Tag: insurance

Obamacare Fraud Estimated To Cost $25 Billion This Year: Report

Taxpayers will foot the bill for up to $25 billion in improper Obamacare payments due to organized fraud and improper enrollments in 2026, according to a June 3 report from Paragon Health Institute.

Some 6.2 million enrollments in the healthcare exchanges during the most recent open-enrollment period were improper, the report said, accounting for 27 percent of all enrollments.

The conservative think tank has studied fraud in the Obamacare program since 2024.

The problem of improper enrollments persists despite recent attempts to curtail it, and appears to involve organized efforts by unscrupulous insurance brokers, the report concluded.

Meanwhile, some industry groups have criticized the findings.

Incentives For Fraud

Obamacare’s premium subsidies, which cover 100 percent of the health coverage policy for many beneficiaries, and referral bonuses offer an incentive for both enrollees and brokers to abuse the system, the report concluded.

Researchers identified improper enrollments by comparing Obamacare data to Census Bureau population estimates. The improper enrollments were calculated by a state-by-state comparison of enrollments in the lowest income category to the number of people having that income level in the state.

The lowest income category is 100 percent to 150 percent of the federal poverty level, or about $16,000 to $24,000 per year for an individual or about $27,000 to $41,000 for a family of three.

Enrollees with incomes at that level receive the highest subsidies. During the 2026 open enrollment period, 29 percent of enrollees chose a plan with a $0 premium.

That gives enrollees and the agents who sign people up for Obamacare an incentive to misstate their income, the report concluded.

The American Hospital Association has said Paragon’s research results are not valid due to flawed methodology. “The Census uses different income and household size definitions than the Marketplace so there is no possibility of the data matching,” the group said in an August 2025 statement. The association also said the Census relies on reported income but Obamacare asks for projected income.

The total value of Obamacare subsidies to be paid in 2026 is $88 billion, according to the Congressional Budget Office.

Agents who enroll individuals or families in Obamacare earn a commission averaging around $20 per enrollee per month for as long as the policy is active.

Obamacare received more than 23 million enrollments during the 2026 open enrollment period.

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Massachusetts Sues UnitedHealthcare Over Alleged $100 Million Fraud

Massachusetts sued UnitedHealthcare on May 29, alleging the company defrauded the state’s Medicaid program by making seniors appear sicker than they were to secure higher payments.

The company contracted with MassHealth to provide a Senior Care Options—which combines Medicare and Medicaid benefits into one plan—for seniors aged 65 and older.

UnitedHealthcare allegedly received more than $100 million in fraudulent payments from MassHealth between 2015 and 2025, Massachusetts Attorney General Andrea Joy Campbell stated in the complaint.

UnitedHealthcare, a subsidiary of UnitedHealth Group, said the complaint is “meritless and doesn’t accurately describe our Senior Care Options program” in ‌a statement emailed to The Epoch Times.

The legal complaint alleged UnitedHealthcare inflated payment rates in three ways.

Upcoding

Massachusetts paid UnitedHealthcare a per-member, per-month rate for each senior enrolled in the plan based on UnitedHealthcare’s assessments of the member’s health conditions.

UnitedHealthcare allegedly labeled members as having behavioral health disorders such as depression or anxiety, or substance use disorders to gain higher reimbursement rates, according to the complaint, when the members had no diagnosis or treatment on record for such conditions.

An analysis by the attorney general’s office revealed that nearly 30 percent of UnitedHealthcare’s 2014 through 2024 behavioral health assessments lacked any matching medical claims to support the mental health diagnoses reported to the state.

Keeping Overpayments

The insurer’s internal reviews identified that many members were incorrectly placed in the highest and most expensive level of care despite not qualifying for it, according to the lawsuit.

While the company eventually downgraded these members to lower-paying levels, it allegedly failed to inform the state of the prior errors or return the extra money it had already collected.

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Americans Who Can Are Dropping Medical Insurance

Have you observed what is happening with medical insurance in the United States? There is an upheaval taking place. You might be experiencing it yourself.

The Wakely Consulting Group has taken upon itself to track trends in the medical insurance market, both pricing and participation.

Their latest report has documented an ongoing and profound shift, one so dramatic that it portends something truly meaningful for the future.

Lacking serious reform of the system from Congress, it seems that consumers are taking matters into their own hands.

Congress declined to extend subsidies for the Affordable Care Act (ACA) starting in January. Consumers have examined their bills and plans in light of the price increases which range from 25 to 115 percent depending on conditions and levels. More than a million people have dropped their coverage entirely. More will do so through the end of the year.

Wakely comments: “Based on unique data collection from 80 percent of the ACA individual market, Wakely … estimates a material reduction in enrollment for 2026, ranging on average from 17 percent to 26 percent in total.”

