Protecting Health Care for All Patients Act of 2023
Floor Speech
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Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume.
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Mr. PALLONE. Mr. Chairman, I rise in strong opposition to H.R. 485, the so-called Protecting Health Care for All Patients Act, a bill that, unfortunately, does not live up to its name.
This legislation is not about protecting healthcare for patients. Instead, it is a Trojan horse intended to undermine the progress that President Biden and Democrats have made in lowering prescription drug costs for American families.
My Republican colleagues say this bill is intended to prevent the Secretary of Health and Human Services from using a measure called ``quality-adjusted life years,'' or QALYs, which could be discriminatory against Americans living with disabilities, but Federal law, including the Inflation Reduction Act, already prohibits Medicare from using QALYs in its coverage determination, and State Medicaid programs are required by law to cover all drugs.
Instead, H.R. 485 goes further than current law and opens a back door that will be used to bar the use of any value measures by the Federal Government. These measures are used by Federal agencies such as the Centers for Medicare & Medicaid Services, the Department of Veterans Affairs, and by States to negotiate fair prices for prescription drugs.
When this bill came before the Energy and Commerce Committee, I sought to clarify its intent through an amendment during markup. My amendment would have ensured the legislation could not be construed to undermine Federal agencies or the Biden administration's ongoing work to lower prescription drug prices for Americans, but that amendment was rejected on a party-line vote.
I still do not understand why the Republican majority would be opposed to clarifying that the bill before us today is not intended to undermine the Federal Government's efforts to determine fair prices for prescription drugs.
Now, I respect the chairman of our committee a great deal, but she keeps talking about how she is banning similar discriminatory measures. Well, the fact of the matter is that the bill doesn't say ``similar discriminatory measures.''
If she had said during the markup that she was willing to ban things that were discriminatory, it might have been a different situation. We might have had a consensus, but that is not what is going on here. This says ``QALYs or similar measures,'' not similar discriminatory measures.
Some may say: Well, what is the difference?
The difference is the word ``discriminatory'' is not in the language of the bill.
We have no problem banning things that are discriminatory, like QALYs or similar discriminatory measures, but that is not in there.
So the problem is that this will be used by pharma to raise prices. The vagueness of the language opens up the door to pharma and the drug companies to sue and say that negotiated prices and efforts to try to reduce costs are not acceptable.
I am not suggesting that that is what the Republicans have in mind necessarily, but that is the reality of it. This is backed by pharma, by the pharmaceutical industry because they want to use it to undermine every effort the Democrats have made to try to bring down costs for prescription drugs in the Medicare market, in the Medicaid market, in Veterans Affairs, and on down the list.
I am deeply concerned that the ambiguity in the bill text would be a prime target for litigation by the pharmaceutical industry, an industry that has already shown a willingness to sue to keep outrageously high prescription drug prices in place.
We know that Big Pharma is already using similar tactics to try to fight the implementation of the Medicare drug price negotiation program enacted by the Inflation Reduction Act. This bill could give them yet another point of entry to undermine Medicare's ongoing work to negotiate prescription drug prices.
Now, in addition, the Congressional Budget Office agreed that this legislation will hinder the ability of our Federal health programs to lower costs. CBO estimates that this bill will increase spending for prescription drugs in Medicare, Medicaid, and other Federal health programs, including the Department of Defense and Veterans Affairs' health programs by $1.1 billion in the next 10 years, and potentially tens of billions in the years that follow.
So because of the fact that this bill raises prices for the Federal Government, increases costs for prescription drugs, the Republicans had to put a pay-for in the bill.
The Republican bill before us today would gut the Affordable Care Act's Prevention and Public Health Fund in order to pay this $1.1 billion for the legislation. It has long been the goal of Republicans to decimate the ACA's essential funding stream to lower healthcare costs through prevention. This funding in the prevention fund goes to our State and local partners to improve public health and prevent chronic diseases.
The prevention fund encourages smoking cessation, prevents childhood lead poisoning, and enhances infectious disease control.
This fund plays a critical role in our efforts to help the American people live healthier lives. House Republicans' decision to cut the prevention fund in order to throw more money at their Big Pharma friends makes it clear that they are not interested in reaching consensus or finding a bipartisan solution.
Instead, they would rather jam through a partisan bill that would hurt the very communities that they claim to be helping.
Mr. Chair, this bill is nothing more than a giveaway to Big Pharma at the expense of the American people and our Nation's public health. I strongly oppose the bill and urge my colleagues to oppose it, as well.
