Congress bans life-devaluing math from Medicare, Medicaid decisions
H.R. 3864 — Protecting Health Care for All Patients Act of 2025 · Filed by Kat Cammack (R-FL) · 3 cosponsors · Introduced Jun 10, 2025 · Referred to committee
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What it does
This bill prohibits federal health care programs (Medicare, Medicaid, CHIP, Medicare Advantage, and Part D) from using quality-adjusted life years (QALYs) and similar cost-effectiveness measures to make coverage and payment decisions. QALYs are metrics that assign lower value to extending the lives of elderly, disabled, or terminally ill people compared to younger, healthier individuals. The bill also increases funding for the Prevention and Public Health Fund and requires annual reporting on how QALYs affect people with intellectual and developmental disabilities.
Why we flagged it
The bill's core function is to protect vulnerable populations (elderly, disabled, terminally ill) from algorithmic discrimination in health care coverage decisions by banning a specific cost-effectiveness metric. This is fundamentally a civil rights and access protection measure, not a market intervention.
What the text implies
- May increase health care costs by preventing use of cost-effectiveness analysis in coverage decisions, potentially shifting burden to taxpayers or other beneficiaries through higher premiums or reduced coverage elsewhere.
- Applies a blanket prohibition without carve-outs for extreme cost scenarios, potentially limiting legitimate cost-containment tools in resource-constrained programs.
The full analysis lists 5 implications of this text.
Who stands to gain
Pharmaceutical companies (may face fewer cost-effectiveness barriers to coverage); Medical device manufacturers (similar coverage expansion incentives); Healthcare providers treating elderly and disabled populations (expanded treatment authorization)