Bill blocks Medicare, Medicaid from devaluing elderly and disabled lives in coverage decisions

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 decide whether to cover treatments or set payment rates. It also requires a report on how QALYs affect people with intellectual and developmental disabilities. The bill aims to prevent health systems from assigning lower value to extending the lives of elderly, disabled, or terminally ill people compared to younger or non-disabled people.

Why we flagged it

The bill's core mechanism is a civil-rights protection: it removes a decision-making tool (QALYs) that systematically devalues care for disabled and elderly people. While framed as a health-care coverage rule, its functional purpose is to prevent discrimination in access to treatment based on age or disability status.

• Section 3 modifies ACA Prevention Fund appropriations for FY 2026–2031, unrelated to QALY prohibition.

What the text implies

• The bill does not explicitly define 'similar measures' to QALYs, creating potential ambiguity about which cost-effectiveness tools are prohibited—health systems may face uncertainty about compliant decision-making frameworks.
• By blocking QALYs across all federal programs simultaneously (Medicare, Medicaid, CHIP, MA, Part D), the bill may force fragmented coverage policies if private insurers continue using QALYs, creating inconsistency in what treatments are available to different populations.
• The prohibition applies to state Medicaid programs and managed-care organizations, potentially shifting cost pressures to states and private plans, which may respond by restricting access through other mechanisms not explicitly prohibited.
• The annual reporting requirement on QALY impact for people with intellectual and developmental disabilities may generate evidence of harm but carries no enforcement mechanism if the report documents continued disparities.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

The bill protects vulnerable populations—elderly, disabled, and terminally ill people—from being systematically excluded from treatments based on cost-effectiveness metrics that assign lower value to their lives. It removes a mechanism that could ration care away from these groups, ensuring broader access to treatments regardless of age or disability status.

Who stands to gain

• pharmaceutical manufacturers (broader access to coverage for treatments affecting elderly and disabl
• medical device manufacturers (same rationale)
• specialty care providers (treatments for rare/chronic conditions affecting disabled populations may

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Centers for Medicare & Medicaid Innovation (CMMI), Medicare, Medicaid, CHIP (Children's Health Insurance Program), Medicare Advantage, Medicare Part D, Social Security Act, Patient Protection and Affordable Care Act, Comptroller General of the United States

Where it stands

3 cosponsors: 3 Republicans.

• Jun 10, 2025 — Introduced · Congress.gov: “Introduced in House”
• Jun 10, 2025 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

2 lobbying clients named this bill on 2 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $80,000 in lobbying spend. A filing names 36 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 41% of bills with at least one filing.

Kat Cammack, the sponsor, reported $799,000 in PAC receipts in the 2026 cycle.

• National Down Syndrome Society — $50,000 on 1 filing
• The Als Association — $30,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.