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Mr. PALLONE. Mr. Chairman, I yield 3 minutes to the gentlewoman from California (Ms. Eshoo), the ranking member of the Health Subcommittee.
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Mr. PALLONE. Mr. Chairman, I yield 3 minutes to the gentleman from California (Mr. Takano), the ranking member of the Veterans' Affairs Committee.
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Mr. PALLONE. Mr. Chairman, I yield an additional 1 minute to the gentleman from California.
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Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from Texas (Mrs. Fletcher), a member of our Energy and Commerce Committee.
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Mr. PALLONE. Mr. Chair, I yield an additional 1 minute to the gentlewoman from Texas.
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Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
Republicans are pointing to the Congressional Budget Office's score of their bill as proof that healthcare programs are already using the QALY to discriminate against people, but that is simply not what the CBO score says.
It is ironic Republicans would point to CBO's analysis, given it highlights my exact concern that this bill's reference to other ``similar measures'' is ambiguous and undermines drug price negotiations.
It is precisely this uncertainty that would result in a chilling effect on States and Federal agencies being willing to look at the cost of prescription drugs.
Again, I take no issue with banning QALYs, and I offered an amendment in committee to ban QALYs when this bill was marked up, but that is not what this is about.
This is an effort by the Republicans to back up pharma and make sure that we don't look at cost measures; that we don't negotiate prices, which they oppose in Medicare; and that we simply let the pharmaceutical companies charge whatever they want.
Imagine what it would be like if the pharmaceutical companies could charge whatever they want. Not only would it cost another $1.1 billion, which is what the CBO says, but it could undermine any efforts to lower the cost of prescription drugs throughout any Federal and State programs.
What does that mean? What does that mean for people? How would we continue to fund programs for seniors, for the disabled, for anyone if we cannot adjust the cost issue and keep costs down for prescription drugs?
There is no effort here on the Democrats' part to continue with QALYs. We are opposed to them, but you have to continue to be able to look at costs in a nondiscriminatory way.
That is what is not going to happen if this bill becomes law. There will not be any way or any effective way for any Federal, State, or local agencies to look at cost measures, and costs will continue to skyrocket, exactly what pharma wants.
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Mr. PALLONE. Mr. Chairman, I continue to reserve the balance of my time.
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Mr. PALLONE. Mr. Chairman, I continue to reserve the balance of my time.
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Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, there is no doubt that the pharmaceutical industry would like to see the gains we have made to lower drug prices through the Inflation Reduction Act halted or reversed. That is why they have brought numerous Federal lawsuits against the law in courts throughout the country, even as the Department of Health and Human Services just announced opening offers for the first 10 drugs selected for negotiation to bring down costs.
This bill would simply provide a new avenue for the pharmaceutical industry to pursue litigation intended to hamper the IRA and the negotiation program overall, and it doesn't stop there. It could strip States of one of the only tools that they have to negotiate Medicaid drug rebates.
Now, while proponents of this legislation would have you believe that this bill just extends current law, unfortunately, that is not the case. It expands and changes current law. It applies the language from the Inflation Reduction Act in a new context and broadens its applicability to ban the use of other similar measures across the Federal Government, and that means limiting the ability to look at costs. If we don't have the ability to compare drugs and see which ones are effective and which ones cost more, then we won't have the ability to lower costs. What that means is we allow pharma to charge whatever they want.
The CBO says this is going to cost another $1.1 billion, which is why the Republicans seek to cut the Prevention and Public Health Fund to pay for it. But this is going to lead us down the path of saying that we can't look at cost at all. That means that costs will balloon for Medicare, for Medicaid, and for prescription drugs. The consequence of that is you can't pay for other programs that help seniors, that help poor people, that help veterans, that help those in the military with their health and the quality of their health.
This is a very dangerous piece of legislation, and Democrats are speaking out against it because of the consequences and our ability to fund health programs around the country at every level.
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Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the Republicans' decision to offset this bill by raiding the Prevention and Public Health Fund underscores the real intentions. They are not seeking to improve the lives of those with disabilities or end the use of discriminatory measures, but to push forward with a partisan bill that will raise prices and cut critical funding used to improve public health.
The Prevention and Public Health Fund was established in the Affordable Care Act to provide for expanded and sustained national investment in health prevention and restrain the rate of growth in healthcare costs. Republicans have consistently sought to undermine, slash, and redirect these essential funds for unintended purposes.
