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Republicans in the House of Representatives want to know if some of the country’s largest Obamacare health insurance brokers are contributing to a dismal picture of fraud spurring the program’s soaring costs.
The House Judiciary Committee led by Chairman Jim Jordan, R-Ohio, sent letters to Blue Shield of California, Centene Corporation, CVS Health, Elevance Health, Kaiser Permanente, Oscar Health Inc. and GuideWell on Monday, demanding detailed information on their enrollment services.
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Rep. Jim Jordan leaves a House Republican Conference meeting at the U.S. Capitol in Washington, Dec. 10, 2024. (Tom Williams/CQ-Roll Call, Inc via Getty Images)
All those companies help consumers sign up for Obamacare’s enhanced health insurance premiums that are at the heart of the committee’s fraud evaluations.
“Brokers have targeted individuals with deceptive advertisements and pressured enrollees to lie about their incomes to obtain Obamacare subsidies. Evidence suggests that many individuals do not even know they are signing up for health insurance or agreeing to switch plans,” the committee said in a statement.
The committee has asked the companies to provide how many people they’ve helped sign up for the enhanced premium tax credits, the number of enrolled people who don’t make use of their benefits, internal communications dealing with fraud and abuse, and a list of employees dealing with anti-fraud efforts.
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House Judiciary Chairman Jim Jordan, R-Ohio, listens during a hearing with the House Judiciary Subcommittee in Washington, Jul. 20, 2023. (Anna Moneymaker/Getty Images)
The Judiciary’s letters come as lawmakers wrestle with whether to extend Obamacare’s enhanced premium subsidies — even as questions about fraud and other inefficiencies remain — or to let them expire at the end of the year.
Congress initially greatly widened Obamacare’s federal assistance in 2021 as an emergency response to COVID-19. Over 90% of Obamacare’s 24 million enrollees now make use of the expanded assistance, according to research from the Kaiser Family Foundation.
Seto Bagdoyan, the director of audit services for the GAO, told Digital that under the expanded current framework, brokers are incentivized to enroll as many people as possible. He helped author a recent GAO report detailing how Obamacare’s administrators have a poor understanding of where federal assistance dollars end up.
“So, the incentive system for brokers is based on commission. They get commission from the subsidies paid to the insurance companies,” Bagdoyan said.
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Seto Bagdoyan, Director of Audit Services, Forensic Audits and Investigative Service at the Government Accountability Office, testifies before the House Ways and Means Oversight Subcommittee in Washington, July 23, 2014. (Win McNamee/Getty Images)
According to the GAO, as many as 29,000 Social Security numbers (SSNs) in 2023 and nearly 68,000 SSNs in 2024 used to receive more than one year’s worth of insurance coverage with APTC in a single plan year.
Bagdoyan explained the extent of the fraud and the role brokers play in that picture isn’t well understood, but believes it has contributed to the program’s exorbitant costs.
“The unscrupulous ones will probably go out and run up the score like we think we are encountering through our analysis. [Fraud examples] include not only changes to the agent or broker of record, but also changes to the policies, new policies, and outright fraudulent policies. So that is part and parcel of the broken side,” Bagdoyan said.
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The Judiciary Committee has requested a response from the letter recipients no later than Dec. 29.
Digital reached out to the recipients for comment.
