Protecting Health Care for All Patients Act of 2025

The Protecting Health Care for All Patients Act of 2025 would bar the use of quality-adjusted life years (QALYs) and similar measures in coverage determinations, reimbursement, and incentive programs for federal health care programs. This means federal agencies, states, and program waivers could not rely on QALY-based approaches (or assign lower value to life extensions for elderly, disabled, or terminally ill individuals compared with younger or non-disabled individuals) when deciding what to cover or pay for. The ban would apply across major programs—Medicare (including Medicare Advantage and Part D), Medicaid, and the Children’s Health Insurance Program (CHIP)—and would extend to certain waivers and demonstrations, with a broad interpretation of “federal health care program.” The bill specifies an implementation date of January 1, 2027, strengthens Medicaid/CHIP/MA/Part D provisions to enforce the prohibition, and requires a government report on impacts, particularly for people with intellectual and developmental disabilities. It also adjusts funding for the Prevention and Public Health Fund for several future fiscal years.