H.R. 4818 · 118th Congress
Treat and Reduce Obesity Act of 2023
Rep. Wenstrup, Brad R. [R-OH-2] (R-OH) · Introduced · 120 cosponsors
This bill died in the 118th Congress
The 118th Congress adjourned without passing it, so it can never become law in this form. It reached the Reported stage. A bill covering the same ground would have to be reintroduced from scratch in a new Congress — this is why most bills die, and why reintroduction matters.
Latest action
Reported (Amended) by the Committee on Ways and Means. H. Rept. 118-959, Part I.
· from Congress.gov, as of August 8, 2026
Committees
Study this bill
AP GovThe constitutional question
None — and that is the lesson. The Treat and Reduce Obesity Act had bipartisan sponsors, broad cosponsorship, and no constitutional controversy. It died anyway, in the 118th Congress, because its CBO score (Medicare coverage of anti-obesity medication is expensive) never fit a budget vehicle. Most bills die exactly this quietly.
The strongest case for
Medicare covers the bariatric surgery that costs tens of thousands of dollars but not the medications and intensive behavioral therapy that could prevent it — a coverage rule written in 2003, before modern GLP-1 drugs existed, that current law forbids CMS to update. Obesity drives diabetes, heart disease, and joint replacement costs Medicare already pays for; treating the upstream condition is how every other chronic disease is handled. With over 40% of seniors affected, the exclusion is both medically outdated and fiscally shortsighted — the drugs' list prices will fall with competition, and the downstream savings are real even if CBO's ten-year window can't capture them.
The strongest case against
Covering GLP-1s for the Medicare population at list prices approaching $1,000 a month, for a condition affecting four in ten seniors, is one of the most expensive coverage expansions ever proposed — estimates ran to tens of billions annually, and CBO scores costs inside the window while the promised offsetting savings arrive, if ever, outside it. Coverage mandates at today's prices also remove the manufacturers' incentive to cut them. Demand at these prices would strain Part D premiums for every enrollee, covered or not. Congress declining to enact an open-ended entitlement expansion until prices fall or evidence of net savings matures is not neglect — it is what budget discipline looks like.
Foundational documents in play
- U.S. Constitution
Medicare coverage rules are spending-power policy; changing them is a budget question before it is a health question.
Organizations supporting
Organizations opposing
This has happened before
Versions of TROA have been introduced in every Congress since 2012. The 118th's version got further than any before — a Ways and Means markup — and still died at adjournment, sine die. The fight then moved to the executive branch: CMS proposed covering the drugs by rule in late 2024, and the incoming administration withdrew the proposal in 2025. When Congress won't decide, the bureaucracy does — until the next administration undecides.
Practice FRQ
Concept Application. "A bipartisan Medicare coverage bill has been introduced in every Congress since 2012, received its first committee markup in 2024, and died when that Congress adjourned." (A) Describe what happens to pending legislation when a Congress adjourns sine die. (B) Explain how the Congressional Budget Office's cost estimates influence which bills advance. (C) Explain why executive-branch rulemaking became the alternative venue for this policy, and one limit of that path.
Sources: www.congress.gov · www.cbo.gov
Action history
Every recorded action from Congress.gov — 9 total.
Reported (Amended) by the Committee on Ways and Means. H. Rept. 118-959, Part I.
House
Reported (Amended) by the Committee on Ways and Means. H. Rept. 118-959, Part I.
House
Committee Consideration and Mark-up Session Held
House
Ordered to be Reported in the Nature of a Substitute (Amended) by the Yeas and Nays: 36 - 4.
House
Referred to the Subcommittee on Health.
House
Introduced in House
House
Introduced in House
House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.