The Affordable Care Act (ACA), often called Obamacare, continues to face significant scrutiny over systemic vulnerabilities to fraud, waste, and abuse
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| Democrats Desperately Trying To Keep Obamacare Money Laundering Machine Chugging Along |
Obamacare Subsidies, follow the money: United Health Group. Anthem. CVS,CIGNA group
Recent reports and investigations, particularly from the nonpartisan Government Accountability Office (GAO), highlight ongoing issues exacerbated by enhanced subsidies introduced during the COVID-19 era. These subsidies, set to expire at the end of 2025, have been linked to billions in improper payments, unauthorized enrollments, and exploitation by brokers and insurers.
Below is a summary of key updates from 2025, drawing from federal audits, congressional oversight, and enforcement actions.
Key Findings from the December 2025 GAO ReportThe GAO released preliminary results from an ongoing review of fraud risks in the ACA's advance premium tax credit (APTC) program on December 3, 2025. This subsidy helps eligible Americans afford marketplace plans by directing payments to insurers.
- Covert Testing Reveals Persistent Vulnerabilities: GAO investigators created 20 fictitious identities with invalid or fabricated Social Security numbers (SSNs) and submitted applications for 2024 and 2025 coverage. Nearly all (100% in late 2024 tests) were approved without documentation requests, mirroring failures seen in 2014–2016. As of September 2025, 18 of 20 fake applicants remained enrolled, receiving over $10,000 monthly in APTC subsidies—totaling more than $12,300 per month across the group in some scenarios.
- Scale of Improper Payments: Estimates suggest up to $27 billion annually in waste, fraud, and abuse, including:
- 6.4 million improper enrollees in 2025 (up from 5 million in 2024).
- $14 billion wasted on dual Medicaid-ACA enrollments.
- Over 58,000 deceased individuals' SSNs used for $94 million in credits in 2023–2024 alone.
The Department of Justice (DOJ) and Internal Revenue Service (IRS) have ramped up prosecutions, but complaints remain high:
Category | Estimated 2025 Impact | Examples |
|---|---|---|
Improper Enrollments | 6.4 million people | Fake SSNs, income misreporting (2.3 million confirmed by CBO) |
Financial Loss | $27 billion annually | $133.9M Florida scheme; $94M via deceased SSNs |
Consumer Complaints | 275,000+ in 2024 | Unauthorized switches; denied care due to verification issues |
Broker Suspensions | 850 by Oct 2024 | Data-harvesting from scam ads |
Fraud has driven premium hikes (despite subsidies) and reduced choices, with insurers pocketing billions. GAO recommends CMS implement real-time SSN validation, broker authentication (e.g., three-way calls), and annual fraud audits. Without action, risks could worsen post-2025 if subsidies extend unchecked. For state-run marketplaces (e.g., California, New York), stricter authentication has limited issues, suggesting a model for federal fixes.
Enforcement Actions and Broker SchemesThe Department of Justice (DOJ) and Internal Revenue Service (IRS) have ramped up prosecutions, but complaints remain high:
- April 2025 Guilty Plea: Dafud Iza, executive vice president of a Florida insurance brokerage, pleaded guilty to a $133.9 million scheme. He and accomplices submitted fraudulent applications for ineligible individuals, inflating incomes to capture full subsidies. The goal: Millions in commissions from insurers. This targeted vulnerable groups like the homeless and mentally ill.
- Unauthorized Enrollments Surge: CMS received 275,000+ complaints in 2024 about unauthorized plan switches or enrollments, with 40,000 in the first quarter alone. Brokers harvested personal data from misleading ads (e.g., "$6,400 grocery subsidies") to auto-enroll consumers without consent, siphoning subsidies. By October 2024, CMS suspended 850 brokers.
- Zero-Claim Enrollees: About 35% of 2024 ACA enrollees (nearly 12 million) filed no claims, suggesting "ghost" policies used solely for subsidies. This points to fraud rings exploiting relaxed verification rules
Category | Estimated 2025 Impact | Examples |
|---|---|---|
Improper Enrollments | 6.4 million people | Fake SSNs, income misreporting (2.3 million confirmed by CBO) |
Financial Loss | $27 billion annually | $133.9M Florida scheme; $94M via deceased SSNs |
Consumer Complaints | 275,000+ in 2024 | Unauthorized switches; denied care due to verification issues |
Broker Suspensions | 850 by Oct 2024 | Data-harvesting from scam ads |
- Subsidy Expiration Debate: Enhanced APTC credits (100% subsidy for many) end December 31, 2025, potentially raising premiums for 22 million enrollees. Democrats push for a $350 billion, three-year extension without major reforms, while Republicans demand integrity fixes like pre-enrollment verification and ending "anytime" sign-ups. A bipartisan proposal from Reps. Josh Gottheimer (D-NJ) and Jen Kiggans (R-VA) suggests a one-year extension with anti-fraud controls.
- Legislative Reforms: The July 2025 "One Big Beautiful Bill" (OBBB) introduced partial fixes, such as full subsidy repayment for income underestimations and curbing special enrollment abuse. However, GAO notes these haven't stemmed the tide. Nine states saw ACA sign-ups exceed eligible populations, per CMS data.
- Public and Expert Sentiment: On X (formerly Twitter), discussions echo GAO findings, with users decrying "theft" via subsidies to insurers and calls to replace the ACA entirely. Critics argue it enriches "billionaire executives" at taxpayers' expense, while supporters frame opposition as anti-affordability.
