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As a physician who has practiced medicine in Indiana for more than 24 years, I have watched countless patients suffer from the chronic conditions of obesity and type 2 diabetes. These conditions aren’t just numbers on a scale, they deeply impact people’s health and quality of life, affect their ability to work, and shorten lifespans.
That’s why the state’s decision to remove GLP-1 medication coverage from the state employee health plan is not just shortsighted, it’s also fiscally harmful.
In my career as a cardiologist, one of the most significant advances in cardiometabolic care that I have seen are the GLP-1 receptor agonist-based medicines. As a medicine that mimics naturally occurring GLP-1, they have an amazing impact on a person’s cardiometabolic health. They reduce the risk of heart attack, heart failure and stroke. Kidney disease and liver disease are stabilized, and often the disease process is reversed, reducing the likelihood of need for dialysis and costly admissions.
One of the biggest drivers of loss of worker productivity is joint pain, and the GLP-1 medications help here as well by reducing joint pain. They are currently being evaluated for prevention of cancers and back pain. The list of benefits is seemingly endless, with much of the benefit coming before people lose weight. The weight loss, which is frequently more than 15% of body weight, is a very meaningful secondary benefit.
Decades of telling people to “eat less and move more” have resulted in an increasingly obese population, triggering heart failure and cardiovascular admissions to our already strained hospital systems. In what is a predominantly genetically driven disease in an environment with poor-quality, processed foods, most people face a set of chronic cardiometabolic challenges that make sustained weight loss near impossible without medical intervention.
Even if a person is able to lose weight, 80% of those people gain it back and begin the harmful process of weight cycling, a condition of considerable medical harm. GLP-1 medications can help patients achieve meaningful weight loss, reducing the likelihood of admission to the hospital and the need for time off work. Most important, they give the individual a pathway to health.
Despite GLP-1’s incredible impact on health, Indiana is choosing to penalize people with obesity and remove access to a very effective, evidence-based treatment that improves their health.
While the immediate costs to the state budget from this policy change can seem difficult in the short term, the cost of medication is rapidly coming down, particularly with the emergence of the new oral GLP-1s. Left without treatment, people with obesity often develop other long-term chronic conditions, such as heart, kidney and liver disease as well as joint pain and cancer, which are even costlier. Untreated obesity and poorly controlled diabetes often lead to a host of downstream costs, including unnecessary emergency room visits for cardiac complications and joint pain.
Obesity increases the cost of hospitalizations, and obese patients often require more prolonged stays. Increased cost of interventions such as chemotherapy or coronary bypass surgery, disability claims and lost workforce productivity are also the financial price that is paid when obesity is treated with the “diet and exercise” approach. Such costs could be prevented if the state chose to continue covering the medicine people need to treat their chronic disease and stop their health from worsening.
As a physician, it is my highest honor and duty to uphold the oath to do no harm. But perhaps a greater oath is to prevent harm. I can’t help but wonder if the policymakers behind this decision have ever thought to observe their work through that lens: of doing no harm and preventing harm. Cutting corners to save money by undercutting access to a scientifically proven treatment does not actually save money for the state if the later-term health care will be more expensive for the state.
Indiana can do better. I urge state leaders to reconsider the decision to roll back the coverage before an aftershock of effects leaves the state with less money and a less healthy population.•
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Bashall is co-director of the American Heart Association’s Cardio Kidney Metabolic Center Alliance and a physician at Franciscan Health Indiana Heart Physicians and Major Health Partners.
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