“ObamaCare really is a gift that keeps on giving – for insurers.”  Those are the words of The Wall Street Journal editorial board.

For months we’ve been hearing about the waste, fraud, and abuse of Medicaid and I’ve written extensively on that subject. (See recent archived articles.) But now we see that there’s another healthcare insurance program that is wasting taxpayers’ money.

ObamaCare was created when The Affordable Care Act was passed in 2010 by Democrats without a single Republican vote. It was implemented in 2014 and was intended to provide lower cost healthcare premiums to millions of Americans. President Obama promised at the time that this new healthcare system would save every American $2500 per year. This was one of several promises made by Obama that went unfulfilled.

The reality is that the cost of healthcare insurance has gone up for everyone who does not qualify for government subsidies. But the Biden administration increased the rolls of those with government subsidies in 2021 by lowering financial eligibility limits. The WSJ editors tell us enrollment has since doubled while taxpayer costs rose by 150%. Spending on ObamaCare subsidies has increased faster than Medicaid or Medicare since 2020 – if you can believe it. Democrats tout this blowout of government-subsidized healthcare as a triumph.

But here’s the really wild part: More than a third of all enrollees generated no medical claims last year, according to Paragon’s analysis. That includes 40% of those in plans that are fully subsidized. Between 2021 and 2024, the number of enrollees who didn’t use their health coverage more than tripled to 11.7 million from 3.5 million.

The Paragon Institute reports that taxpayers are subsidizing the insurance for nearly 12 million people who never use their coverage. As Paragon explains, tens of billions of dollars in subsidies for these 11.7 million enrollees “went to insurers and middlemen without funding a single medical service.” After individuals enroll in plans, the government pays monthly premium subsidies directly to the insurers. Even most healthy people have some sort of medical claim in a year. Why don’t these ObamaCare enrollees?

As Paragon earlier documented, insurance brokers have been fudging incomes of people in order to enroll them in government-subsidized plans for which they aren’t eligible, often without their knowledge. The Biden Administration facilitated such fraud by easing income verification and eligibility checks.

Paragon estimates that about 6.4 million people this year were improperly enrolled in exchange plans. The Justice Department has charged several brokers with enrolling consumers in ObamaCare plans for which they weren’t eligible in order to obtain commissions. In other words, insurance companies are stealing from the American taxpayer by falsifying income data in order to make ineligible people eligible for government subsidies.

What is being done about this?

This is why Republicans in their tax bill strengthened income verifications for ObamaCare plans. Democrats claim such measures will cause millions of people to lose coverage. But many of them don’t need or use their insurance. Many were ineligible for this coverage in the first place. Some are enrolled in employer plans or Medicaid. The subsidies pad the profits of insurers – at the expense of taxpayers.

The Centers for Medicare and Medicaid Services last month found that 1.6 million Americans each month last year were enrolled in both Medicaid and subsidized ObamaCare plans. Insurers might respond that they aren’t profiting from such phantom and duplicate enrollees because ObamaCare requires them to spend at least 80% of premium dollars on medical care. Democrats intended this rule as a de facto profit cap. But insurers have circumvented this by increasing payments to providers, pharmacies and middle-men they own.

WSJ editors say, “If insurers don’t benefit from the sweetened subsidies, why are they protesting their expiration at the end of this year? Insurers say their expiration could result in sicker risk pools. Their concern seems to be that reduced subsidies and the tax bill’s stricter income verifications will result in fewer phantom enrollees who don’t use their insurance. Forgive us for being old-fashioned, but why should taxpayers subsidize insurance for healthy people who don’t need or use it?”

President Trump’s Big Beautiful Bill (BBB) has been discussed a lot in the media. We’ve heard how it eliminates taxes on tips, overtime, and social security for low-income seniors. We’ve heard how it provides money for the border wall that needs to be finished. We’ve heard complaints from Democrats that it takes away Medicaid and “people are going to die,” even though the only people losing their Medicaid are people who were ineligible enrollees in the first place.

But we’ve heard very little about ways the BBB actually improves healthcare. Former Louisiana Governor Bobby Jindal and Charlie Katebi give us more insights in their recent Op-ed in The Wall Street Journal. Here’s what they say: “Health-insurance companies have long dictated which doctors Americans can consult, trapping patients in narrow networks and bureaucratic red tape. The One Big Beautiful Bill Act breaks that monopoly. By loosening the grip of insurers and empowering families with greater choice and flexibility, this bold reform restores control to patients.”

Most Americans pay for medical care through traditional health insurance provided by their employer or through the individual market. This system puts insurers in charge of determining which physicians and facilities families can visit, often through network restrictions and prior-authorization barriers. It also forces healthcare providers to spend large sums of money on billing departments to request and negotiate payments from health insurers. One 2009 study estimates that physician practices spent 13% of their revenue on administrative overhead for insurance billing and reimbursement. Every dollar that healthcare providers spend on their billing departments shows up in higher prices.

