Protecting Health Care for All Patients Act of 2025
HB3864, titled the “Protecting Health Care for All Patients Act of 2025,” would prohibit the use of quality-adjusted life years (QALYs) and similar comparative-effectiveness measures in coverage, reimbursement, and payment decisions under federal health care programs. The bill expands existing Social Security Act protections by barring federal agencies, states, and certain program administrators from using measures that value extending the life of elderly, disabled, or terminally ill individuals as less valuable than extending the life of younger, non-disabled, or non-terminally ill individuals.
The bill applies this prohibition across Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), Medicare Advantage, Medicare Part D, and other federal health programs, and it also limits the use of these measures in demonstrations and waiver programs. It directs conforming changes to Medicaid managed care and state child health plans, and it delays implementation until January 1, 2027. In addition, it revises funding levels for the Prevention and Public Health Fund for fiscal years 2026 through 2031 and requires the Comptroller General to report annually on the effects of QALYs on access to care for individuals with intellectual and developmental disabilities.
The bill’s practical impact would be to constrain how federal and state health programs evaluate the cost-effectiveness of treatments, especially where those evaluations might disadvantage older adults, people with disabilities, or people with terminal illnesses. It would affect agencies, state Medicaid programs, managed care organizations, and Medicare plans by removing QALY-based tools from coverage and payment determinations and by making those restrictions non-waivable in many demonstration or waiver contexts.
The available context shows no recorded committee debate or votes, so there is no documented floor or committee sentiment in the provided materials. Based on the bill text, the measure appears framed as a patient-protection and disability-rights bill, with an emphasis on preventing discriminatory valuation of life-extending care. The main likely point of contention is that supporters may view QALY restrictions as necessary to prevent discrimination, while critics may argue that banning these measures limits cost-effectiveness analysis and could make it harder for public programs to manage spending and prioritize treatments.
The bill would amend the Social Security Act and related federal health program provisions to prohibit QALY-based and similar measures in coverage and payment decisions across Medicare, Medicaid, CHIP, Medicare Advantage, and Part D, while also extending the prohibition to certain federal and state waiver and demonstration authorities. It would require conforming changes to Medicaid state plans, managed care contracts, and state child health plans, and it would direct the Comptroller General to produce recurring reports on the impact of QALYs on access to care for people with intellectual and developmental disabilities. The bill also revises scheduled appropriations from the Prevention and Public Health Fund for fiscal years 2026 through 2031.
No committee transcripts or votes were provided, so there is no direct recorded sentiment from legislative discussion or roll call history. The bill’s title and findings suggest supportive framing around equal access to care and opposition to discriminatory rationing tools, especially for elderly, disabled, and terminally ill patients. The absence of recorded opposition in the supplied materials means any broader sentiment can only be inferred from the bill’s purpose, not from debate history.
The central policy dispute is over the use of QALYs and similar cost-effectiveness metrics in public health coverage decisions. Supporters are likely to argue that these tools can undervalue the lives of older adults, people with disabilities, and terminally ill patients, and that banning them is necessary to prevent discrimination. Opponents are likely to contend that such measures are useful for comparing treatment value and controlling costs in public programs, and that prohibiting them could reduce flexibility in coverage and payment policy. The bill also potentially raises concern among budget-focused policymakers because it restricts a common health economics tool while simultaneously altering Prevention and Public Health Fund allocations.