Health

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. ###

WASHINGTON, D.C.  – Today, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, issued the following statement after President Trump signed H.R. 2483, the SUPPORT for Patients and Communities Reauthorization Act, into law. “Today, America celebrates the passage of the SUPPORT for Patients and Communities Reauthorization Act—legislation that takes significant steps toward reducing the toll illicit fentanyl and fentanyl-related substances take on our communities. As the Chairman of the House Committee on Energy and Commerce, I’m proud of the bipartisan work that has been done through this important legislation to continue empowering first responders, supplying recovery resources, and increasing access to treatment options for individuals with substance use disorders,” said Chairman Guthrie. “I want to thank President Trump for his continued commitment to combatting the opioid crisis, and the reauthorization of this legislation ensures continued investment in prevention, recovery, and hope for families nationwide.” Background: H.R. 2483 , the SUPPORT for Patients and Communities Reauthorization Act of 2025 , was reported to the full House from the Committee on Energy and Commerce by a roll call vote of 36 yeas – 13 nays and passed the full House by a vote of 366 yeas – 57 nays.  The Senate passed the legislation by unanimous consent on September 18. The SUPPORT Act:  Ensures first responders can access and administer naloxone;  Allows for enhanced SUD treatment options for pregnant and postpartum women;  Strengthens state PDMP systems;  Encourages individuals in recovery to participate in the workforce; and  Continues the supply of resources for Comprehensive Opioid Recovery Centers, which provide a full spectrum of treatment and recovery support services. ###

WASHINGTON, D.C.  – Today, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, issued a statement following the House passage of H.R. 1262, the Mikaela Naylon Give Kids a Chance Act— a bipartisan piece of legislation which reauthorizes the FDA’s Rare Pediatric Disease (RPD) Priority Review Voucher (PRV) Program to incentivize the development of treatments for rare pediatric diseases, and authorizes the FDA to direct companies to study a combination of cancer drugs and therapies in pediatric trials. “H.R. 1262, the Mikaela Naylon Give Kids a Chance Act, builds on current programs to accelerate research and drug development for rare pediatric diseases, including cancer,” said Chairman Guthrie. “The reauthorization of the Rare Pediatric Disease Priority Review Voucher Program has led to over 50 new treatment approvals for nearly 40 different rare pediatric diseases, many of which had no options prior. The impact of this program is profound for patients, and I am grateful to the sponsors of this legislation and their commitment to promoting research and addressing gaps in pediatric therapeutics.” Background on H.R. 1262:   H.R. 1262 , the Mikaela Naylon Give Kids a Chance Act , is a comprehensive piece of legislation that increases access to innovative treatments for children by:  Reauthorizing the FDA Rare Pediatric Disease (RPD) Priority Review Voucher (PRV) Program through Fiscal Year 2029 and clarifies that orphan drug exclusivity applies to the approved indication, rather than the potentially broader designation;  Providing the Food and Drug Administration (FDA) with additional authority to require pediatric cancer trials for new combinations of drug therapies;  Authorizing the FDA to take enforcement action against companies that fail to meet pediatric study requirements under the Pediatric Research Equity Act (PREA);  Directing the FDA to establish an office in an Abraham Accord country to enhance facilitation with the agency; and   Requiring FDA to disclose to certain generic drug applicants if any ingredients cause a drug to be quantitatively or qualitatively different from the listed drug, speeding up patients access to more affordable medications.  ###

