H.R. 485 Could Change How Medicare Advantage Plans Allocate Some Care
Supporters want to block the program from considering the quality of any years of life gained.
House Energy and Commerce Committee members voted 27-20 last week to approve H.R. 485 — a bill that would block Medicare Advantage plans from considering patients’ quality of life when deciding how to cover care.
Rep. Cathy McMorris Rodgers, R-Wash., the committee chair, introduced H.R. 485, the Protecting Health Care for All Patients Act bill, in January.
Section 1182 of the Social Security Act now prohibits the Medicare program from using “quality-adjusted life year,” or QALY, estimates in coverage allocation decisions. If implemented as written, H.R. 485 would apply the restrictions to all other federal health care programs as well as private Medicare Advantage plans.
The Medicare Advantage program gives private insurers a chance to provide what to an enrollee looks like an alternative to traditional Medicare coverage. About 31 million of the Medicare program’s 64 million enrollees have Medicare Advantage plan coverage.
What It Means
Clients with Alzheimer’s disease, diabetes and other chronic health conditions or disabilities might have an easier time getting Medicare to pay for certain kinds of care.
QALYs
A QALY is a measure that researchers, health plans and others use to try to reflect how much factors such as pain, mental health problems and the ability to carry out activities of daily life affect the value of a year of life.
Democrats’ View
All House Energy and Commerce Republicans who voted on H.R. 485 supported the bill, and all Democrats who voted opposed it.
Rep. Frank Pallone Jr., D-N.J., the highest-ranking Democrat on the committee, said he worries that the scope of the bill could be broader than expected.
“I need assurances that nothing in the legislation would go beyond banning the use of QALYs,” Pallone said.
Pallone said one concern is that the McMorris Rodgers version could disrupt implementation of drug price management provisions in the Inflation Reduction Act of 2022.
Pictured: Rep. Cathy McMorris Rodgers. (Photo: Rodgers)