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.
Sponsors
Legislative Progress
Passed HouseMrs. Rodgers of Washington (for herself, Mr. Smith of Missouri, …
Passed House (inferred from eh version)
Summary
What This Bill Does
Prohibits federal agencies and states from using quality-adjusted life years (QALYs) or similar measures in coverage and payment decisions for federal health programs. Extends existing Medicare prohibition to all federal health programs.
Who Benefits and How
People with disabilities and chronic conditions gain protection against discriminatory valuation. Patients aren't disadvantaged by measures that devalue disabled lives. Treatment access isn't limited by QALY-based cost-effectiveness.
Who Bears the Burden and How
Federal and state health programs cannot use QALY-based pricing metrics. Some cost-effectiveness analysis tools become prohibited.
Key Provisions
- Extends Medicare QALY prohibition to all federal health programs
- Prohibits using QALY-derived prices directly or indirectly
- Applies to FEHB program
- Requires Medicaid compliance
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Prohibits use of QALYs in federal health program coverage decisions
Policy Domains
Legislative Strategy
"Protect against discrimination in health coverage based on disability status"
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology