Protecting Health Care for All Patients Act of 2023

Floor Speech

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Mrs. RODGERS of Washington. 485.

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Mrs. RODGERS of Washington. Mr. Chairman, I yield myself such time as I may consume.

Mr. Chairman, I rise in strong support of H.R. 485, my Protecting Health Care for All Patients Act, which affirms every person's life has value by banning the use of quality-adjusted life years, or QALYs, and similar discriminatory measures from all Federal healthcare programs.

As many of you know, my son Cole was born with an extra 21st chromosome. Most of you know it as Down syndrome.

When Cole was born, the doctors gave us a long list of challenges and chances for heartache. It was difficult, but I could have never imagined just how positively he would impact my life, my family's life, and the world.

Today, Cole is a fun-loving 16-year-old with big dreams. He wants to be a football player, a pastor, and a race car driver. He is on the basketball team. He plays the drums. For Cole, the sky is the limit.

Cole and others with disabilities deserve every opportunity to succeed. We shouldn't be discounting their potential or prejudging the quality of their life just because of their disabilities.

Unfortunately, several tools frequently used in our healthcare system do just that. QALYs, and other similar discriminatory measures, assign a dollar value on the life of a patient to decide if a certain treatment is cost effective, oftentimes discounting an individual's worth and the need for care solely because of their disability or chronic illness.

It means a bureaucracy coldly determines the value of someone's life and could deny necessary healthcare due to that calculation.

Measurements like QALYs remove the consideration of unique circumstances and health conditions of a patient and their doctor's judgment from deciding what is best for the patient.

I am not alone in opposing the use of these measures.

Democrats acknowledged this when they passed the Affordable Care Act, and they banned the use of QALYs in Medicare.

In 2020, the Democratic National Committee platform stated that: ``Democrats will ensure that people with disabilities are never denied coverage based on the use of quality-adjusted life year (QALY) indexes.''

The nonpartisan National Council on Disabilities wrote a report in 2019 titled: ``Quality-Adjusted Life Years and the Devaluation of Life with a Disability'' that condemned the usage of QALYs and they have continued to write additional letters to Congress urging us to ban their use.

Additionally, we have heard from nearly 200 advocacy groups spanning the political spectrum who are calling on Congress to prohibit the use of QALYs and other discriminatory measures.

This legislation, the Protecting Health Care for All Patients Act, bans Federal payers, like Medicaid and VA healthcare, from using QALYs or other discriminatory measures that devalue the lives of people with disabilities and chronic or rare diseases, and it does it by simply applying the current ban on QALYs and other similar measures that exist in Medicare today to all Federal payers.

In passing this bill, it will mean that healthcare bureaucracies can no longer discriminate against the weakest and most vulnerable patients, and it will help ensure that people can get the healthcare that they need and that their doctors think is best.

This would be a big deal.

Medicaid is the largest payer for people with disabilities, and we are letting it use measures that discriminate against the very people it was designed to support.

That is nothing to say of the millions of injured or disabled veterans who rely on the VA for their healthcare, which is also allowed to use these types of measures.

However, let me be clear in this: H.R. 485 does not prohibit healthcare programs from rewarding value or finding other ways to hold down costs.

For example, if a treatment does not work or shouldn't be covered or it is more appropriate to start with other more cost-effective treatments first, nothing in this bill will preclude the Federal payers from continuing to make these kinds of coverage decisions.

In fact, the National Council on Disability has already identified alternative ways to measure value that do not devalue the life of someone with a disability or chronic illness.

Because of Cole, I have spent my time in Congress as an ability advocate, encouraging people to focus on every individual's God-given talent and potential.

Millions of Americans like Cole need their voices to be heard. Whenever I meet someone with a disability or chronic illness, or with their family, I hear the same thing over and over: They want the same chances to succeed in life as everyone else.

You know what? We are all just one car accident or one diagnosis away from having a disability ourselves.

I hope that banning the use of discriminatory measures by Federal payers against people with disabilities and chronic illness and affirming every person's life has value is something that we can agree on. Let's give people with disabilities, rare diseases, or chronic diseases hope.

Mr. Chairman, I urge support of this important legislation, and I reserve the balance of my time.

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Mrs. RODGERS of Washington. Mr. Chairman, I yield myself such time as I may consume.

The reasons that the ranking member says to oppose the bill, they do not match what the bill actually says.

Current law already prohibits the use of QALYs and other similar measures in Medicare. Current law reads: ``The Secretary shall not utilize such an adjusted life year or (such a similar measure) as a threshold to determine coverage. . . . ''

I am not sure why all of a sudden we have this concern about other measures. All the bill would do is apply current Medicare law to other Federal payers, and if people are insistent that other measures are not discriminatory, then they should have no problem in using them.

I will also point out to anyone who may be listening, according to CBO's cost estimate: ``CBO does not expect that enacting H.R. 485 would affect the prices that result from negotiations between the Secretary and drug manufacturers.''

