James Varney: Budget Negotiations Are Poisoned by Democrats' Insistence on Paying Out Billions in Obamacare Fraud

Now there's the Democrat Party of old!

No transgender cultism -- just endless graft for all its dependent criminals.

At issue are the generous subsidies the Biden administration created for Affordable Care Act policies, sweeteners that are slated to expire in December. Making healthcare essentially free for millions of Americans, those policies have skyrocketed enrollment in Obamacare plans. But a recent study found they have also sparked a curious phenomenon: an estimated 12 million enrollees "without a single claim -- no doctor visit, lab test, or prescription filled" in 2024.

The Paragon Health Institute study reports that this is triple the number of no-claim policyholders before the Biden sweeteners were put in place. "Among those now eligible for zero-premium plans with low or no deductible," the study found, "that number increased nearly sevenfold. ... A whopping 40 percent of enrollees in fully subsidized plans had no claims in 2024. In 2024 alone, taxpayers sent at least $35 billion to insurers for people who paid no premiums and never used their plan," the report said.

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Critics say they underscore the findings of the Department of Government Efficiency (DOGE), which has highlighted a lack of accountability in massive government spending programs at a time when the federal government is struggling to corral massive deficits and debt. They say the Biden sweeteners also illustrate how and why government spending keeps increasing: Once a subsidy is put in place, it is hard to take it away from voters.

The Biden "sweeteners" were supposed to be temporary "emergency" relief during Covid. Of course "temporary emergency relief" is always Democrat-Media-Antifa Party code for "stealing money from Non-Democrats to give to Democrats forever until the very end of days."

The Obamacare expansion at issue came about through legislation and regulations during Biden's term and was often cast as a response to the COVID pandemic. First, the scope of who was eligible for subsidies was broadened, making it available to households with incomes above 400% of the federal poverty line -- making a family of four earning up to $160,000 eligible for subsidized plans. Also, increased subsidies made Obamacare free for those with incomes between 100% and 150% of the poverty line, and longer enrollment periods were created.

The cost for this, on the other hand, is borne by taxpayers.

"Biden's COVID credits didn't reduce health care costs -- they just shifted them to taxpayers while padding insurer and enrollment intermediary profits," Paragon President Brian Blase said.

Like all gigantic markets and massive government programs, the Affordable Care Act and what people pay each month have become a very complicated thing, varying by age, state, level of plan, and other factors. But the figures for the Obamacare "reference plan" (silver level) reveal what has happened since the COVID pandemic.

In 2021, when Biden was inaugurated, that basic plan cost an individual $27 a month if they reported income along the federal poverty line, which stood around $14,500 a year. For those making 50% more, the "reference plan" cost $75 a month, and so on up to $152 a month for someone making more than $30,000. Those monthly payment figures were constant regardless of what the insurers charged, with taxpayers making up the difference.

Through legislation Biden pushed through by narrow majorities or via reconciliation, the amount someone would pay each month in the first two categories dropped to zero. And as Obamacare became essentially free, millions signed up -- enrolling at rates the plan had never seen since its inception in 2013.

The overall figures reflect this explosion. Between 2016 and 2020, an average of 8.5 million people signed up for a subsidized Obamacare policy each year, and in none of those years did the figure equal 9 million, according to the Center for Medicare and Medicaid Services (CMS).

In 2021, however, the subsidized total topped 10 million, and by 2024 it had nearly doubled to 19.5 million, CMS figures show.

"It's all counter-intuitive, that when enrollment isn't being publicized, no one is out beating the bushes to get people enrolled like we had in the early years of Obamacare," said Ed Haislmaier, a healthcare expert at the conservative Heritage Foundation. "Amazing, that a product's sales would go through the roof when nobody was talking about it."

Some analysts believe the numbers indicate rampant fraud. Blase claimed in a letter to the Wall Street Journal that the expansion has created an explosion of phantom patients -- including 6.4 million of them so far in 2025. "The problem isn't real people with coverage they don't use -- it's fraudulent sign-ups who never should have been subsidized."

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Paragon is not the only group voicing concerns. It often seems like fraud is endemic in federal programs, and government healthcare appears to offer a rich vein for such activity.

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Opponents of expanded subsidies note that when the government makes a deep pool of money available, as has happened with the ACA, fraud is sure to follow. In June, Bloomberg did a deep dive on the phenomenon, describing a rat's nest of unscrupulous call centers, primarily based in Florida, that have lured people in with various gimmicks and then signed them up for subsidized plans.

What's more, those licensed to sell plans had access to Obamacare exchange databases, which allowed them to change both the "agent of record" (thereby making themselves recipient of whatever bonus insurers paid for new signups), or the plan a person was enrolled in (thereby increasing their commission and the taxpayers' bill), according to Gabrielle Kalisz, one of the authors of Paragon's report.

Consequently, millions of Americans may be unaware that they own a subsidized Obamacare policy, and horror stories abound of unsuspecting people hit with tax bills seeking to recoup the subsidies.

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Nor are the so-called "phantom enrollees" the only issue. For example, the numbers don't add up when percentages of state populations according to census data are measured against the Obamacare subsidies. Fourteen states have more people enrolled at up to 150% of the federal poverty line than they do residents who fit that category, and Florida's total is five times what census data shows it could be.

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Republicans, including some who got fabulously wealthy through the healthcare system, like Florida's Sen. Rick Scott, have said extending the subsidies is ruinously expensive and foolhardy, given what has happened since they were introduced.

"COVID opened the door for massive waste, fraud, and abuse of government programs, like the billions in fraud and abuse allowed by the 'temporary COVID' enhanced Obamacare subsidies," Scott posted last week. "Americans don't want their tax dollars lining the pockets of insurance companies -- it's time to end this clear abuse of YOUR dollars."

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Whatever the outcome, large subsidies that have always been part of Obamacare will continue. For all the hue and cry about rising costs, the elimination of Biden-era sweeteners would simply return the system to the way it was operating before 2021, Kalisz said.

"It's crony math, a kind of corporate welfare," she told RealClearInvestigations. "Why are the insurers now making it seem like all the subsidies are going away? It's a form of scaring and spooking the public."

posted by Ace at 05:35 PM

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