WASHINGTON, D.C. – In a new preliminary report published by the Government Accountability Office (GAO), waste, fraud, and abuse have run rampant through Affordable Care Act marketplace plans, worsening health care plans for Americans, all while enriching big insurance companies. The new watchdog investigation finds large-scale systemic failures that allow fake identities, dead people, and massive improper use of Social Security numbers to receive Obamacare subsidies. As part of the analysis, GAO even conducted covert operations which even included creating fictitious identities that flooded health insurers with unjustified subsidies. In fact, 100 percent of fake applicants were approved by the ACA Marketplace as recently as late 2024, and 90 percent of fake applicants continue to receive coverage in 2025. As the report notes, such practices can result in wasteful federal spending on subsidies for enrollees who are not eligible. Further, such practices can result in harm and unexpected costs for consumers. These can include loss of access to medical providers and medications, higher copayments and deductibles, or repayment of subsidies if income or other eligibility was misrepresented. The GAO investigation was requested by Committee on Energy and Commerce Chairman Brett Guthrie (KY-02), Committee on Ways and Means Chairman Jason Smith (MO-08), and Judiciary Committee Chairman Jim Jordan (OH-04). Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce: “Republicans have consistently prioritized protecting patients and taxpayers by ridding our federal health programs of the waste, fraud, and abuse that ultimately drive up costs for patients,” said Chairman Guthrie. “Republicans have sounded the alarm on the flawed structural integrity of Obamacare and how Democrats’ failed policies to temporarily prop up the program have exacerbated fraud, hurt patients, increased the burden on American taxpayers, and artificially masked the true health care affordability crisis plaguing Americans today. The concerning findings from GAO’s report further confirm that Republican efforts to strengthen, secure, and sustain our federal health programs are critical and necessary to ensure access to quality health care at prices Americans can afford.” Congressman Jason Smith (MO-08), Chairman of the House Committee on Ways and Means: “While Democrats defend waste, fraud, and abuse, Republicans are taking action to lower health care costs and protect care for all real, living Americans. GAO’s troubling report is the smoking gun that shows how this broken system, shielded by Democrat policies, has led to the federal government shoveling tens of billions of tax dollars to insurance companies through identity fraud and caused health care costs to skyrocket for all Americans,” said Chairman Smith . “While Obamacare fraud is being confirmed by GAO, CMS, CBO and other outside reports, patients are suffering. They face higher health care costs and denied claims or delayed care when their providers struggle to verify which insurance is valid due to these fraud schemes. Rather than simply rubber stamp more bad spending and failed policies, we must take action to prevent further harm.” Congressman Jim Jordan (OH-04), Chairman of the House Committee on the Judiciary: “For years, we were told we could keep our plan, keep our doctor, and premiums would go down. None of it happened. This new report confirms what we already knew: under Obamacare, hardworking Americans saw their premiums skyrocket and their healthcare choices shrink, all while fraud benefitted insurance companies. Obamacare was built on lies and broken promises that hurt families and drove up costs,” said Chairman Jordan. GAO investigated the scope of improper payments and weakened program integrity within the ACA marketplace. Estimates based on analysis by both the Congressional Budget Office (CBO) and independent external research organizations indicate millions of enrollees in the ACA marketplaces may be enrolled improperly, costing taxpayers as much as $27 billion a year in improper payments and imposing a great deal of harm and distress on families and victims of alleged fraud. BACKGROUND: Investigators Created Fake Identities – and CMS Provided Taxpayer Subsidies GAO created fictitious identities with fake or never issued SSNs and still got subsidized ACA coverage, meaning criminals and fraudsters can too. 100 percent of fake applicants were approved in late 2024. 18 out of 20 fake applicants are still receiving subsidized coverage for 2025. CMS approved coverage even when no documents were requested or fake documents were submitted. This includes fake citizenship eligibility documents confirming fraud concerns for illegal immigrants . Brokers were able to bypass verification by calling the call center and submitting applications without the applicant present. Monthly subsidies paid to health insurers on behalf of GAO’s fake identities exceeded $12,300 per month . Shocking Misuse of Social Security Numbers Including a Single Social Security Number Used for Over 125 Policies for the Equivalent of 71 Years One Social Security Number (SSN) was used for “71 years” of subsidized coverage. In 2023, one single SSN was used on applications for over 125 insurance policies totaling over 26,000 days of coverage, the equivalent of 71 years. 66,000 SSNs in 2024 had more than a years’ worth of subsidized coverage. CMS does not block new applications using the same SSN and relies on a broken document-request process that often never works. $21 billion in subsidies paid out with no evidence of tax reconciliation in 2023. That is 32 percent of all advanced premium tax credits (APTC) paid to identifiable SSN holders . No reconciliation means no accountability, no verification, and likely billions in improper payments. Big Insurers Still Collecting Subsidies for Deceased Individuals 58,000 SSNs receiving APTC matched Social Security death data. At least 7,000 were dead before coverage even began, meaning the applications used SSNs of deceased individuals. $94 million in taxpayer-funded subsidies were sent to health insurers on behalf of deceased individuals. Explosive Growth in Unauthorized Plan Switches that Harm Consumers Bad actors engaged in mass unauthorized enrollment activity to chase commissions, resulting in: 160,000 likely unauthorized changes by three or more brokers in 2024. CMS itself received 275,000 complaints in just eight months (Jan–Aug 2024) from Americans who were enrolled in or switched into plans without their consent. Repeated Warnings Have Gone Unheeded by Democrats GAO has repeatedly warned that Obamacare subsidies are and have been at risk of fraud structurally. For 2015 enrollment, GAO found that federal and state marketplaces approved coverage for fictitious applicants, and nearly all of those fake identities stayed enrolled—even after submitting fictitious documents or no documents at all. For 2016 enrollment, GAO again reported that CMS had failed to design basic eligibility safeguards, including controls to stop duplicate or overlapping subsidized coverage. These weaknesses were supercharged after Democrats enacted and repeatedly extended Biden’s COVID-era subsidy expansions, which facilitated millions of fully subsidized fraudulent enrollments, and without corresponding fraud controls, created the perfect environment for criminals, identity thieves, and unscrupulous brokers. With Stronger Integrity for Taxpayers, Republicans Have Taken Steps to Lower Premiums Republicans are focused on restoring accountability and fairness to the health care marketplace through program integrity reforms that save taxpayers billions of dollars and drive down costs for everyone: Full income and eligibility verification before subsidies are issued, ensuring assistance goes only to those who qualify. Ending “anytime” enrollment abuse that fueled fraudulent sign-ups and drove premiums higher for everyone. Closing loopholes that allowed illegal immigrants and other ineligible groups to access taxpayer-funded health benefits. Even the Congressional Budget Office has found that these measures have already produced $185 billion in savings for taxpayers and reduced premiums by 0.6 percent . That’s real savings for working families. ###
