“The scale of the problem suggests bad faith,” Reps. Cathy McMorris Rodgers (R-Wash.), Jason T. Smith (R-Missouri) and Jim Jordan (R-Ohio), who chair the Energy and Commerce, Ways and Means and Judiciary committees, respectively, said in the letter, calling on the watchdog agency to conduct a “systematic review of the registers.”
At the heart of the suspicions report The conservative think tank Paragon Health Institute concluded that up to 5 million Americans may be unfairly receiving ACA insurance subsidies. The Paragon report compared ACA enrollment numbers to Census estimates of how many Americans may be eligible for subsidies.
The allegations also stem from recent KFF Health News reports that unscrupulous brokers are signing up customers with false information or mistakenly switching them between plans without their knowledge or consent. It stirred anger on both sides of the aisle..
The Centers for Medicare and Medicaid Services recently Announced The department said it received about 90,000 complaints about unauthorized enrollment and plan switching in the first quarter of 2024. Brokers profit from the practice by receiving commissions, but unauthorized plan enrollment and switching can harm consumers, and federal health officials say they are cracking down on brokers’ conduct.
Democrats share concerns about possible fraud, with Sen. Ron Wyden (D-Ore.), chairman of the Senate Finance Committee, recently saying: Calling for further enforcement To protect consumerss From unscrupulous brokers.
The spotlight on potential fraud in the ACA has grown as lawmakers continue to battle over how to fund the health care law and its programs. Democrats have celebrated the ACA’s enrollment numbers, and President Biden touted during Thursday night’s debate that more than 40 million Americans are now insured through the ACA’s insurance marketplaces and Medicaid expansion.
Republicans counter that the program’s objectives have been misconstrued and that Democrats have been too generous in providing federal subsidies to private health insurance.
Under the American Rescue Plan Act and the Inflation Reduction Act, people who report incomes between 100 and 150 percent of the federal poverty line can receive increased subsidies that reduce premiums for very low-deductible plans (so-called “zero” plans) to zero. Zero premium planFor example, a family of four would need to report an income between about $30,000 and $45,000 to qualify for the increased benefits. The boosted benefits are set to expire in 2025, but Republicans have been hesitant to extend them, threatening a fight in Congress.
About half of people who signed up for private health insurance during the recent ACA enrollment period reported having the income to afford a fully subsidized or zero-premium plan, up from about one-third before the expanded subsidies became available. The Paragon report argues that individual enrollees, insurance brokers, and private health insurers all have financial incentives to take advantage of the subsidies, and that no one has closely examined the reasons for the surge in subsidy use.
“It’s surprising how little has been done to address these issues,” Brian Blades, president of Paragon and a former White House health policy adviser to President Trump, said in an interview.
Other researchers and health policy experts said they had doubts about Paragon’s conclusions.
Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy, said he supports a federal investigation into broker practices and other potential sources of enrollment fraud, but warned that Republicans repeatedly use fraud allegations as a way to attack Obamacare and other health programs.
“Beneficiary fraud has always been a small percentage of fraud and abuse in programs like Medicaid,” Park said.
He also criticized the Paragon report for relying on a “relatively simplistic methodology” that doesn’t account for important differences between Census estimates and ACA enrollment data.
Asked about the report’s findings, Blades said he was confident in its conclusions.
“I don’t think this is suspicion. I think this is data,” he said.
