“The scale of the problem suggests malicious intent,” Reps. Cathy McMorris-Rodgers (R-Wash.), Jason T. Smith (R-Mo.) and Jim Jordan (R-Ohio) wrote in their letters, calling for a “review registration system” by supervisors. The three legislators are chairmen of the Committee on Energy and Commerce, on Ways and Means and on the Judiciary.
The allegations center on a report by the Paragon Health Institute, a conservative think tank, which concluded that up to 5 million Americans may be receiving ACA insurance subsidies in error. The Paragon report compared census estimates of the number of Americans potentially eligible for such subsidies against the level of ACA enrollment.
The allegations are also fueled by recent KFF Health News reports about unscrupulous brokers falsifying information to enroll customers or mistakenly switching customers between plans without their knowledge or consent, a development that has fueled bipartisan outrage.
The Centers for Medicare and Medicaid Services recently announced that the agency received nearly 90,000 complaints about unauthorized enrollments or plan switches in the first quarter of 2024. While brokers benefit from the moves by receiving commissions, unauthorized plan enrollments or switches can harm consumers . and federal health officials have said they are cracking down on the broker’s behavior.
Democrats share some concerns about potential fraud, with Sen. Ron Wyden (D-Ore.), chairman of the Senate Finance Committee, recently calling for more enforcement to protect consumerss from unscrupulous brokers.
The focus on potential ACA fraud comes as lawmakers continued to battle over the health law and how to fund its programs. Democrats have celebrated enrollment through the ACA, with President Biden in Thursday night’s debate claiming that more than 40 million Americans are covered through its insurance marketplaces and its Medicaid expansion.
Republicans have countered that the program’s purpose has been distorted and that Democrats have been too generous in providing federal subsidies for private health insurance.
Under the American Savings Plan Act and the Inflation Reduction Act, people who report incomes between 100 and 150 percent of the federal poverty line can receive extended subsidies that lower their premium to zero for a plan with very high payments. low out of pocket. known as a zero premium plan. A family of four, for example, can report income between $30,000 and $45,000 to qualify for the expanded subsidies. The expanded subsidies are set to expire in 2025, and Republicans have opposed extending them, setting up a fight in Congress.
About half of people who signed up for private health insurance in the last ACA enrollment period reported income that qualified them for a fully subsidized or zero-premium plan, up from about a third before they did. extended subsidies available. The Paragon report argues that individual enrollees, insurance brokers and private health insurers all have financial incentives to take advantage of those subsidies, and that no one has bothered to look closely at the reasons for the increased use of subsidies.
“It’s amazing how little has been done to date to look at these issues,” Brian Blase, Paragon’s president and a former Trump White House health policy official, said in an interview.
Other researchers and health policy experts have said they doubt Paragon’s conclusions.
Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy, said he supports federal investigations into broker behavior and other sources of potential registration fraud. But he warned that Republicans have repeatedly raised allegations of fraud as a way to attack the Affordable Care Act and other health programs.
“Beneficiary fraud has always been a small part of any fraud and abuse in any of the programs like Medicaid,” Park said.
He also criticized the Paragon report for relying on “a relatively simplistic methodology” that failed to account for critical differences between enrollment estimates and ACA enrollment data.
Pressed on his report’s findings, Blase said he was confident in the conclusions.
“I don’t think they are accusations. I think it’s data,” he said.
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