WASHINGTON, D.C.  – House Committee on Energy and Commerce Chairman Brett Guthrie (KY-02) and Ranking Member Frank Pallone Jr., (NJ-06), along with Energy and Commerce Subcommittee on Oversight and Investigations Chairman John Joyce, MD (PA-13), and Ranking Member Yvette D. Clarke (NY-09), wrote to the Health Resources and Services Administration (HRSA) requesting a briefing on its ongoing oversight of patient safety in our nation’s organ procurement and transplant system.   In July, the Committee’s Oversight and Investigations Subcommittee held a hearing in response to a HRSA investigative report that found patient safety concerns at Kentucky Organ Donor Affiliates (KYDA) – the organ procurement organization (OPO) serving the state of Kentucky. In the investigative report, HRSA revealed that of the 351 cases reviewed, 103 cases (29.3 percent) showed “concerning features.” These concerning features included problems with patient-family interactions, medical assessments and team interactions, recognition of high neurologic function, and recognition and documentation of drugs in records.   In addition, HRSA issued a corrective action plan to address the findings in its report specific to KYDA and directing the Organ Procurement and Transplantation Network (OPTN) Board of Directors to develop certain safety guidelines for the entire OPTN. The corrective action plan raised further questions about the possibility that there may be more systemic issues at OPOs across the country, noting that “ [s]ince the review of KYDA was initiated, HRSA has received reports of similar patterns of high risk [donation after circulatory death] procurement practices at other OPOs .” Moreover, during the July hearing, HRSA’s Organ Transplant Branch Chief, Dr. Raymond Lynch was questioned about the potential failure to adhere to existing protocols by Rep. Erin Houchin (IN-09): “ is it a broader systemic issue or is it limited to KYDA ?” Dr. Lynch responded that “ [u]nfortunately, it is not limited to KYDA. During the course of this investigation we received concerns that were in areas served by other OPOs. ”  Chairmen Guthrie and Joyce and Ranking Members Pallone and Clarke issued the following joint statement:    “ The Committee’s examination of the organ procurement and transplant system has demonstrated the need for further oversight.  Testimony from the July hearing, HRSA’s investigative report and corrective action plan, and continued reports of similar patterns at other OPOs all raise serious concerns. The American people should be able to have full faith and confidence in our organ donor and transplant system, and we will continue to work together to prevent these harmful practices from continuing. Americans’ confidence in the system comes when patient safety is protected. ”    Read the full letter  here . Background:  ·       During the 118th Congress, the Committee on Energy and Commerce  passed  the Securing the U.S. Organ Procurement and Transplantation Network Act to both modernize the OPTN and allow HRSA to institute a competitive contracting process to find the best contractors for various OPTN functions. This legislation was signed into law on September 22, 2023.   ·       On March 20, 2024, the Committee  launched an investigation  into the organ procurement and transplantation system by sending  a letter  to United Network for Organ Sharing (UNOS) requesting information related to concerns surrounding data security and operability, patient safety and equity, and conflicts of interest.    ·       On March 20, 2024, the Committee also sent  a letter  to HRSA requesting information related to implementation of the Securing the U.S. Organ Procurement and Transplantation Network Act as well as other concerns related to effective oversight and management.   ·       On September 11, 2024, the Subcommittee on Oversight and Investigations held a  hearing  that focused on the implementation of reforms at the OPTN, including the need for stronger oversight and accountability as well as ongoing patient safety concerns.   ·       During the hearing, questions were raised related to allegations of mismanagement and patient safety concerns after patients began exhibiting signs of increased neurologic function after being previously deemed suitable as an organ donation candidate. Several of these allegations, particularly those related to patient safety, were later substantiated through the findings contained in HRSA’s March 2025 report.   ·       On March 24, 2025, HRSA’s Division of Transplantation issued a  report  that summarized the findings of its investigation into KYDA, the OPO now known as Network for Hope, which serves Kentucky and parts of Ohio, West Virgina, and Indiana.  ·       On May 28, 2025, HRSA issued a  CAP  to OPTN, which directed the OTPN to take specific actions within a specified period of time, including developing a 12-month OPTN monitoring plan for KYDA to address concerns identified. The corrective action plan also requires the OPTN to propose policies for public comment to improve safeguards for potential donation after circulatory death (DCD) patients in the organ procurement process and increase information shared with patient families regarding DCD organ procurement.   ·       On July 22, 2025, the House Committee on Energy and Commerce’s Subcommittee on Oversight and Investigations held a  hearing  examining concerning practices within our nation’s organ procurement and transplant system that were identified by HRSA’s investigation.   ###

