“Affordability” is just covering for Bidenflation, since the subsidized Obamacare premiums were a % of wages, while wages didn’t keep pace with inflation or healthcare costs.
The average Obamacare premium for 2025 was $619 per month, of which subsidies covered more than $500. More than 10 million enrollees, 46 percent of those receiving aid, paid $10 or less per month out of pocket for premiums.
About 8 million paid $0, according to Brookings. That’s exactly the problem, according to some analysts, because the possibility of enrolling large numbers of people who would never receive a bill created a ripe opportunity for fraud. Many people were enrolled in the program without their knowledge by unscrupulous insurance brokers, Blase alleges, prompting the federal government to send a commission check to them—and premium payments to an insurance company.
Another indication of fraud is the number of states where enrollment in Obamacare plans with a $0 premium is unreasonably high compared to the number with a qualifying income. Twenty-four states have more Obamacare enrollees claiming incomes between 100 percent and 150 percent of the federal poverty level than there are people living in the state with that income, according to data from the U.S. Census Bureau.
Obamacare customers are automatically re-enrolled each year, so a fictitious account would continue to generate fraudulent commissions and wasteful insurance payments until detected.
At least this makes premiums cheaper for the rest of us - if all these people dont know they’ve been enrolled, they dont know they have insurance coverage to use.
Here’s the guy who’s talking about the fake Obamacare signups, head of some think tank.
In the 2nd link, he goes into more details about the misaligned incentives and weak oversight that make federal healthcare spending ripe for state level fraud.
I guess sure, more premiums increase the pot they’re taking a percentage from for profit. But moreso arent all these policies with no claims (since no one knows they have the policy) lowering premiums across the board? 6.4 million policies is a lot of premium money to subsidize other people’s claims.
It’s like the discussion earlier - if everyone with insurance all submit a $1,000 claim, everyone’s premiums will be at least $1,000. It’s not the right way to do it, but these 6.4 million ghost policies are what allows those people to save money by having insurance, collecting premiums with no claims produces lower premiums for everyone.
Which is to say, without all this alleged fraud, everyone’s health insurance costs/premiums would’ve skyrocketed even higher than they have.
Unless I’m missing something, that claim seems like a highly tenuous one to me.
The US population is roughly insured 55% via employer-sponsored plans, 35% on Medicare/Medicaid, and about 10% ACA and similar private insurance. Even then, ACA is not totally taxpayer paid either since many people have a remaining premium still.
So for insurer revenues to be 85% from taxpayer subsidies, it’d mean they have to generate tons more revenues from ACA plans compared to employer-sponsored plans. I highly doubt it considering employer-sponsored plans are not significantly cheaper than ACA plans typically.
I could believe that 85% of the premiums collected on ACA plans are taxpayer funded though but that’s not quite the same claim. It doesn’t excuse enrolling fictitious people or against their will or without their knowledge.
Only if the money fraudulently paid to insurers for fake/fraudulent policies, was not redistributed to other legitimate ACA enrollees, in the form of increased subsidies.
I still think the whole ACA broker - direct-subsidies-to-insurer system creates an opacity and conflicts of interests that will always get exploited.
Curious how does that solution work practically? Surely shutting down Medicare, Medicaid, and Child Care Assistance altogether would stop the fraud… If on the other hand, the implied remedy is more oversight, I think that’s fair and possibly worth the extra administrative costs but if it has not been implemented yet, there may be a reason.
Complaints about the “newer” generation of doctors treating people off of scripts (not yet AI ones) rather than knowing the patient’s history and giving relevant, holistic medical advice.
Alex, You have seen the underbelly of Obamacare and what it has wrought. One of the main purposes of Obamacare was to essentially force doctors to become employees of health care (using the word loosely) organizations. There had been decades of political frustration because old-line doctors were the mainstay support for patients throughout the health system and the political system. Many, I venture to say most, were like your old doctor. That was the person they most wanted to eliminate and they have. Now doctors do what their health system measures them against this week and shut up and live with it. Together with radically reduced qualifications for going to medical school, it is a perfect storm to get the kind of algorithmic, non-individual care you got.
Getting what you want out of healthcare costs a lot
Premiums for employer-sponsored insurance will go up by another 9 percent in 2026. Public spending on Medicare, Medicaid, and Obamacare is also surging.
This is not due to surging profits among insurers or hospitals. Insurance and entitlement programs are largely passing along the rising cost of care, even as average prices paid to hospitals, physicians, and drugmakers decline in real terms. The true driver is higher utilization of medical services—especially newly developed drugs and newly available outpatient procedures.
From 2014 to 2023, prices for medical services rose by less than the overall rate of inflation. Increased enrollment has driven up Medicare costs (as baby boomers retire) and Medicaid costs (as eligibility expands). But the main factor behind higher insurance expenses has been greater utilization per enrollee, which has grown by roughly 20 percent across both public entitlements and private insurance.
California Democratic candidates for governor can’t stop talking about single-payer health care — again.
The idea of a government-run universal health care program that would replace private insurance as the sole payer of health care costs faces as many headwinds as ever. It had fallen onto the backburner after Gov. Gavin Newsom and Democratic lawmakers failed to get it done, with some balking at the $392 billion estimated annual cost.
