When it comes to potential fraud in government health care programs, the hits just keep on coming. Thankfully, Congress has (finally) done something about it.
Two new reports illustrate why Congress needed to act to boost program integrity efforts in the Obamacare exchanges and in Medicaid. After four years where the Biden administration prioritized enrolling people in government-funded health coverage over any other priority, taxpayers may finally get a dose of some sanity.
Exchange ‘Ghost Enrollees?‘
The first data point came via the federal Centers for Medicare and Medicaid Services (CMS), which released data from exchange insurers’ risk adjustment submissions. The spreadsheet contains enough numbers to make one’s head spin, but two sets of numbers — lines 4 and 7 of the spreadsheet — stand out. Those two lines show that the percentage of enrollees in Bronze and heavily subsidized Silver plans without claims rose from roughly one-quarter (29 percent and 23 percent, respectively) in 2019 to 40 percent last year.
To some, that change may not seem like a big deal — after all, isn’t it a good thing when people don’t make claims on their health coverage? But it suggests that, after four years of Biden administration policies, a growing number of individuals were being auto-enrolled (and/or automatically reenrolled) into taxpayer-funded “free” health coverage that they did not want, need, or use.
It also means that insurers had a slew of enrollees on their hands for whom they received premium payments — funded by taxpayers, of course — and yet didn’t have to pay out a single cent in claims. (Think about it: Will 40 percent of Americans not go to the doctor at all, or pick up a single prescription, this year? I doubt it.) For all Democrats’ tough talk about insurance companies, the last four years look like a gravy train for insurers on the exchanges.
As an article on the release noted, the data have some drawbacks. The spreadsheet shows over 33 million enrollees on insurance exchanges last year — definitely an overestimate — in part because it double-counts enrollees who switched plans mid-year.
But the spreadsheet also shows the biggest percentage of zero-claims enrollees in states like Florida and Texas. Other data points also show those states as potentially having large numbers of individuals who lied about their income to receive “free” taxpayer-funded coverage, meaning that the CMS spreadsheet merely provides confirmation of existing trends.
Thankfully, help is on the way. On Dec. 31, the enhanced subsidies that allow so many individuals to qualify for “free” zero-dollar benchmark coverage will expire, sharply reducing the incentive for fraud. The additional verification provisions mandated in the recently passed reconciliation bill will also ensure that only individuals with a documented need for assistance will receive it.
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