WASHINGTON, D.C. – Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, along with Reps. Palmer (AL-06), Carter (GA-01), Bilirakis (FL-12), and Obernolte (CA-23), penned a letter to the Executive Director of Covered California (CoveredCA), Jessica Altman, to request further information related to the potentially unauthorized transmission of sensitive personal health information involving Covered California’s website. Key Letter Excerpt: “According to public reports and agency statements, tracking technology was embedded on Covered California's website beginning in February 2024, as part of a broader digital advertising effort, and in direct contravention of the tracking platform’s user agreement, which prohibits the use of such tools on pages that collect sensitive health information. Although the tags were reportedly removed in April 2025, following external scrutiny and a vendor transition, the extended period of data exposure raises serious questions about the adequacy of safeguards that Covered California had in place. Forensic testing by investigative reporters identified the trackers in operation and confirmed that user-entered health information was being transmitted to third parties without consent. These circumstances warrant examination of Covered California’s actions under federal privacy standards.” “Ensuring the confidentiality of health information is a foundational obligation for entities operating within the health insurance ecosystem. Federal privacy protections, particularly the Health Insurance Portability and Accountability Act (HIPAA), establish expectations for how covered organizations handle sensitive data. Recent reports and public filings raised questions about whether those expectations were met in this case, and whether existing oversight mechanisms are sufficient to detect and prevent improper disclosures.” Background: Forensic testing shows Covered California —the State of California’s official health insurance marketplace—has been sending sensitive user health data to third-party websites through several online data trackers. Prior to removal of the trackers, CoveredCA had more than 60 trackers active on its website; the average number of trackers on a government website is three. Some types of information sent to such websites include: Searches for doctors in network with specific plans/specializations Demographic information, including gender, ethnicity, and marital status Length of treatment a patent received by a provider Frequency of doctor visits If the user indicated they were blind, pregnant, a victim of domestic abuse, or used prescription medications. The State of California independently operates CoveredCA. As the state’s official ACA marketplace, CoveredCA falls under the purview of Health Insurance Portability and Accountability Act (HIPAA). The disclosure of information such as pregnancy or prescription drug use without proper consent—even for “marketing purposes”—may violate HIPAA. This Congress, the Committee has sent letters to 23andMe and DeepSeek over potential data privacy concerns: The Committee also held a hearing last Congress on the Change Healthcare hack, where personal health information was also jeopardized. CLICK HERE to read Fox News coverage of the letter. CLICK HERE to view the full letter. ###

Washington, D.C. — In a new letter to Department of Health and Human Services (HHS) Inspector General Christi Grimm, House Energy and Commerce Committee Republicans requested an investigation into the strength, quality, and types of evidence-based scientific and pediatric medical literature relied on by the department to promote gender transition procedures for children.  KEY LETTER EXCERPT:  “As the agency responsible for safeguarding the health and well-being of Americans, all of HHS’s medical treatment recommendations, especially medical treatment recommendations for children, should be based on rigorous and well-established research, such as randomized controlled trials, that have definitively illustrated the long-term benefits of gender affirming care treatments.”  BACKGROUND:  Under the Biden administration, HHS has advocated for sex reassignment procedures on minors, including the use of serum puberty blockers, which have historically been used to treat children with precocious puberty (i.e., early onset puberty affecting about one percent of U.S. children) and sex offenders.   Puberty blockers, however, are known to stunt normal childhood development in children unaffected by precocious puberty.  HHS officials contend that sex reassignment procedures on minors are an unanimously accepted medical practice.  HHS Secretary Becerra testified before Congress that “every major medical association,” “medical journals,” and “scientific and medical evidence” has demonstrated the benefits of transitioning children’s biological sex.  When asked, via a Freedom of Information Act request, for the underlying scientific or medical basis for its position, HHS was only able to produce a two-page brochure that was already publicly available.  In contrast to HHS, a growing body of literature from medical experts and authorities around the world, including those in Europe, caution against performing such procedures on minors.   Courts and government health agencies responsible for determining child welfare have sought to limit child sex reassignment procedures.   Other countries have banned these interventions and surgeries on minors altogether.  An article published in the British Journal of Medicine found “there is great uncertainty about the effects of puberty blockers, cross-sex hormones, and surgeries in young people.”   A court in the United Kingdom noted the obvious about administering puberty blocking chemicals onto children: “[i]t is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.”  In April 2024, the Cass Review , an independent review of gender identity services for children and young people, commissioned by the National Health Service England, found “[w]hile a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.”   The Cass Review also found that “[t]he rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health,” as well as unknown effects on cognitive and psychosexual development.  In August 2024, the American Society of Plastic Surgeons (ASPS) became the first major U.S. medical association to express caution on the use of gender surgery for gender dysphoria in adolescents. In its formal statement, the association stated: “ASPS currently understands that there is considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions for the treatment of adolescents with gender dysphoria, and the existing evidence base is viewed as low quality/low certainty. This patient population requires specific considerations.”   The letter was signed by Committee Chair Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chair Brett Guthrie (R-KY), Subcommittee on Oversight and Investigations Chair Morgan Griffith (R-VA), Rep. Dan Crenshaw (R-TX), Rep. Gus Bilirakis (R-FL), Rep. Buddy Carter (R-GA), Rep. Gary Palmer (R-AL), Rep. Neal Dunn (R-FL), Rep. Randy Weber (R-TX), Rep. Troy Balderson (R-OH), Rep. August Pfluger (R-TX), Rep. Diana Harshbarger (R-TN), and Rep. Kat Cammack (R-FL).  CLICK HERE to read the letter.