Traditional insurance can often lead to lower-quality care. Because insurers pay providers on a fee-for-service basis, these middlemen create incentives for physician practices to spend less time with more patients. On average, primary-care doctors spend 13 to16 minutes with each patient. Less time with physicians can lead to diagnostic errors, medically inappropriate prescriptions, and more-frequent hospital stays.

After years of paying higher prices for worse care, many families are seeking healthcare without insurance through direct primary care practices. DPC is a new model of care in which physicians charge patients a flat monthly membership fee for primary and preventive care, including physicals, chronic-disease management, and basic lab and diagnostic testing. This model cuts out insurance and allows physicians to invest more time and resources into caring for patients instead of complying with paperwork for health insurers. DPC physicians on average spend 38 minutes with each patient, nearly three times longer than traditional doctors.

When doctors spend more time with patients, they can develop a better understanding of their conditions and deliver better care to keep them healthy. A case study by the Society of Actuaries found that patients who rely on direct primary care had 40% fewer emergency-room visits and 19.9% fewer hospital admissions than patients who rely on traditional primary-care practices.

 Despite DPC’s enormous benefits, government red tape constrains families who want to go to these innovative doctors. Federal law prohibits roughly 61 million Americans who use health savings accounts from enrolling in a DPC practice. To be eligible for a health savings account, individuals must be exclusively covered by a high-deductible health plan. The agency charged with enforcing HSA rules, the Internal Revenue Service, asserted that DPC practices are health insurers, not healthcare providers. That prevents those who have HSAs from enrolling in a DPC practice.

In 2019 President Trump directed the IRS to clarify that DPC constitutes medical care, not insurance. Bureaucrats at the tax agency flouted the president’s direction and maintained this barrier for families, asserting that patients are “not eligible to contribute to an HSA if that individual is covered by a direct primary care arrangement.”

It doesn’t take a rocket scientist to realize this IRS ruling makes no sense. The BBB ends this disastrous policy. The law officially designates DPC as a form of healthcare, allowing patients who enroll in these practices to own an HSA and pay their DPC membership fees with HSA dollars. This lets families—not insurance companies—choose the best doctors for their individual needs.

Wow! Freedom to choose your own doctor! What a concept.

The extent of Medicaid waste, fraud, and abuse keeps getting worse. We already know the federal government admits it made $543 billion in inappropriate Medicaid payments from 2015 through 2024, according to The Wall Street Journal. The One Big Beautiful Bill recently passed by Congress intends to cut the program’s spending by nearly $700 billion over the next ten years.

But none of these cuts impact legitimate Medicaid enrollees. Despite what the Democrats keep saying, no one’s Medicaid is being taken away from them if they were properly enrolled in the first place.

But now there is even more evidence of waste, fraud, and abuse. The Epoch Times reports millions of people are enrolled in government health-care programs in more than one state or are signed up concurrently in multiple programs, costing taxpayers about $14 billion a year, the Centers for Medicare and Medicaid Services announced on July 17.

The announcement came after an analysis of 2024 enrollment data from Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA) Exchange. Investigators found that an average of 1.2 million people were enrolled in Medicaid or CHIP in two or more states in 2024. Another 1.6 million were enrolled in Medicaid or CHIP along with a subsidized ACA plan. The total number of dual enrollees was about 2.8 million.

“Under the Trump Administration, we will no longer tolerate waste, fraud, and abuse at the expense of our most vulnerable citizens,” Health Secretary Robert F. Kennedy Jr. said in a statement cited in the July 17 announcement.

Dual enrollment wastes money without providing additional care for the patient. About 75 percent of Medicaid enrollees and an even higher percentage of ACA plan enrollees are in managed care plans. In these plans, the government pays an insurer a monthly fee to provide all necessary care for the insured person. When a person is dual-enrolled, the government pays twice.

Some Medicaid recipients unwittingly double enroll when they move to another state, enroll in Medicaid there, and forget to notify the state that they moved from. In other cases, Medicaid enrollees who begin to earn more money no longer qualify for the program. They may then sign up for an ACA plan but forget to cancel their Medicaid coverage. Federal regulations require semiannual data checks to weed out dual enrollment. But those checks were temporarily suspended in the COVID-19 pandemic era to make sure people did not lose coverage during the health emergency.

Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, said the agency will return to doing regular, thorough checks of the enrollment data. “This is exactly why we fought for stronger [fraud-detection] tools in the One Big Beautiful Bill Act—to go after this type of waste and finally put a stop to paying twice for the same person’s health coverage,” Oz said in a statement.

The One Big Beautiful Bill Act includes provisions aimed at ensuring that only qualified beneficiaries are enrolled in the program. Enrollees will be required to verify their Medicaid eligibility for enrollment every six months instead of once a year. The purpose is to ensure that those whose incomes exceed the eligibility limit are removed and that people not lawfully residing in the country are not enrolled. This provision takes effect in October 2027.

According to Congressional Budget Office data, some 1.4 million people who are not legal residents of the United States are enrolled in Medicaid. Also, under the act, some Medicaid enrollees will be required to spend 20 hours per week in employment, educational activities, training, or community service. This provision, which takes effect no sooner than Jan. 1, 2027, applies only to adults who are not disabled and are not responsible for caring for children or other dependents.