This is happening because, fortunately, there is no individual mandate to be enrolled in anything since the Supreme Court deleted that portion of the program.

Individuals are downgrading their coverage to plans with fewer benefits and higher deductibles. Or they are just doing without and paying cash or shopping for crowdhealth options.

The implications for the ACA, also known as Obamacare, are profound.

First, this changes the risk pool calculation in ways that are disruptive. The whole machinery fundamentally depends on large risk pools that mask costs and separate premiums from actual individual circumstance. With such large pools, the architects hoped to take a sideways route to a privatized form of socialized medicine.

That scheme now lies in tatters.

Second, with so many people leaving (obviously those who don’t anticipate system needs) those who remain in the system are less healthy: the very people more willing to pay the higher premiums are those who expect to use the services. From an actuarial point of view, this change puts further pressure on prices. And with risk pools shrinking and data pointing to higher costs, we have a system that seems to be eating itself on both ends.

You would think that the implosion of the medical-care system of the world’s biggest economy would be big news. Somehow it is not. Why has this not been widely reported?

A theory as to why: It is happening too slowly and with too much data diffusion. It is genuinely difficult to get a handle on the pace of the increases because every state is different, every age group is priced differently, and the diversity of real-world experience not only differs on the household level but even on the event level.

Which is to say, you never know until it hits you precisely what you will pay given any particular medical-care event. As for the premiums and deductibles, people are remarkably unwilling to share personal stories of what they face due to privacy concerns and also some element of personal shame related to financial burdens.

The system as it stands is so enormously complicated that hardly anyone can really understand the whole, much less characterize the aggregate experience with the sector. It keeps growing larger, more expensive, and more exploitative, but also more complicated and diffuse, leaving writers like me ever less willing to make a judgment on it.

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UnitedHealthcare Learns You Can’t Fix Stupid, Fires Social Media Manager Over Trump Post

When my kids were very young, one of the first words that we banned was “stupid.” No one is stupid, I would tell them; some people just don’t think things through. Well, to borrow from that explanation, I probably didn’t think that all the way through.

While I don’t regret teaching the kids not to use “the S word,” as we used to call it, the older I’ve gotten, I’ve had to face the reality that, yes, some people who otherwise are of sound mind are just stupid. Nowhere is this more evident than on social media. The latest example is a social media manager, of all things, who used to work for UnitedHealthcare. That was until the brass at her employer saw this post of hers, where she gave her take on the most recent assassination attempt on the President of the United States.

Keep in mind, this is a person who gets paid to work as a “professional” in social media, and she’s lacking the good judgment to know you shouldn’t go online to wish harm to someone who’s now had three assassination attempts on his life, and the Secret Service and the FBI both report up to him. Now, that’s stupid. There is no other way to say it.

This dunce’s name is Alison King, and according to Fox News, she was “identified as a social media manager for UnitedHealthcare.” Apparently, she was fired for making a TikTok video where she expressed regret that the president survived this latest attempt on his life, when a shooter targeted President Donald Trump and his administration at the recent White House Correspondents’ Association (WHCA) dinner.

In the video, King says, “We’re cooked as a country when my first reaction to hearing the news about Trump’s (with a hand motion of a slit throat) attempt was, ‘It was probably fake’…Like, immediately I was like, ‘Oh, that wasn’t real, probably fake.’” She then added sarcastically, “And the second was ‘Aww, they missed? So happy they missed.’ Yeah, that’s sad.’”

Fox News Digital reported that a spokesperson for UnitedHealthcare responded to inquiries about King’s post, saying, “Violence is never acceptable and any comments that suggest otherwise are in no way consistent with our mission and values. The person who made comments online about Saturday night’s incident at a Washington event where President Trump and many other political leaders were gathered is no longer employed by the company.”

Keep in mind, this is a company that on Dec. 4, 2024, lost its own CEO to a successful assassination attempt. That was when Luigi Mangione allegedly pulled a gun and ambushed UnitedHealthcare CEO Brian Thompson at point-blank range just outside a hotel where Thompson was to attend a business meeting.

You’d think that a social media manager who worked for that company would know that things like assassination attempts, and online chatter about them, are taken quite seriously by the government, by lawyers, by law enforcement agencies —and, oh, by the way, by your own dang employer.

Do you think she might have learned her lesson? You be the judge. 

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One in Five California Home Sales Canceled Due to Unaffordable Insurance

Glenn and Lorraine Crawford paid about $500 a month to insure their home in Agoura Hills northwest of Los Angeles when they bought it in 2012.

The Crawfords say they have little alternative but to pay the bill that arrived last month, which, at more than $44,000 a year, is almost as much as their mortgage bill. The only other insurer willing to cover their home, Lloyd’s of London, quoted them $80,000 a year.

