Bipartisan GUARD Act Would (Finally) Make Insurers Pay — Not Just Veterans and Taxpayers

A rare bipartisan bill in Congress aims to end the health insurance industry’s billion-dollar scam that charges taxpayers twice for care only the VA provides.

The insurance industry has pulled off a multi-billion-dollar heist for years — one that’s come at the direct expense of America’s veterans and the taxpayers who want to support them. But now, in a rare act of bipartisan sanity, Congress has the chance to stop it.

Lawmakers have introduced the Guarantee Utilization of All Reimbursements for Delivery of Veterans’ Health Care Act, or GUARD Veterans’ Health Care Act. The proposed legislation would finally close a loophole that allows private insurers to collect full Medicare Advantage (MA) and Part D payments for veterans — even when those veterans receive their care through the VA.

Billed Twice, Served Once

In simpler terms, health insurers get paid by the federal government as if they’re delivering care, even though the VA is doing the work. Meanwhile, taxpayers are billed twice — once through Medicare and again through annual VA funding.

Insurers have capitalized on this setup. From 2011 to 2020, dual enrollment in Medicare Advantage among veterans rose by 63%, driven by aggressive marketing campaigns that wrap these plans in patriotic branding. The sales pitch says it’s about honoring veterans; the reality is it’s about maximizing revenue for insurers.

According to Congressional estimates, these duplicative payments could total $357 billion over the next decade. That’s money that should be reinvested into VA hospitals, mental health care, and essential services—not diverted to corporate profits.

The Cost is on Veterans, Seniors and Taxpayers

This loophole isn’t the only way insurers profit off veterans. Under the Veterans Community Care Program, UnitedHealth Group’s Optum subsidiary manages outsourced private care networks. The results? Inflated costs, rampant upcoding, and poor oversight. Between 2017 and 2020, spending on non-VA evaluation and management services surged 500%, much of it driven by questionable billing practices flagged by the VA’s own Inspector General.

While the VA delivers care with generally better outcomes and higher patient satisfaction, we continue shifting resources away from it and into a fragmented, corporate system that rewards Wall Street gaming over patient care. Veterans deserve better than being treated as revenue opportunities.

What the GUARD Act Would Do

The GUARD Act would empower the VA to recover payments for care it provides to veterans who are also enrolled in MA or Part D plans. This would align the system with how other insurers are already billed and ensure that taxpayer funds are used efficiently.

Read the full bill here.

The potential savings are enormous  $12.1 billion in just the first year. But this legislation is also about principle. It stops rewarding insurers for care they didn’t deliver and helps rebuild the public system designed for veterans.

Veterans didn’t serve this country to become line items on insurers’ balance sheets. They deserve a health care system that puts them – not shareholders – first. Congress must stop this waste and pass the GUARD Act now.

Let’s stop subsidizing corporate freeloading. Reinvest in the VA. And finally, put an end to this multi-billion-dollar scam.

---

Previous post you might like:

Privatizing the VA: The Unseen Costs to Veterans and Taxpayers Alike

OV 19, 2024

In 2018, Congress passed the VA MISSION Act, which was celebrated as a pathway to expanding veterans' access to health care, theoretically giving them a choice to see private providers when the VA couldn’t meet their needs. However, the reality of this privatization effort has been less about expanding choices and more about lining corporate pockets at the expense of veterans, their families, and American taxpayers. If you look closely, you’ll see how some of the very same companies behind the Medicare Advantage scheme — like Optum, a subsidiary of UnitedHealth Group — are cashing in on both fronts.

By Wendell Potter