Cutting the Prevention and Public Health Fund decimates our ability to effectively prepare for the next pandemic, respond to ongoing public health threats, and puts our States and local healthcare partners at a disadvantage moving forward.
Nearly 200 public health organizations sent a letter earlier this week expressing strong concerns with the manager's amendment, noting how detrimental cuts to the Prevention and Public Health Fund would be.
It is the height of irony that Republicans claim this bill would reduce discrimination for those with disabilities, while also cutting Federal investment in programs that improve the lives of those with disabilities.
The American people deserve better.
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Mr. PALLONE. Mr. Chairman, I yield myself the balance of my time to close.
Mr. Chairman, I feel very strongly about why we need to oppose this bill, and I urge my colleagues to oppose it.
Democrats, and, hopefully, some Republicans, too, have spent a lot of time trying to reduce the cost of prescription drugs--and the States, as well. The bottom line is that we know that prescription drugs now are, if not the majority, a significant portion of healthcare costs.
If the Federal Government or the State government, or any government, is going to continue to provide quality care in this country, we must rein in the cost of prescription drugs, not only the cost but also have our agencies determine what drugs are effective and what drugs are not. We have no problem as Democrats in banning QALYs.
I have said that over and over again today, and I will keep repeating it. The bottom line is the way the language of this bill is constructed, it could easily lead to a situation where no Federal, State or government agency could effectively look at whether or not a drug is effective and what the cost is or make any decisions to pay for it based on the actual costs.
Now, sure, we could live in a world where the government pays unlimited amounts of money for everything--and I am sure pharma would love that because they like to charge whatever they want to increase their profits--but that is not a real situation. If you don't rein in the cost of prescription drugs, it not only is going to cost more for individuals out of their pocket, but it also means that the government can't provide services to people with disabilities or to seniors or to veterans.
That is why the CBO was saying that this bill is going to cost another $1.1 billion, at a minimum, and possibly even more in the future, if you read what the CBO has actually said.
Republicans have a pay-for rule, so they say that if it is going to cost more, they have to pay for it in some way.
Well, how do they pay for it?
They cut the Prevention and Public Health Fund, the very fund that is used to prevent worse diseases, worse outbreaks, fund local public health programs so they can deal with public health in an effective way.
How is that beneficial to people with disabilities or anyone? It certainly isn't.
That is why there is so much opposition by various public health agencies to cutting this prevention fund to pay for this bill.
There is no justification for this bill. There was an opportunity in the Energy and Commerce Committee. I submitted language that would say not only would we ban QALYs, but we would ban any kind of discriminatory measures being used. The Republicans wouldn't accept that. This is what we are left with, a bill that is very dangerous, that is just a giveaway to pharma.
Mr. Chair, I urge my colleagues to oppose what I consider rather dangerous legislation, and I yield back the balance of my time.
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Mr. PALLONE. Mr. Chair, I claim the time in opposition to the amendment.
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Mr. PALLONE. Mr. Chair, I appreciate and respect the views of the disability community and their strongly held belief that the use of QALYs in Federal health programs is discriminatory. That is why I do not oppose this amendment.
However, the amendment does not cure the problem with the underlying bill. This bill is a Trojan horse that purports to ban discriminatory measures like QALYs but in reality does a lot more. This bill has the potential to ban a broad swath of cost containment measures that are not discriminatory and could harm the very communities that this bill is purported to help.
Those with disabilities need access to lower drug prices and healthcare services, and the Federal Government's and States' ability to use nondiscriminatory health measures is essential to bringing down costs. Otherwise, without leverage to get a better deal, we are stuck paying whatever pharma wants. The CBO agrees. That is why they estimate this bill will increase Federal spending by over a billion dollars in the next 10 years and potentially tens of billions of dollars more in the years ahead.
For this reason, I do not oppose the amendment, but, unfortunately, it does not resolve my concerns with the underlying bill.
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Mr. PALLONE. Mr. Chair, I yield the balance of my time to the gentlewoman from Texas (Ms. Jackson Lee).
Ms. JACKSON LEE. Mr. Chair, I thank the distinguished gentleman for yielding.
We want to rise and help all of the families, particularly those families who every day are dealing with children and family members with disabilities.
This is an instance where I say can we all get together and can we try to find a resolution toward making sure that we have good healthcare for these families and for these persons?
