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 concrete action this step requires, who is responsible, and when it happens relative to enactment.

#	Action	Owner	When	Trade-off
4.4.1	UHP pays first for injuries and recovers from workers' comp and auto/liability insurers at UHP rates (subrogation), so patients never wait for liability decisions.	UHA	Year 1	Paying first and recovering later protects patients but makes UHP absorb disputes with liability insurers.
4.4.2	Require workers' comp and auto insurers to pay UHP fee-schedule rates for medical care they owe.	Congress / states	Year 2	Requiring UHP rates lowers workers' comp and auto costs but may reduce clinicians' willingness to treat injury cases.
4.4.3	Veterans: enroll all veterans in UHP while keeping VA eligibility; VA Community Care referrals become UHP care; VA keeps specialized services (spinal-cord injury, PTSD, prosthetics).	VA / UHA	Year 1	Dual VA/UHP eligibility gives veterans choice but can erode VA volume and expertise.
4.4.4	TRICARE dependents and retirees move to UHP by wave; active-duty care stays with the Defense Health Agency.	DoD / UHA	Years 1–4	Moving TRICARE dependents to UHP simplifies coverage but separates military families from military facilities.
4.4.5	IHS & tribal programs: UHP pays IHS, tribal, and urban Indian facilities at UHP rates for eligible patients; formal tribal consultation on implementation.	UHA / IHS / tribes	Year 1	Paying IHS at UHP rates adds funding but requires tribal consultation that can slow implementation.
4.4.6	Visitors and short-term residents: emergency care billed to travel insurance; unpaid balances covered by UHP.	UHA	Year 1	Billing travel insurance first recovers costs but adds collection work for hospitals.