Phase 4: Wave 4: everyone · Step 4.4

Coordinate with continuing payers: workers' comp, auto, VA, TRICARE, IHS

Years 1–4 · UHA; state workers' comp agencies & insurance regulators; VA; Defense Health Agency; IHS & tribesDiscuss this step

Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.

What	Today	Change	Trade-off
TRICARE (military dependents & retirees) amendedYears 1–4 Federal programs	Defense Health Agency coverage for about 9.5M.	Active-duty care continues through the military health system; dependents and retirees move to UHP.	Simplifies coverage for families; military health leadership loses a large beneficiary population used for medical readiness training.
Veterans Health Administration continues— Federal programs	Direct-care system for about 9M enrolled veterans; Community Care program pays outside providers.	Continues as a delivery system; veterans are also UHP-eligible and may use either.	Preserves VA's specialized care; may reduce VA volume as veterans use UHP providers closer to home.
Indian Health Service & tribal programs expandedYear 1 Federal programs	Treaty-based care, chronically underfunded (per-capita spending far below other federal programs).	Continues; UHP pays IHS and tribal facilities for care to UHP-eligible patients, adding revenue.	More money for IHS without disturbing tribal sovereignty; requires consultation under treaty obligations.
Medicare Secondary Payer rules & coordination of benefits replacedYear 4 Federal insurance & health law	Complex rules decide which insurer pays first.	Replaced by UHP recovery from workers' comp and auto/liability insurers only.	Eliminates most coordination-of-benefits work for providers.
Workers' compensation medical benefits amendedYear 4 States & localities	Separate state systems pay for work injuries.	Continue (they also replace wages), but pay UHP rates and reimburse UHP. Workers' comp, worksite clinics, temporary disability $55.1B → $55.1B	Keeps employer liability incentives for safety; some double administration remains.
Auto insurance personal injury protection & liability medical payments amendedYear 4 States & localities	Auto insurers pay medical bills for crashes.	Continue; UHP pays first and recovers from auto insurers. Medical portion of auto & property insurance $55.3B → $55.3B	Patients never wait on auto insurers to get care.