Protecting Health Care for All Patients Act of 2025

This bill stops federal health programs from using “quality-adjusted life years” (QALYs) and similar scores to decide what care is covered, how much to pay, or how to reward plans. These scores can lower the value of a person’s life because of disability, age, or serious illness. The ban covers Medicare, Medicaid, CHIP, Medicare Advantage, prescription drug plans, and the Federal Employees Health Benefits Program, and it can’t be bypassed with federal or state waivers.

It also requires yearly reports on how QALYs harm people with intellectual and developmental disabilities. The law resets funding levels for the Prevention and Public Health Fund for 2026–2031.

Key points

• Who is affected: People covered by Medicare, Medicaid, CHIP, Medicare Advantage, prescription drug plans, and federal employee health plans; state Medicaid managed care plans; and federal and state health agencies.
• What changes: QALY-based thresholds can’t be used for coverage, payment, or incentive programs; agencies can’t use waivers to get around this; annual reports will track harms to people with intellectual and developmental disabilities; prevention and public health funding levels are adjusted for 2026–2031.
• When: Most program rules start January 1, 2027. The first report is due one year after enactment, then every year. Funding changes apply to fiscal years 2026–2031.