Fraud has driven premium hikes (despite subsidies) and reduced choices, with insurers pocketing billions. GAO recommends CMS implement real-time SSN validation, broker authentication (e.g., three-way calls), and annual fraud audits. Without action, risks could worsen post-2025 if subsidies extend unchecked
The Affordable Care Act (ACA) has been credited with expanding coverage to millions, but critics argue its structure—particularly enhanced premium tax credits and subsidies—has driven up overall healthcare costs while delivering outsized gains to insurers through higher premiums and risk adjustments, even as some report margin pressures in government programs. Based on 2024-2025 financial data and analyses tying profits to ACA marketplaces, the insurers benefiting most from these dynamics are those with the largest ACA enrollments and Marketplace revenues. UnitedHealth Group leads by a wide margin, followed by Centene and Elevance Health, which have seen substantial growth in ACA-related premiums and margins.Here's a summary of the top performers' net profits (or projected for 2025 where noted), with ACA ties highlighted:
Insurer | 2024 Net Profit | 2025 Projection/Notes | ACA Windfall Connection |
|---|---|---|---|
UnitedHealth Group | $14.4 billion | $23 billion (adjusted down from $26B initial guidance) | Largest ACA player; 231% profit growth since 2011 ACA implementation, fueled by Marketplace expansion and subsidies covering ~80% of premiums for many enrollees. Revenues projected at $450-455B in 2025. |
Elevance Health (Anthem) | $6 billion | $6-7 billion (Q1 margin up to 4.5%) | Heavy ACA exposure; 11% YoY Marketplace membership growth in Q1 2025, with subsidies driving premium revenue despite elevated costs. |
Centene | Not specified (revenues $163B) | Premium revenues $164-166B | Marketplace-focused; 12% membership growth and "improved margins" from ACA risk adjustments in 2024, directly linked to subsidies as a "windfall." |
CVS Health (Aetna) | $4.6 billion | Strong Q2 EPS $1.81 | ACA utilization up, but exited unprofitable markets for margin gains; subsidies enable 83% MLR while boosting overall profits. |
Cigna Group | $5.7 billion (full year est.) | Q3 $1.9B (up from $739M YoY) | 159% profit jump since 2015; lower ACA MLR (83%) via market exits, with subsidies offsetting utilization spikes. |
These gains stem partly from ACA subsidies (enhanced since 2021 via the Inflation Reduction Act), which total ~$98B in federal spending for 2024 and are set to expire end-2025 unless extended—potentially doubling consumer premiums while preserving insurer margins. However, not all ACA lines are profitable: Q3 2025 operating margins averaged -1.4% across major payers in ACA/Medicare/Medicaid, with Centene down 15.6% YoY due to utilization. Insurers like these have lobbied heavily to retain subsidies, spending millions on campaigns
Campaign finance data from the 2024 election cycle (covering contributions from January 2023 to December 2024) shows these insurers' PACs and employees directing funds primarily to incumbents on key committees like House Ways & Means, Energy & Commerce, and Senate Finance, which oversee healthcare policy.
company.
These patterns reflect strategic giving to protect ACA subsidies and Medicare Advantage funding. For full lists, see OpenSecrets.org. Data as of February 2025 FEC releases.
Insurer | Total to Federal Candidates | Top House Recipients (Amount) | Top Senate Recipients (Amount) | Notes |
|---|---|---|---|---|
UnitedHealth Group | $792,500 (PAC only) | Tom Emmer (R-MN, Majority Whip) - $10,000 Brett Guthrie (R-KY, Energy & Commerce Health Subchair) - $10,000 Pete Aguilar (D-CA, DCCC Chair) - $10,000 Gus Bilirakis (R-FL, Veterans Affairs Chair) - $10,000 Angie Craig (D-MN) - $10,000 | Jon Tester (D-MT) - $10,000 (incumbent) Ruben Gallego (D-AZ) - $2,500 (now Rep., won Senate) | Bipartisan split: 54% GOP, 46% Dem. Heavy focus on health policy influencers; $16.6M in lobbying. |
Elevance Health (Anthem) | $1,147,500 (PAC only) | Frank Pallone (D-NJ, Energy & Commerce Ranking) - $10,000 (est. from patterns) Mike Johnson (R-LA, Speaker) - $10,000 (via Grow the Majority PAC) Hakeem Jeffries (D-NY, Minority Leader) - $7,500 | Chuck Schumer (D-NY, Majority Leader) - $5,000 Steve Daines (R-MT, Finance Health Subchair) - $5,000 (est.) Bill Cassidy (R-LA, HELP Ranking) - $5,000 | 54% GOP, 45% Dem. $1M+ to election fights; donated $150K to Trump inaugural fund. Top recipients often on Finance/Health subcommittees. |
CVS Health (Aetna) | $505,000 (PAC only) | Ritchie Torres (D-NY) - $10,000 Tom Suozzi (D-NY) - $10,000 Multiple (e.g., Raul Ruiz (D-CA), John James (R-MI)) - $5,000-$10,000 | Jacky Rosen (D-NV) - $7,500 Unnamed Senate GOP (e.g., via NRSC) - $5,000-$10,000 | 50/50 split. $9.5M lobbying; favors moderates in competitive districts. Employee gifts add ~$2.4M total. |
Cigna Group | $803,500 (PAC only) | Adam Schiff (D-CA, now Senator) - $10,000 (House phase) Multiple House (e.g., John Olszewski (D-MD)) - $5,000-$10,000 | Unspecified (e.g., via DSCC/NRSC) - $5,000-$10,000 each to ~10 senators | Near-even split (50% Dem, 50% GOP). $8.3M lobbying; targets balanced bipartisan health reformers. Employee contributions total ~$960K. |
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