Now more than ever, we need to listen to and respect one another’s views and values, whether on the floor of Congress or in individual health care decisions. 

As former members of Congress on different sides of the aisle, we found common ground. We fiercely believe older adults and people with disabilities should not be devalued, especially in our nation’s health care system. The United States should not embrace health care rationing that de-prioritizes the health and wellness of people living with disabilities, or older adults or even infants. Yet that’s where the current political debate takes us.

Therefore, we have a shared interest in barring measures that devalue the lives of older adults and people with disabilities, particularly the quality-adjusted life year, known as the QALY. This is a cost-effectiveness measure invented by other countries to ration health care. It is used to justify declining coverage of treatment that doesn’t meet a threshold for cost effectiveness based on years that person may live, or whether society deems their quality of life worth living. 

As the parent of a child with Down syndrome and a person with epilepsy, preventing discrimination against people with disabilities and chronic illnesses and affirming that every person’s life has value is something we can — indeed must — agree on. The nonpartisan National Council on Disabilities report in 2019 titled “Quality-Adjusted Life Years and the Devaluation of Life with a Disability” condemned usage of QALYs. NCD’s additional letters to Congress urge banning their use. NCD recognized that QALYs are used internationally against people with disabilities, stating, “The coverage denials and loss of access to care faced by people with disabilities in these countries illustrate what might happen if the United States made a similar choice.” 

Additionally, more than 100 advocacy groups across the political spectrum called on Congress to prohibit QALYs and similar measures consistently across federal programs.They raise the impact on people with disabilities’ access to organ transplants, how ranking coverage based on QALYs may restrict access to care for conditions like spina bifida or the impossibility of a person to judge quality of life for people with conditions like Down syndrome. Even care for infants is at risk when health programs rely on these measures.

The United States has a long history of bipartisan opposition to corrupt value standards that, in effect, devalue those of us living with disability and our loved ones with disabilities. After passage of the bipartisan Americans with Disabilities Act in 1992, a Republican administration told states that using QALYs in coverage decisions would violate the law. In 2010, a Democratic Congress passed a law specifically barring Medicare from using QALYs and similar measures in coverage and reimbursement decisions. In 2024, Republicans in the House of Representatives passed the Protecting Health Care for All Patients Act, which would extend Medicare’s ban to other programs. If this bill becomes law, it means health care bureaucracies would be barred from determining that someone’s life is worth less just because they have a disability or disabling chronic illness.

For example, Medicaid is the largest payer for people with disabilities, yet it uses measures that discriminate against the people that it was designed to support. For millions of injured or disabled veterans relying on the VA, we allow these metrics. To be clear, the bill would not prohibit programs from rewarding value or finding other ways to hold down costs. In fact, we encourage efforts to incentivize care demonstrating clinical effectiveness and reducing long-term costs. This bill would simply preclude doing so at the cost of caring for people with disabilities, older adults and patients with disabling chronic conditions, as is already the law governing Medicare.

The Protecting Health Care for All Patients Act was a priority for us in the last Congress. People with disabilities and serious chronic conditions support this legislation extending the law barring Medicare’s use of QALYs and similar measures to other programs. It would impose no cost to federal budgets. Therefore, there’s no reason not to move it forward now.
 
As CBO stated when originally introduced, current law already prohibits the secretary from using QALYs and similar measures in Medicare, giving it no impact on the Medicare Drug Price Negotiation Program, which is subject to nondiscrimination provisions in the Inflation Reduction Act and the Affordable Care Act. The bill would simply make the existing statute barring use of QALYs and similar measures clear and consistent across federal programs.

We are grateful to Congresswoman Kat Cammack for leading the bill’s reintroduction and urge Chairman Brett Guthrie to again give it a fair hearing in the House Energy and Commerce Committee. We appreciate their commitment to its passage.

Getting it across the finish line will require both sides to set aside partisan rhetoric and come together to make all federal health programs accountable for decisions about health care coverage. 

Cathy McMorris Rodgers served as a Republican U.S. representative for Washington’s 5th District from 2005 to 2025, becoming the first woman to chair the House Energy and Commerce Committee. She now leads the Cathy McMorris Rodgers Leadership Institute (cmrli.org) to inspire a rebirth of freedom and faith in America’s future leaders.

Tony Coelho is a Democratic former U.S. representative from California who served from 1979 to 1989. He was the primary author and sponsor of the Americans with Disabilities Act. He now chairs the Partnership to Improve Patient Care (PIPC) and is the founder of the Coelho Center for Disability Law, Policy and Innovation at Loyola Marymount University.