President-elect Donald Trump's pick to lead the National Institutes of Health (NIH) suggested obese people should pay higher health insurance premiums, Newsweek can reveal.
Jay Bhattacharya, a professor at Stanford University School of Medicine who was selected to run the nation's leading medical research agency on Tuesday, suggested increasing insurance premiums for obese people would mitigate against the costs of treating obesity related health conditions.
His comments, made in academic papers seen by Newsweek, indicate what his policies and positions might be in the White House. A health law expert has called them "ludicrous."
Newsweek has contacted Bhattacharya and the Trump team by email to comment on this story.
The cost of healthcare has long been a hot topic in the US. Some Republicans are against health insurance subsidies provided through the Affordable Care Act which lower the cost of insurance for eligible Americans. The subsidies are set to expire at the end of 2025 when Congress will vote on whether to renew them.
Obesity specifically is a rising cause for concern among health policymakers. According to the Centers for Disease Control and Prevention, around 40 percent of all American adults are obese, as of August 2023, making them more susceptible to conditions such as Type 2 diabetes, heart disease and cancers, which in turn are associated with health costs.
On Tuesday, President Joe Biden's administration unveiled a proposal to allow people to obtain anti-obesity drugs via Medicare and Medicaid.
Bhattacharya wrote about the costs associated with obesity in at least three academic papers as part of his research career into the economics of healthcare. In one January 2006 paper called Health Insurance and the Obesity Externality, Bhattacharya and his co-author, public policy professor Neeraj Sood, argued that obese people create surging healthcare costs which are subsidized by collective insurance payments; and if they pay greater health insurance premiums, they will be incentivized to lose weight.
"As long as insurance premiums are not risk-rated for obesity, health insurance coverage systematically shields those covered from the full costs of physical inactivity and overeating," they wrote.
"Since the obese consume significantly more medical resources than the non-obese, but pay the same health insurance premiums, they impose a negative externality on normal weight individuals in their insurance pool."
In another passage in the paper, they wrote: "If premiums adjust to reflect weight gain (or loss) then the change in premiums internalizes the medical care costs of weight gain. In this actuarially fair premiums case, even if individuals are fully insured, they will still have an incentive to decrease expected medical care expenditures through weight loss."
They added that insurance plans could access body weight information in medical records when setting the price of premiums. "In public insurance settings, subsidies could be given to individuals who maintain healthy body weight," they wrote.
In a working paper called Does Health Insurance Make You Fat?, published in July 2009 by the National Bureau of Economic Research and co-written by Kate Bundorf, Noemi Pace and Sood, the authors reaffirmed the argument that health insurance subsidizes obese people, causing them to have no incentive to lose weight.
"Our results indicate that health insurance does indeed make you fat," they wrote.
"In a health insurance pool with inadequately risk-adjusted premiums, one person's increase in body weight really is everyone else's business, since obesity often leads to higher medical expenditures."
"When insurance premiums do not depend on weight, consumers do not view the reduction in medical expenditures as an additional benefit of weight loss when making decisions about bodyweight."
In a third paper, Who Pays for Obesity?, published by Bhattacharya and Sood in a 2011 edition of the Journal of Economic Perspectives, the authors posited: "If health insurance premiums are risk-adjusted to reflect expected costs related to obesity, then these costs would be internalized and not be passed on to others."
Bhattacharya is not the only public figure to have made such suggestions. Eric Hovde, a Republican who ran and narrowly lost against Democrat incumbent Tammy Baldwin for the Wisconsin Senate in November's election, called for obese people to pay more for healthcare in a July 2012 interview with WisconsinEye, The Daily Beast reported.
Newsweek has contacted Hovde via email for comment.
James Hodge, a law professor and director of the Arizona State University Center for Public Health Law, called Bhattacharya's position "ludicrous" and discriminatory.
"Incentivizing healthy behaviors is a standard mantra of public health messaging," he told Newsweek. "Punishing persons through the rescission of access to care—via higher costs for insurance, for example—for conditions that are not caused directly by their specific choices, runs counter to public health ethics, legal principles, and ultimately is an affront to healthy societies."
He added: "There are so many health behaviors for which one may run similar analyses and conclude access to health insurance—which in the U.S. is virtually equivalent to access to health services—incentivizes one to engage in such behaviors.
"Taken to the extreme, access to health insurance would be a contributing factor to a plethora of human conditions tied to individual choices, notwithstanding the fact that these 'choices' are not the root causes of the underlying conditions.
"The causes of rising rates of obesity in the U.S.—and globally—are multifarious. Access to health insurance/care is not a primary one in my view. To suggest otherwise leads to patent levels of discrimination in the provision of health services which the Affordable Care Act, Americans with Disabilities Act, and other laws prohibit."
Bhattacharya's views on other health issues have previously drawn scrutiny. In 2020, then NIH director Francis Collins and other public health officials rejected the Great Barrington Declaration, an open letter which Bhattacharya co-authored that argued against lockdowns and promoted herd immunity during the coronavirus pandemic.
Trump said in a statement that Bhattacharya will work with Robert F. Kennedy Jr., who he has chosen to run the Department of Health and Human Services, "to direct the nation's medical research, and to make important discoveries that will improve health, and save lives."
After his appointment, Bhattacharya posted on X, formerly Twitter, that he was "humbled" to be picked.
"We will reform American scientific institutions so that they are worthy of trust again and will deploy the fruits of excellent science to make America healthy again!" he said.
Trump has nearly finalized his picks for his next Cabinet. Newsweek previously revealed that Sean Duffy, the nominee for secretary of the Department of Transportation, previously lobbied on behalf of interests at odds with some of Trump's positions.
Other high-profile nominations include former Fox News host Pete Hegseth for defense secretary and South Dakota Governor Kristi Noem for secretary of the Department of Homeland Security.
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