The Centers for Medicare and Medicaid Services says it canceled the policies only after investigating and confirming that the enrollments were unauthorized.
Many involved people enrolled without their knowledge, sometimes by dishonest insurance agents and brokers.
Those cancellations are expected to return roughly $2.2 billion in taxpayer-funded subsidies. And there’s ample evidence that they represent only part of Obamacare’s much larger integrity problem.
Last December, the Government Accountability Office (GAO)reported the results of an undercover test of the exchanges. Investigators submitted applications using fictitious identities to see whether fake applicants could obtain subsidized coverage.
All four fictitious applicants tested in late 2024 received subsidies.
Of the 20 tested for 2025, 18 were still receiving subsidized coverage as of September.
The report also revealed that CMS received roughly 275,000 complaints in 2024 from consumers who said they had been enrolled in coverage or had their plans changed without their consent.
Another 160,000 applications appeared to contain likely unauthorized changes by agents or brokers.
Research from the Paragon Health Institute suggests the problem may be far larger. One analysis found that the number of exchange enrollees with no medical claims tripled between 2021 and 2024, reaching almost 12 million.
Of those with with fully subsidized coverage 40% recorded no claims in 2024.
Zero claims don’t prove an enrollment is improper. But the dramatic increase is consistent with other evidence of widespread “phantom” enrollment — people who don’t know they have exchange coverage or have other insurance.
How did the exchanges become so vulnerable?
Read the entire op-ed here.
Obamacare Vulnerable to a Real Fraud Problem
Sally C. Pipes
Policymakers should keep rooting out fraudulent enrollments, strengthening eligibility checks, and holding dishonest brokers accountable. Protecting public programs from fraud isn’t cruel. It’s how government ensures that taxpayer dollars actually reach the people Congress intended to help.
The Centers for Medicare and Medicaid Services says it canceled the policies only after investigating and confirming that the enrollments were unauthorized.
Many involved people enrolled without their knowledge, sometimes by dishonest insurance agents and brokers.
Those cancellations are expected to return roughly $2.2 billion in taxpayer-funded subsidies. And there’s ample evidence that they represent only part of Obamacare’s much larger integrity problem.
Last December, the Government Accountability Office (GAO)reported the results of an undercover test of the exchanges. Investigators submitted applications using fictitious identities to see whether fake applicants could obtain subsidized coverage.
All four fictitious applicants tested in late 2024 received subsidies.
Of the 20 tested for 2025, 18 were still receiving subsidized coverage as of September.
The report also revealed that CMS received roughly 275,000 complaints in 2024 from consumers who said they had been enrolled in coverage or had their plans changed without their consent.
Another 160,000 applications appeared to contain likely unauthorized changes by agents or brokers.
Research from the Paragon Health Institute suggests the problem may be far larger. One analysis found that the number of exchange enrollees with no medical claims tripled between 2021 and 2024, reaching almost 12 million.
Of those with with fully subsidized coverage 40% recorded no claims in 2024.
Zero claims don’t prove an enrollment is improper. But the dramatic increase is consistent with other evidence of widespread “phantom” enrollment — people who don’t know they have exchange coverage or have other insurance.
How did the exchanges become so vulnerable?
Read the entire op-ed here.
Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.