What’s behind Obamacare congressional wrestling

A brief summary about WTF is going on in the partisan battle over Obamacare (the Affordable Care Act) and its subsidies.

First, what both sides agree on: Health care costs too much. 

Second, something must be done.

That’s all both sides agree on.

I think it’s fair to say Democrats want the maximum benefits for everyone.

I think it’s fair to say Republicans want coverage for everyone who qualifies.

That brings me to the nonpartisan General Accounting Office that has repeatedly warned about fraud related to the Advance Premium Tax Credit since 2014-2016. The GAO’s latest report  suggests that current fraud management is out of date and does not reflect the current state of Obamacare, especially after the implementation of enhanced premium tax credits.

The report did not get much attention in the MainStream Media. Here are its key findings, which included covert testing:

1. Ease of Enrollment for Fictitious Applicants:

 * High Approval Rate: The federal marketplace approved subsidized coverage for nearly all of the GAO's fictitious applicants (23 out of 24 applications) submitted during plan years 2024 and 2025.

 * Lack of Verification: These fake applications used invalid information, such as fake or never-issued Social Security numbers (SSNs) and unverifiable identities. In many cases, the applicants received coverage even when the GAO failed to provide requested documentation for SSN, citizenship, or income.

 * Subsidies Paid: For the fictitious enrollees, the Centers for Medicare & Medicaid Services (CMS) paid thousands of dollars per month in APTC.

2. Widespread Misuse of Social Security Numbers (SSNs):

 * Multiple Uses: Preliminary analyses identified instances of SSNs being overused. For example, in plan year 2024, nearly 68,000 SSNs were used to receive more than one year's worth of subsidized coverage in a single plan year.

 * Identity Theft/Fraud: One single SSN was found to have been used on applications for over 125 insurance policies in 2023.

 * Deceased Individuals: The analysis found that millions of dollars—such as an estimated $94 million in one analysis—were paid in subsidies for plans associated with SSNs that matched Social Security death data.

3. Unauthorized Enrollment Changes by Agents/Brokers:

 * Unauthorized Activity: The GAO identified at least 160,000 applications in plan year 2024 that had likely unauthorized changes made by agents or brokers.

 * Consumer Complaints: CMS reported receiving approximately 275,000 complaints from January to August 2024 from consumers who found they were either enrolled in a plan or had their coverage changed without their consent.

4. Failure in Subsidy Reconciliation:

 * Unreconciled Payments: The report noted a massive failure to reconcile subsidies through IRS processes. Preliminary analysis suggests that over $21 billion in APTC for enrollees who provided SSNs in plan year 2023 could not be identified as reconciled to their income. This lack of reconciliation can allow enrollees to receive larger subsidies than they are eligible for by misrepresenting their income.

There you have it.

I would call it massive fraud, but that’s my subjective opinion. It reeks of the Big 3: waste, fraud and abuse. As a matter of fact, Health & Human Services has historically been vulnerable to fraud, not to mention the pandemic fraud perpetrated during the Covid years.

Right now, Democrats want to extend the Covid-era subsidies for three years while Congress talks about fixing it.

Republicans, basically, are saying it is insane to extend a flawed program until after it gets fixed.

If we had a Congress we could trust, a compromise extending the subsidies with additional strong guard rails would not be difficult.

The clock is ticking.

Congress wraps up its year in a few days and if Obamacare is not fixed, premiums are expected to skyrocket after January 1.

Then much of America will be screaming WTF?