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Congress Takes on Discriminatory Health Metrics

Should federal health programs rely on calculations that discriminate against some patient groups? The U.S. House of Representatives thinks not. 

The House recently passed H.R. 485, which protects patients by banning the use of a metric known as the Quality-Adjusted Life Year, or QALY, in federally administered health programs. The metric gauges a medical treatment’s value by calculating the years of “perfect health” that it offers patients and assigns a dollar value to the treatment. The approach discriminates against the elderly and people with disabilities and chronic ailments by discounting their lived experience. 

All eyes now turn to the Senate, which must act to advance the ban and protect patients from further discrimination. 

The Affordable Care Act already limits QALY use in Medicare, but other taxpayer-funded health programs are currently allowed to utilize  the metric.  

Advocates Demand Dignity and Care for All Patients 

The National Council on Disability reported to Congress that ending the use of QALYs and other discriminatory metrics was essential to treating all patients with equity and dignity. Advocacy organizations for both patients and providers have also called on policymakers to end the practice.  

The largest federal health programs that would be prohibited from using QALYs or similar metrics if HR 485 becomes law include Medicare, Medicaid, the Children’s Health Insurance Program, TRICARE, the Veterans Health Administration and the Federal Employees Health Benefits program 

QALYs are often used by academic researchers and health economists, but their real-world impact has been both discriminatory and damaging. Well-established alternative measures can be used, which do not assume that age or disability make patients less worthy of quality treatment. QALYs are simply not an ethical or effective tool for a patient-centered health care system.  

The Value of Care 

All insurers use some mechanism for controlling costs and assessing the value of certain treatments that are eligible for reimbursement. But patients’ experience can’t be reduced to an equation. Lives impacted by chronic illness or disability are not worth less, nor are they unworthy of optimal care.  

The House of Representatives has affirmed this fact with its recent vote. Now it’s time for swift, bipartisan follow through from the Senate.  

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