I don't support this capping or government price fixing of drugs. I don't support it. I would like to see us work together to reduce the cost of drugs, but this bill, according to CBO, does not expect that H.R. 485 would affect the prices that result from negotiations between the Secretary and drug manufacturers.

Don't get distracted from the underlying bill here.

Mr. Chair, I yield 2 minutes to the gentleman from Kentucky (Mr. Guthrie).

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Mrs. RODGERS of Washington. Mr. Chairman, this bill should be bipartisan. This legislation before us today takes the language that the Democrats put into the Affordable Care Act, and again I will quote it: ``The Secretary shall not utilize such an adjusted life year (or such a similar measure) as a threshold to determine coverage. . . .'' We take that language from Medicare inserted by the Democrats in the Affordable Care Act, and we apply it to all Federal payers. It should be bipartisan.

Mr. Chairman, I yield 2 minutes to the gentleman from Florida (Mr. Bilirakis).

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Mrs. RODGERS of Washington. Mr. Chair, I yield 2 minutes to the gentleman from Georgia (Mr. Carter).

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Mrs. RODGERS of Washington. Mr. Chairman, if this legislation harms people who we are intending to help, why do we have support letters from nearly 200 disability patient advocate groups across the political spectrum? Down Syndrome Society, Autism Speaks, Disability Law Center, and ARC all support this bill.

If the Democrats want to suggest that they are committed to lowering the cost of prescription drugs and that the reason to oppose this bill is because it is going to increase costs, the only reason this bill would increase costs is if you are denying care to people who have disabilities. That is the only reason. You are discriminating against people. That is the only reason this bill would cost any money.

CBO already estimates that this bill is going to cost $1.1 billion. Why is that? Why would this legislation cost $1.1 billion? Because CBO is forecasting that there are going to be discriminatory measures used against individuals, and we are going to ban that. We are going to make sure that doesn't happen.

Mr. Chair, I am pleased to yield 2 minutes to the gentleman from Pennsylvania (Mr. Joyce).

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Mrs. RODGERS of Washington. Mr. Chair, I am pleased to yield 1\1/2\ minutes to the gentleman from Indiana (Mr. Pence).

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Mrs. RODGERS of Washington. Mr. Chair, I am pleased to yield 2 minutes to the gentlewoman from Tennessee (Mrs. Harshbarger).

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Mrs. RODGERS of Washington. Mr. Chairman, I am pleased to yield 2 minutes to the gentlewoman from Iowa (Mrs. Miller-Meeks)

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Mrs. RODGERS of Washington. Mr. Chairman, I yield 2 minutes to the gentlewoman from Florida (Mrs. Cammack).

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Mrs. RODGERS of Washington. Mr. Chairman, may I inquire as to how much time is remaining on each side.

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Mrs. RODGERS of Washington. Mr. Chairman, I yield 2 minutes to the gentleman from Ohio, (Mr. Wenstrup).

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Mrs. RODGERS of Washington. Mr. Chair, I yield 2 minutes to the gentleman from Minnesota (Mr. Stauber).

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Mrs. RODGERS of Washington. Mr. Chair, I yield an additional 1 minute to the gentleman from Minnesota.
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Mrs. RODGERS of Washington. Mr. Chair, I yield myself the balance of my time.

I am quite disappointed today that my colleagues on the other side of the aisle have refused to come to the table on this one.

We just heard that there is no justification for this legislation. The ranking member actually said it is dangerous. Let me just point out again, nearly 200 advocacy groups, spanning the political spectrum, are calling on Congress to prohibit the use of QALYs and other discriminatory measures, perhaps because they see the VA's website today. Go to the VA's website and you will read, to date, the quality- adjusted life year, QALY, is the preferred metric for estimating health effect.

We have also heard that this bill is a big giveaway, a blank check, to pharma. Republicans agree, we must lower the cost of prescription drugs, and we have worked on it. Discriminatory action, discriminatory metrics against people with disabilities and chronic illnesses is not the way to do it.

We have heard today that the offset is a partisan pill. Let me just highlight that Senator Sanders is using the prevention fund. Senator Sanders is proposing right now to use the prevention fund to offset increased funding for community health centers. The Senate passed this provision 90-6. It is disappointing that now this is an issue of offsetting costs of no longer discriminating against those with disabilities.

Yes, we have to offset the cost of no longer discriminating against those with disabilities. That is why there is even a CBO score on this bill.

I also note that ``similar measures,'' which seems to be an issue today with my colleagues across the aisle, are current law for Medicare. We are simply expanding that same language in Medicare to other Federal health programs. Why have different standards?

Mr. Chair, this should be the law of the land. This legislation is important. Those with disabilities and the advocacy groups are asking for Congress to take action. We have addressed the issues in the underlying bill.

Mr. Chair, I urge support. I hope today that we can come together, Republicans and Democrats, as Americans, to protect the healthcare and the access to healthcare for every individual with disabilities and chronic illnesses. As I mentioned, we are all just one car accident or diagnosis away from being that person. Vote ``yes.''

Mr. Chair, I yield back the balance of my time.

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