Connecticut House Bill HB05861

Connecticut 2019 Regular Session

• Introduced: 1/23/19
• Refer: 1/23/19

Caption

An Act Prohibiting Health Insurers From Using A Dollars-per-quality Adjusted Life Year Or Any Similar Measure As A Threshold.

Impact

If enacted, HB 5861 would directly amend Title 38a of the general statutes, impacting various entities involved in health insurance within the state, including insurers, fraternal benefit societies, and healthcare centers. By ruling out the use of QALYs as a factor in coverage decisions, the bill aims to increase patient access to treatments that may be undervalued by traditional cost-effectiveness analyses. This shift could have implications for how health care providers and reimbursement programs evaluate and recommend services, potentially leading to broader coverage for interventions deemed necessary from a health perspective rather than a cost perspective.

Summary

House Bill 5861 aims to prohibit health insurers in the state from using a dollars-per-quality adjusted life year (QALY) or any similar metric as a threshold for determining coverage or recommendations for health care services. This legislation seeks to eliminate the use of financial thresholds that may limit access to necessary medical treatments based on cost-effectiveness measures. The intent of the bill is to promote a more equitable approach to health care where decisions about coverage are not solely based on economic considerations.

Contention

The discussion surrounding HB 5861 is likely to bring forward differing viewpoints related to the balance between health care costs and access. Supporters of the bill argue that reliance on QALYs can disproportionately affect vulnerable populations by restricting access to care based on cost-efficiency rather than the medical needs of individuals. Opponents may be concerned about the potential financial implications for insurers and the sustainability of health care funding if economic evaluations are disregarded in coverage decisions.