Source: United States House of Representatives – Congressman Lloyd Doggett (D-TX)
Contact: Alexis.Torres@mail.house.gov
Washington, D.C. — Today, U.S. Representatives Lloyd Doggett (D-TX), Ranking Member of the House Ways & Means Health Subcommittee, Greg Murphy, M.D. (R-NC), member of the House Ways & Means Health Subcommittee, Mark Takano (D-CA), Ranking Member of the House Veterans’ Affairs Committee, David Schweikert (R-AZ), Chair of the House Ways & Means Oversight Subcommittee, John Joyce, M.D. (R-PA), member of the House Energy & Commerce Health Subcommittee, along with Senators Elizabeth Warren (D-MA), member of the Senate Finance Health Subcommittee, Bill Cassidy, M.D. (R-LA), Chair of the Senate Health, Education, Labor, and Pensions Committee, and Richard Blumenthal (D-CT), Ranking Member of the Senate Veterans’ Affairs Committee, introduced the bicameral Guarantee Utilization of All Reimbursements for Delivery of (GUARD) Veterans’ Health Care Act.
The legislation will permit the Veterans Health Administration (VHA) to recoup health care costs for dually enrolled veterans in private insurance Medicare Advantage (MA) and Medicare Prescription Drug (Part D) plans. Thereby removing a longstanding statutory loophole that results in taxpayers paying twice for veterans’ health care while private insurers profit and resources are diverted away from the VHA.
“Big health insurers have found a nifty way to make an estimated $357 billion profit off veterans and taxpayers: they collect premiums, but taxpayers cover the cost of care. These wasted double payments mean veterans are missing out on critical resources that could be reinvested in delivering more and better care at the VA, such as hiring more providers, purchasing medical equipment, surgical supplies, and devices, and expanding available services at VA clinics,” said Rep. Doggett. “To obtain genuine savings and improve veterans’ health, Congress and the Administration must tackle the insurance lobby. Taxpayers, our veterans, and those at the VA dedicated to serving them deserve better.”
“It’s a mistake to let Medicare Advantage plans exploit a costly loophole and pocket taxpayer money at the expense of veteran care,” said Sen. Warren. “Instead of ripping away health care from millions of Americans, Congress should crack down on the genuine waste, fraud, and abuse in Medicare Advantage.”
“Our veterans deserve to receive accessible, high-quality care, and their benefits are meant to cover the services they receive, not line the pockets of insurers who double-dip in the process,” said Rep. Murphy. “For too long, inefficiencies within the system have resulted in a lack of coordinated benefits for veterans dually enrolled with Medicare Advantage and can result in excess payments to insurance companies. I’m proud to join the effort to close the loophole that has allowed insurers who provide Medicare Advantage and Medicare Part D supplemental plans to receive duplicative Medicare payments while the Veterans Health Administration foots the bill.”
“Insurance companies are capitalizing on a loophole that allows them to make billions of dollars off the backs of veterans while taxpayers are paying twice—both in the form of Medicare’s monthly payments to the insurers, which happen regardless of whether veteran enrollees are using the Medicare plans’ benefits, and in our annual appropriations to the Veterans Health Administration,” said Rep. Takano. “I look forward to ending this predatory practice with the help of Senator Warren, Senator Cassidy, Senator Blumenthal, Representative Doggett, Representative Murphy, Representative Schweikert, and Representative Joyce, and reinvesting these funds into VA’s healthcare system.”
“Congress must modernize Medicare Advantage and Close the loopholes that allow Medicare Advantage insurers to bill for veteran care they didn’t provide,” said Rep. Schweikert. “From 2018 to 2021, these duplicative payments earned insurers an estimated $44 billion, just a fraction of what companies in this $450 billion-a-year industry have extracted. There is more to uncover and much more to fix. Now is the time to realign incentives in favor of patients.”
“For too long, private insurers have shaken down the government and taxpayers for care veterans receive at VA hospitals,” said Sen. Blumenthal. “This legislation gives VA the power to claw back these payments and use those funds to provide more quality health care to those who served.”
For years, a loophole has allowed MA insurers to pocket billions in taxpayer money through upfront fixed payments from the Centers for Medicare and Medicaid Services for enrolled veterans, despite some veterans never using their benefits, and the VHA shouldering most costs for those who do. As a result, taxpayers are paying twice for the same services, and veterans are losing critical resources that could be reinvested in improving and expanding veterans’ health care. Recognizing the opportunity to profit, insurers deploy disingenuous marketing practices to entice more enrollees for their own lucrative benefits. From 2011 to 2020, dual enrollment in MA plans grew by 63%.
The GUARD Veterans’ Health Care Act would save American taxpayers an estimated $12.1 billion in a single year, and $357 billion over a decade, by allowing VHA to recover payments for any health care items or services provided to veterans dually-enrolled in an MA or Part D plan. The bill also strengthens VHA’s ability to recover payment from third party insurers for care furnished to veterans.
Endorsing organizations include the American Federation of Government Employees (AFGE), National Committee to Protect Social Security and Medicare, Medicare Rights Center, Center for Medicare Advocacy, Justice in Aging, National Nurses United (NNU), Public Citizen, and American Economic Liberties Project.
View the bill text here, and a one-page fact sheet here.
A 10-year savings estimate from the Center for Advancing Health Policy through Research (CAHPR) is here.