We are grateful that President Trump took an important step forward to protect people with disabilities and older adults from policies that would otherwise make them less worthy of health care when taking a stand against state Crisis Standards of Care that violated federal law. These standards would have explicitly put people with disabilities and older adults at the back of the line for care in a shortage. Instead, President Trump openly recognized that every American is worth treating regardless of age or disability. President Trump’s bulletin to states stated, “As such, persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative ‘worth’ based on the presence or absence of disabilities or age. Decisions by covered entities concerning whether an individual is a candidate for treatment should be based on an individualized assessment of the patient based on the best available objective medical evidence.”
Consistent with the President’s first term, we hope the administration will reconsider looking to foreign nations that do not share his commitment to valuing the lives of all people, including those with disabilities and older adults. We remain concerned that the pricing, reimbursement and coverage policies in other countries rely on measures of cost effectiveness to ration care that devalue people with disabilities and older adults, contrary to federal law and policy. Therefore, we urge Congress and the administration to reconsider a Most Favored Nation policy that would import foreign standards for health care where disabled lives are too often not considered worth saving. In this moment, we are especially concerned about giving states more tools to restrict access to care for people with disabilities and older adults, as CMS had acknowledged to be the impact of a similar policy proposed in 2020. In the 2020 proposal, CMS acknowledged that a portion of the Most Favored Nation model’s savings “is attributable to beneficiaries not accessing their drugs through the Medicare benefit, along with the associated lost utilization.”
As Congress and the administration seek policies to improve patient care and health care affordability, we urge all policymakers to again reject any policy that relies on QALYs or similar measures. Instead, PIPC supports approaches that ensure patients, people with disabilities and older adults are valued in the U.S. health care system – a key differentiator between our country and countries that openly embrace utilitarian models of health care and care rationing, dictating the care provided based on its cost effectiveness and the value placed on those receiving care in those countries. We appreciate that in the last Congress, every House Republican voted to ban the use of QALYs in a bill advanced by the Energy and Commerce Committee and lauded by disability and patient advocates across the country.
We look forward to working with the Congress and administration on policies that build on the President’s first term efforts to assure every person is valued in America’s health system. We look forward to working together to put America’s patients and providers in charge of healthcare.