WASHINGTON, June 20,
2024 /PRNewswire/ -- Paragon Health Institute, a
leader in health care research and market-based policy proposals,
has released alarming findings from an analysis of Obamacare
subsidy beneficiaries. Using a combination of government data
related to enrollees claiming 100 percent to 150 percent of the
federal poverty level (FPL), Paragon found the number of Obamacare
subsidy recipients for this income bracket exceeded by millions the
number of Americans who actually qualify for this assistance.
Paragon's findings are reported in The Great Obamacare
Enrollment Fraud, where fraudulent enrollment
is estimated to be five million people in 2024 representing
waste of about $20 billion in tax
dollars a year.
![Paragon Health Institute is an independent, non-profit, non-partisan research institution that examines how government health programs are working and develops health policy solutions to make life better for Americans. Paragon’s orientation is to empower patients, unleash providers and entrepreneurs to develop methods and products to improve American well-being, and reform government programs to align incentives to focus on maximizing value from our health care expenditures. (PRNewsfoto/Paragon Health Institute) Paragon Health Institute is an independent, non-profit, non-partisan research institution that examines how government health programs are working and develops health policy solutions to make life better for Americans. Paragon’s orientation is to empower patients, unleash providers and entrepreneurs to develop methods and products to improve American well-being, and reform government programs to align incentives to focus on maximizing value from our health care expenditures. (PRNewsfoto/Paragon Health Institute)](https://mma.prnewswire.com/media/2423462/Paragon_Health_Institute_Logo.jpg)
The Affordable Care Act provides large financial subsidies for
lower-income Americans to purchase health insurance coverage in
Healthcare.gov and other state-run health insurance marketplaces
known as "exchanges." The subsidies are composed of the Premium Tax
Credit (PTC), which lowers the monthly cost of coverage, and the
CSR Program, which lowers the out-of-pocket costs. President Biden
signed the American Rescue Plan Act of 2021 (ARPA) and the
Inflation Reduction Act of 2022 that increased the PTCs through
2025. As a result of these laws, people claiming income between 100
percent and 150 percent of the FPL pay $0 for benchmark plans (i.e. the
second-lowest-cost silver plan) from a health insurance exchange.
Additionally, enrollees claiming this income range enjoy the
benefit of insurance paying a greater portion of covered medical
expenses, reducing the enrollees' out-of-pocket expenses.
Paragon identified nine states (Alabama, Florida, Georgia, Mississippi, North
Carolina, South Carolina,
Tennessee, Texas, and Utah) where the number of sign-ups reporting
income in the 100-150 percent FPL range exceeded the number of
residents in this earning bracket. The over-subsidization problem
is particularly acute in Florida,
where there were four times the number of exchange enrollees
reporting 100-150 percent FPL income as there were eligible
Floridians. This misstating of income is more than twice as common
in states using HealthCare.gov as opposed to a state-based
exchange.
Some brokers are certainly contributing to fraudulent enrollment
and the enhanced direct enrollment feature of HealthCare.gov
appears to be a problem. Brokers just need a person's name, date of
birth, and address to enroll them in coverage, and reports indicate
that many people have been recently removed from their plan and
enrolled in another plan by brokers who earn commissions by doing
so. Unfortunately, brokers are not alone in financially benefitting
from fraudulent enrollments. Health insurers are also reaping
windfalls from these improper enrollments.
Brian Blase, former official on
the White House's National Economic Council and founder of Paragon
Health Institute, observed, "Affordable Care Act subsidies are
being exploited so health insurers and brokers enjoy more income
while hard-working Americans pay for it. At this time of profound
economic pressures facing the nation, Obamacare subsidies need
better oversight and accountability."
Launched in late 2021 by Brian
Blase, Paragon Health Institute provides health policy
research as well as market-based policy proposals for improved
outcomes in the public and private sectors. Journalists and health
care analysts can review Paragon's latest studies and commentary at
paragoninstitute.org.
Contact:
Anthony Wojtkowiak
media@paragoninstitute.org
703.527.2734
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SOURCE Paragon Health Institute