Protecting Health Care for All Patients Act of 2025
This bill prohibits all federal health care programs, including the Federal Employees Health Benefits Program, and federally funded state health care programs (e.g., Medicaid) from using prices that are based on quality-adjusted life years (i.e., measures that discount the value of a life based on disability, age, or terminal illness) to determine relevant thresholds for coverage, reimbursements, or incentive programs.
The Government Accountability Office must annually report on how the use of quality-adjusted life years negatively affects individuals with intellectual and developmental disabilities.
The bill also reduces funding for the Prevention and Public Health Fund for FY2026-FY2031.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3864 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 3864
To amend title XI of the Social Security Act to prohibit the use of
quality-adjusted life years and similar measures in coverage and
payment determinations under Federal health care programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 10, 2025
Mrs. Cammack (for herself and Mr. Hern of Oklahoma) introduced the
following bill; which was 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
_______________________________________________________________________
A BILL
To amend title XI of the Social Security Act to prohibit the use of
quality-adjusted life years and similar measures in coverage and
payment determinations under Federal health care programs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Protecting Health Care for All
Patients Act of 2025''.
SEC. 2. PROHIBITING THE USE OF QUALITY-ADJUSTED LIFE YEARS AND SIMILAR
MEASURES IN COVERAGE AND PAYMENT DETERMINATIONS UNDER
FEDERAL HEALTH CARE PROGRAMS.
(a) In General.--Section 1182(e) of the Social Security Act (42
U.S.C. 1320e-1(e)) is amended--
(1) by inserting ``or treats extending the life of an
elderly, disabled, or terminally ill individual as of lower
value than extending the life of an individual who is younger,
non-disabled, or not terminally ill'' after ``because of an
individual's disability'';
(2) by inserting ``described in the preceding sentence''
after ``such a similar measure'';
(3) by striking ``The Secretary shall not'' and inserting
``A Federal agency (including the CMI (as described in section
1115A)) or State may not'';
(4) by striking ``under title XVIII.'' and inserting the
following: ``under any Federal health care program (as defined
in section 1128B, except that such term shall include the
health program established under chapter 89 of title 5, United
States Code).''; and
(5) by adding at the end the following new sentence:
``Notwithstanding any other provision of law, a Federal agency
(including the CMI) or State may not waive the application of
the provisions of this subsection (or the provisions of section
1852(o), section 1860D-12(h), section 1902(a)(88), section
1932(b)(9), or section 2102(e)) under section 1115, section
1115A, or any other demonstration or waiver authority.''.
(b) Conforming Amendments.--
(1) Medicaid.--
(A) In general.--Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)) is amended--
(i) in paragraph (86), by striking ``and''
at the end;
(ii) in paragraph (87)(D), by striking the
period and inserting ``; and''; and
(iii) by inserting after paragraph (87) the
following new paragraph:
``(88) provide for compliance with the requirements of
section 1182(e) (relating to prohibiting the use of certain
measures in coverage determinations, reimbursement, and
incentive programs).''.
(B) Managed care organizations.--Section 1932(b) of
the Social Security Act (42 U.S.C. 1396u-2(b)) is
amended by adding at the end the following new
paragraph:
``(9) Prohibition on use of quality-adjusted life years.--
The provisions of section 1182(e) shall apply to the
utilization of a dollars-per-quality adjusted life year or
similar measure (as described in such section) by a medicaid
managed care organization under this title (or a prepaid
inpatient health plan or prepaid ambulatory health plan, as
defined in section 438.2 of title 42, Code of Federal
Regulations (or any successor regulation), under a contract
with the State) in the same manner as such provisions apply to
the utilization of such a year or measure by a State under this
title.''.
(2) CHIP.--Section 2102 of the Social Security Act (42
U.S.C. 1397bb) is amended by adding at the end the following
new subsection:
``(e) Prohibition on the Use of Quality-Adjusted Life Years and
Similar Measures.--A State child health plan shall provide for
compliance with the requirements of section 1182(e) (relating to
prohibiting the use of certain measures in coverage determinations,
reimbursement, and incentive programs).''.
(3) Medicare advantage.--Section 1852 of the Social
Security Act (42 U.S.C. 1395w-22) is amended by adding at the
end the following new subsection:
``(o) Prohibition on Use of Quality-Adjusted Life Years.--The
provisions of section 1182(e) shall apply to the utilization of a
dollars-per-quality adjusted life year or similar measure (as described
in such section) by an MA plan in the same manner as such provisions
apply to the utilization of such a year or measure by the Secretary
under this title.''.
(4) Medicare part d.--Section 1860D-12 of the Social
Security Act (42 U.S.C. 1395w-112) is amended by adding at the
end the following new subsection:
``(h) Prohibition on Use of Quality-Adjusted Life Years.--The
provisions of section 1182(e) shall apply to the utilization of a
dollars-per-quality adjusted life year or similar measure (as described
in such section) by a prescription drug plan in the same manner as such
provisions apply to the utilization of such a year or measure by the
Secretary under this title.''.
(c) Implementation.--The amendments made by this section shall
apply beginning on January 1, 2027.
SEC. 3. PREVENTION AND PUBLIC HEALTH FUND.
Section 4002(b) of the Patient Protection and Affordable Care Act
(42 U.S.C. 300u-11) is amended by striking paragraphs (7), (8), and (9)
and inserting the following:
``(7) for each of fiscal years 2026 and 2027,
$1,102,000,000;
``(8) for each of fiscal years 2028 and 2029,
$1,327,000,000;
``(9) for each of fiscal years 2030 and 2031,
$1,526,000,000; and''.
SEC. 4. REPORT.
Not later than 1 year after the date of the enactment of this Act,
and annually thereafter, the Comptroller General of the United States
shall submit to Congress a report on how quality-adjusted life years
negatively impacts individuals with intellectual and developmental
disabilities and their access to care.
<all>
Introduced in House
Introduced in 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.
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.
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