Health advocates have since turned their focus to the impending Trump administration cuts to Medi-Cal, the state’s expanded government health coverage for low-income residents. Even so, the progressive rallying cry of “Medicare for All” has become a staple of Democratic platforms. Few of them offer any specifics on how they would make it happen.
California Governor Gavin Newsom is embroiled in a national fraud scandal. Thus far, much of the coverage has focused on alleged schemes related to unemploymentinsurance, hospice care, and food stamps. In this exclusive investigation, we shine a light on one of California’s largest initiatives: the In-Home Supportive Services Program, or IHSS, which pays family members and other individuals to provide home-based care for the elderly and disabled—at a cost of nearly $30 billion per year.
On the surface, IHSS presents itself as an instrument of compassion, directing billions to caregivers who help with cooking, personal care, laundry, and other daily needs inside recipients’ homes. But a growing number of experts and critics argue that the program is rife with fraud, losing roughly an estimated $6 billion to $12 billion yearly to scammers. Meantime, the state’s powerful home-care unions collect more than $149 million in membership dues, funneling money into the political network supporting Newsom and California Democrats.
This is one of the main reason why Medicaid needs to be reformed badly away from the current state spending match system. Each state healthcare should be funded by FICA taxes on its residents so they can freely spends these FICA tax proceeds according to what its constituents vote for (or against). Current system of having federal system inter-weaved in it is not only unnecessary but it effectively gives a say to people who do not pay into your state’s spending. I think that would help residents take a much closer look at their state spending and see a direct link between votes and state spending instead of having Medicaid involvement muddy the waters (and provide an easy target to blame).
On the other end of the spectrum are the businesses we have divested where the assets no longer support our strategic direction or have reduced management focus from our core growth platforms. Our divestiture of our group life and disability business, which also meaningfully reduced the company’s exposure to economic downturns is a prime example. As is the more recent sale of our Medicare businesses. Divesting each of these assets enabled greater focus and investment in the remaining businesses within our portfolio, supporting our forward-looking growth path.
In keeping with this portfolio shaping discipline, today, we are announcing 2 additional actions. First, we are planning to exit our individual exchange business [Obamacare] at the end of this year. We did not make this decision lightly and appreciate the importance of ensuring patients have continuity through the transition. There are no changes to coverage or networks related to this announcement, and we will support members through their open enrollment transitions into 2027.
Sounds like existing customers might need to find another provider in a year or so. I’m not sure if they mean you’ll have to pick someone else this Dec, but it sounds like it.
Sounds to me like they’re gonna help current enrollees with transition to their 2027 insurer during open enrollment. That’s plenty of notice for most to tell members now that they’ll need a new insurer next year. I cannot imagine why they’d continue this part of their business next year but announce it now.
Move over MN, the Somalis in OH are giving you a run for the taxpayers money to the tune of $1B/year.
Ohio, which like Minnesota has been granted waivers to expand Medicaid well beyond its original purpose. Under the guise of health care, Ohio pays people to go to Medicaid beneficiaries’ homes to perform “homemaking” and “chores” like cooking and cleaning. The people performing these “personal services” tasks don’t even have to be health care workers — and in many cases, are actually relatives of the Medicaid recipient.
According to a Daily Wire data analysis, Ohio spent a billion dollars on home health care in 2024, the last year for which data is available.
The business model is simple: a 40-year old Somali immigrant gets paid for spending time with, and maybe cooking for, his own 65-year-old mother. The middle-man is one of thousands of “home health” firms that have the “NPI” number necessary to bill Medicaid.
The 40-year-old becomes an “employee” of that company, but has no clients other than his mother. There is no way to verify whether he actually even provided the “services” — unless his own mother is willing to testify against him.
This poverty program is different from things like food stamps, because it has no monetary cap and its extent is decided not by politicians, but by any doctor willing to sign a form saying you could use some help around the house. It only takes one doctor who will say yes to churn out enough forms to bankrupt a state.
There’s nothing wrong with this – caring for old / disabled people is hard work, and it’s better and cheaper (for everyone) to do it this way than in a nursing home. You missed the more relevant quote:
California has a program like that (IHSS), but as far as I know there is no middle-man and the program pays employees directly (slightly above minimum wage IIRC), so nobody is getting rich. Ohio f’d up.
There’s also nothing wrong with daycares. The problem is it is ripe for fraud, in this case with even less auditing ability than empty daycare centers.
System of having a middle-man company sounds like it’d make the fraud potential way worse. It’d probably be less prone to fraud if nobody else but the “homemaker” stood to make money and they along with the Medicaid recipient had to personally apply for financial assistance directly (hopefully with documentation of their work hours and services provided).
Short 15min video by the guy doing OH Medicare fraud investigation. Hundreds of companies with no one home billing millions or tens of millions each for unverified services, often run by repeat criminals.
State run audits have no teeth and barely care, certainly not to shut down or investigate fraud. After all, it’s nearly all the Fed’s money, ie yours.
If on the other hand, the implied remedy is more oversight, I think that’s fair and possibly worth the extra administrative costs but if it has not been implemented yet, there may be a reason.