Protecting Health Care for All Patients Act of 2025
- Bill Number
- H.R. 3864
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-06-10: 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.
- Last Updated
- 2026-03-18T08:06:39Z
AI-Generated Summary
Purpose of the Legislation
The "Protecting Health Care for All Patients Act of 2025" (H.R. 3864) aims to prevent the use of certain health care evaluation tools, like quality-adjusted life years (QALYs—a metric that measures the value of medical treatments based on both length and quality of life), in decisions about covering treatments or setting payments under federal health programs. It seeks to ensure that coverage and payment choices do not discriminate against groups such as the elderly, disabled, or terminally ill by undervaluing their lives compared to healthier or younger people.
Key Provisions
- Prohibition on QALYs and Similar Measures: Amends Section 1182(e) of the Social Security Act to ban federal agencies (including the Center for Medicare and Medicaid Innovation, or CMI), states, and certain health plans from using QALYs or comparable tools in coverage, reimbursement, or incentive decisions. This includes measures that treat extending the life of elderly, disabled, or terminally ill individuals as less valuable than for others.
- Scope of Application: The ban applies to all federal health care programs, including Medicare (Parts A, B, C, and D), Medicaid, the Children's Health Insurance Program (CHIP), and the Federal Employees Health Benefits (FEHB) program. It extends to managed care organizations, prepaid health plans, and prescription drug plans.
- No Waivers Allowed: Federal agencies or states cannot bypass this prohibition through waivers, demonstrations, or other authorities under sections like 1115 or 1115A of the Social Security Act.
- Conforming Amendments: Adds requirements to specific laws for Medicaid (Section 1902(a)), Medicaid managed care (Section 1932(b)), CHIP (Section 2102), Medicare Advantage (Section 1852), and Medicare Part D (Section 1860D-12) to enforce the QALY ban.
- Implementation Timeline: Changes take effect on January 1, 2027.
- Funding Adjustment: Modifies the Prevention and Public Health Fund (from the Affordable Care Act) by setting new annual funding levels: $1.102 billion for fiscal years 2026–2027, $1.327 billion for 2028–2029, and $1.526 billion for 2030–2031.
- Reporting Requirement: The Government Accountability Office (GAO) must submit an annual report to Congress, starting one year after enactment, on how QALYs harm access to care for people with intellectual and developmental disabilities.
Significant Changes to Existing Law
- Expands the existing prohibition in Section 1182(e) of the Social Security Act, which previously limited QALY use mainly in Medicare, by broadening it to all federal health programs and explicitly including discrimination against elderly, disabled, or terminally ill individuals.
- Introduces a blanket ban on waivers, closing loopholes that could allow exceptions under demonstration projects.
- Increases funding for the Prevention and Public Health Fund compared to prior levels (e.g., previous appropriations were lower for later years), redirecting resources potentially toward non-discriminatory health initiatives.
- Adds new reporting obligations focused on disabilities, which were not previously mandated.
Potential Impacts
- On Government Agencies: Agencies like the Centers for Medicare & Medicaid Services (CMS) and states administering health programs must revise policies, guidelines, and contracts to comply, potentially increasing administrative costs but ensuring uniform anti-discrimination standards. The CMI's innovation projects will face restrictions on using cost-effectiveness metrics like QALYs.
- On Citizens: Improves access to treatments for vulnerable groups (e.g., elderly, disabled, terminally ill) by preventing denials based on life-value metrics, which could lead to broader coverage of expensive therapies. However, it may raise overall program costs, possibly affecting premiums or taxes indirectly.
- On International Relations: No direct impacts mentioned; the bill focuses on domestic U.S. health programs.
Main Stakeholders Affected
- Patients and Beneficiaries: Especially elderly individuals, those with disabilities (including intellectual and developmental), terminally ill people, and children in CHIP, who gain protections against biased coverage decisions.
- Health Care Providers and Insurers: Medicare Advantage plans, Medicaid managed care organizations, prescription drug plans, and prepaid health plans must adjust operations to avoid QALY-based decisions, potentially shifting how they evaluate treatments.
- Federal and State Governments: CMS, state Medicaid/CHIP agencies, and the Office of Personnel Management (for FEHB) bear implementation and compliance burdens.
- Advocacy Groups and Researchers: Disability rights organizations may benefit from enhanced protections, while health economists or pharmaceutical companies could face limits on using QALY data for program approvals.
Notable Legal, Constitutional, or Political Implications
- Legal Implications: Strengthens anti-discrimination rules in federal health law by codifying broader prohibitions, potentially leading to fewer lawsuits over coverage denials but inviting challenges if programs struggle with alternative evaluation methods. The no-waiver clause limits administrative flexibility, which could be tested in court.
- Constitutional Implications: Aligns with equal protection principles under the 14th Amendment by addressing potential biases against protected groups (e.g., disabled persons under the Americans with Disabilities Act), though it does not directly invoke constitutional language.
- Political Implications: Reflects debates over balancing health care equity with cost control; the bill's focus on vulnerable populations may appeal to pro-life or disability advocacy constituencies, while critics might argue it hinders evidence-based resource allocation in taxpayer-funded programs. The funding boost for public health could signal priorities in preventive care amid fiscal constraints.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (2)
Rep. Hern, Kevin [R-OK-1], Rep. Harris, Andy [R-MD-1]
Recent Actions
- 2025-06-10: 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.
- 2025-06-10: 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.
- 2025-06-10: Introduced in House
- 2025-06-10: Introduced in House
Bill Versions
- Protecting Health Care for All Patients Act of 2025 — issued 2025-06-10 — PDF (6 pages)