The House passed GOP legislation on Wednesday that would prohibit all federally funded healthcare programs from using cost-saving practices that discriminate against people with disabilities.
The Protecting Health Care for All Patients Act, HR 485, passed 211 to 208 along party lines. It would prohibit all federal healthcare payers from using quality-adjusted life years, or QALYs, and other similar measures to determine patient coverage.
Under the Patient Protection and Affordable Care Act, also known as Obamacare, Medicare was prohibited from using QALYs for rationing care to senior citizens. Other federal health programs, including the Veterans Affairs system and Medicaid, which treat many disabled patients, have been allowed to use QALYs in cost-benefit analysis in providing care.
“Measurements like QALYs remove the consideration of unique circumstances and health conditions of a patient and their doctor’s judgment from deciding what’s best for the patient,” said Energy and Commerce Committee Chairwoman Cathy McMorris Rodgers (R-WA), the author of the bill.
Rodgers also referenced her experience as an advocate for her son, Cole, who has Down syndrome.
“Cole and others with disabilities deserve every opportunity to succeed,” Rodgers said. “We shouldn’t be discounting their potential or prejudging their quality of life just because of their disabilities.”
More than 100 other patient advocacy organizations supported the legislation, calling QALYs an “antiquated metric” that does not meet science-based standards of care.
“Evidence shows QALYs lack scientific rigor and don’t reflect patient preferences,” said Terry Wilcox, CEO of Patients Rising. “They fail to capture what truly matters: meaningful health improvements and individual values. … HR 485 is a step towards a future where healthcare prioritizes people, not outdated and biased metrics.”
Several Republicans rose in support of the bill.
“QALY metrics intentionally devalue the treatments for disabled and chronically ill patients in determining whether it is cost-effective,” said Rep. Brad Wenstrup (R-OH), the co-chairman of the GOP Doctors Caucus. “In other words, [QALYs] tell the patient you’re not worth it.”
Rep. Pete Stauber (R-MN) emphatically spoke in support of the bill, referencing his experience as a father of a child with Down syndrome.
“The use of quality-adjusted life years is disgusting,” Stauber said. “This is called rationalized healthcare.”
Rep. Frank Pallone (D-NJ), the top Democrat on the Energy and Commerce Committee, called HR 485 “dangerous legislation” because of its built-in cuts to public health prevention funds directed largely toward pandemic and other emergency preparedness.
Pallone said the bill gives a “blank check” to the pharmaceutical industry by removing a central tool in keeping healthcare costs down.
“Republicans agree that we must lower the cost of prescription drugs, and we have worked on it,” Rodgers said. “Discriminatory metrics against people with disabilities is not the way to do it.”
Last year, former Democratic California Rep. Tony Coelho, author of the Americans with Disabilities Act, supported the Protecting Health Care for All Patients Act as a means to ban QALYs and similar cost analysis measures.
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“Congressional Democrats decided to bar QALYs and similar measures in Medicare long ago when passing the ACA,” Coelho said at the time. “The Protecting Health Care for All Patients Act is a rare opportunity to strengthen the existing ACA protections against discrimination with support from Republicans.”
“I hope that banning the use of discriminatory measures by federal payers against people with disabilities and chronic illness — and affirming every person’s life has value — is something we can come together on,” Rodgers said.
