. Spiraling costs explain much, but also concerns over health implications and value have driven these decisions.

The bill tries to create space for regulatory action that might limit eligible clients, but the fact is much cheaper and less risky solutions exist (along the lines of the Make America Healthy Again movement concentrating on food selections and intake), although these require ongoing individual effort. When evaluating costs and benefits, it’s a bill Landry must veto.