On Wednesday, February 7th, the House endorsed a bill banning the use of Quality Adjusted Life Year (QALY) calculations in some federal health programs. Disabilities activists, who have long called QALY calculations discriminatory, see this as a positive moment, but it also raises questions on how to evaluate drug treatments’ value. 

A QALY is a year of life that is actuarially adjusted for how comfortable that year of life would be. This metric helps determine whether extending a patient’s life by another year or more, in conjunction with any changes in the patient’s quality of life, would be worth a particular treatment’s cost. Notably, this calculation, which involves multiplying the duration of a treatment’s effect by its marginal utility value, significantly discounts a year lived with a disability, a fact that causes many disabilities activists to call for its exclusion in medical decision-making. 

The Affordable Care Act and Inflation Reduction Act already contain provisions banning the use of QALY calculations in Medicare, however the new bill would extend this ban to Medicaid, the largest payor for people with disabilities. The Biden Administration and Democrats publicly denounced the bill as a “trojan horse” meant to weaken public health and drug-price negotiation efforts. 

The Bill passed through the House narrowly, with a vote of 211-208, and, with continued Democratic resistance, it is unlikely to pass in the Senate. If it were to pass, however, it would raise multiple legal and ethical questions about how treatments are to be evaluated, as the bill calls for the prohibition of QALY metrics and other similar measures. McMorris Rodgers (R-WA), who introduced the bill, has not yet proposed an alternative she would consider less discriminatory.