What I would offer is that presently this legislation undermines the Affordable Care Act by stripping dollars from the Prevention and Public Health Fund and undermining its critical investments in health and well-being. It makes it very difficult to help those who need help. It would stop funding from the Prevention and Public Health Fund, which supports critical investments to help prevent disease.
At the same time, this legislation opens the possibility of limiting the use of any value metrics when determining a drug price.
Furthermore, the Congressional Budget Office determined that this bill would raise drug costs for Medicare, Medicaid, and the Department of Defense. The CBO also estimates that this legislation would increase costs for Veterans Affairs health programs, raising Federal spending on prescription drugs by $1.115 billion over 10 years and billions more in the following decades.
Americans are looking for answers, and they are looking for answers for all persons who need healthcare. To pay for these increased costs, there are plans to cut from the Prevention and Public Health Fund and cutting programs to improve public health and to prevent chronic diseases such as childhood lead poisoning and improving immunization rates.
Democrats in Congress, along with the Biden-Harris administration, are working to ensure all Americans have access to affordable care and effective healthcare treatments. This bill claims to protect people from discrimination. It would, in fact, result in harm to patients if enacted into law.
I believe that people with disabilities deserve equality, inclusion, and access to all aspects of American life.
Instead of prioritizing legislation that could lower prices for them, access value, and improve health, Republicans are attempting to pass legislation that undermines the work that we have done over a 10-year period to really include the disabled community.
If this bill is enacted, then the language referring to similar measures in the current version of the bill would introduce ambiguity across the health sector. It could invite lengthy lawsuits from an industry eager to stop any efforts to constrain its ability to set prices as high as it wants.
I simply want to say, as I started, can we all work together?
All aspects of our community need access to good healthcare-- certainly, our disabled community--and this does more to undermine their access than to expand their access.
Mr. Chair, I ask my colleagues to send this back to the committee so that we can find common ground and really serve the disabled community and many others and not allow those who seek profit to overcome those who seek good healthcare, including our seniors, our veterans, and many aspects of our community that have chronic diseases.
Mr. Chair, I rise today to discuss the issue concerning H.R. 485, the Protecting Health Care for All Patients Act.
The Protecting Health Care for All Patients Act of 2023 does not protect health care for patients, but rather undermines our progress in lowering prescription drug costs for American families.
This bill claims to prevent the federal government from using a measure called the Quality Adjusted Life Year (QALY).
This is a red herring, as the Inflation Reduction Act already explicitly prohibits the use of QALYs.
The legislation goes further by banning the use of the QALY ``or such a similar measure,'' across all federal health care programs, without defining what such a similar measure could include.
A long-standing criticism of QALY has been that it would:
Discriminate against people in poor health.
Extending the lives of individuals with underlying health conditions gains fewer QALYs than extending the lives of `healthier' individuals.
This blanket prohibition on the use of ``similar measures'' applied across the federal government.
This legislation opens the possibility of limiting the use of any value metrics when determining a drug's price.
Furthermore, the Congressional Budget Office determined that this bill would raise drug costs in Medicare, Medicaid, the Department of Defense (DoD).
CBO also estimates that this legislation would increase costs for Veterans Affairs health programs, raising federal spending on prescription drugs by $1.115 billion over 10 years and billions more in the proceeding decades.
Americans are looking for Congress to lower drug prices further, not increase them.
To pay for these increased costs, there are plans to cut from the Prevention and Public Health Fund and cutting programs to improve public health and prevent chronic diseases, such as childhood lead poisoning, and improving immunization rates.
Democrats in Congress along with the Biden Harris Administration are working to ensure all Americans have access to affordable and effective health care treatments.
This bill claims to protect people from discrimination but would in fact result in harm to patients if enacted into law.
I believe that people with disabilities deserve equality, inclusion, and access in all aspects of American life.
Instead of prioritizing legislation that could lower prices, assess value, and improve health Republicans are attempting to pass legislation that undermines the work of Congress and the Biden Administration.
If this bill is enacted the language referring to ``similar measures'' in the current version of the bill would introduce ambiguity across the health sector.
It could invite lengthy lawsuits from an industry eager to stop any efforts to constrain its ability to set prices as high as it wants for any drug--regardless of the drug's value.
In closing, it is imperative that health care be made affordable for those with disabilities.
Disabled patients in this country deserve a reliable health care system.
We need to consider real legislation that will address prescription drug pricing at its core.
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Mr. PALLONE. Mr. Chair, I yield back the balance of my time.
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Mr. PALLONE. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
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