More than a year after infernos tore through Los Angeles County, millions of Californians like the Crawfords are suffering through a home-insurance crisis that has rolled on for years with eye-watering rate increases, canceled policies and rejected claims.

Two of the biggest insurers, State Farm and Allstate, aren’t selling to new customers in the state, despite getting double-digit rate increases approved for their existing policyholders. A third, Farmers Insurance, has committed to cover more homes in fire-prone areas, but only a fraction compared with the drop in its overall number of policies since the crisis began.

The insurance dysfunction has spread to California’s housing market, the country’s biggest and most expensive, with nearly one-in-five real-estate agents reporting a canceled sale last year because of clients unable to find affordable insurance, according to a survey by the trade body California Association of Realtors.

The roots of California’s insurance crisis go back years. The state’s tough rate caps kept premiums low. But home insurers eventually balked, saying they couldn’t charge enough to cover rising wildfire and other losses, made worse by climate change and development. Insurers didn’t renew tens of thousands of policies, especially in fire-prone areas.

California’s uphill battle to draw insurers back could prove a template—or cautionary tale—for other disaster-prone states. New rules implemented last year, for instance, require home-insurers in the state to pledge to sell new policies in high-risk wildfire zones, in return for allowing them to charge higher rates.

As part of a request for a 6.99% rate increase, Farmers, the second-biggest home-insurer in the state, pledged to add at least 5,596 policies in high-risk areas by September 2028. That is less than a 10th of the 59,806 reduction in Farmers’ total number of California home-insurance policies in the previous two years, according to a Consumer Watchdog analysis.

Others continue to shun the state despite winning big concessions. California regulators approved a 34% rate increase for Allstate in 2024. Yet it has no “growth aspirations” in California home insurance, Chief Executive Tom Wilson said last year, adding that it would take time to fix the market. A spokesman said that remains Allstate’s position.

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Former Obama Adviser David Axelrod Gets Absolutely RIPPED on Social Media for Complaining About Rising Cost of Obamacare

David Axelrod, the Chicago Machine Democrat considered the ‘architect’ of Obama’s 2008 presidential run, recently complained on Twitter/X about the rising cost of healthcare premiums under the Affordable Care Act or Obamacare as it’s widely known.

Other Twitter/X users ripped into Axelrod, pointing out his involvement in this issue.

This has become a running theme among Democrats who desperately want the country to forget that Democrats passed Obamacare on an entirely party-line vote while they controlled everything in Washington during Obama’s first term.

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Democrats Who Let Covid-Era Child Tax Credits Expire Now Cry ‘Crisis’ Over Lapsing Obamacare Giveaway

ontrary to the media’s blaring headlines about “the health care crisis,” there’s another question the press should answer but won’t. To wit: Why is it only a “crisis” when a Covid-era entitlement expires on Republicans’ watch?

While Senate Minority Leader Chuck Schumer, D-N.Y., eggs on the press by pontificating about a “health care crisis” caused by the recent expiration of enhanced Obamacare subsidies, he and his colleagues selectively and cynically ignore the recent past. The same Senate Democrats who now call the lapse of enhanced Obamacare subsidies a “crisis” let a far larger Covid-era program expire on their own party’s watch with barely a peep of objection.

Covid-era Child Tax Credit

In 2021, the American Rescue Plan Act, enacted in the Biden administration’s opening months, significantly expanded the child tax credit. The law increased the maximum available credit from $2,000 per child to $3,600 per child under age 6, and $3,000 for other kids under age 18. It also made the credit fully refundable for families with no income tax liability and provided for periodic monthly disbursements to beneficiaries. But fiscal and political constraints meant that the legislation enhanced the child tax credit for 2021 only.

House Democrats included a one-year extension of the enhanced child tax credit in their so-called Build Back Better legislation, which they passed in November 2021. But objections from Sen. Joe Manchin to the costly House bill meant Schumer spent months negotiating a slimmed-down package with the West Virginia Democrat.

Senate Democrats Oppose an Extension

When that smaller package came to the Senate floor in August 2022 without an extension of the enhanced child tax credit, Socialist Sen. Bernie Sanders of Vermont offered an amendment extending the program for four years, funded by a corporate tax hike. All of Sanders’ Senate colleagues present that day, including all Senate Democrats, voted against his amendment, with two not voting.

On the Senate floor, Sens. Sherrod Brown, D-Ohio, and Michael Bennet, D-Colo., both claimed they supported an extension but could not vote for Sanders’ amendment for fear it would kill the entire bill. Sanders responded with a reasonable enough question: Even if Manchin opposed his amendment, “Why would … getting 48 votes on this amendment bring the overall bill down?” He received no substantive reply.

The enhanced child tax credit that expired on Democrats’ watch had a far bigger effect than the enhanced Obamacare subsidies. Internal Revenue Service data shows that in 2021, just under 62 million children received child tax credit payments, nearly triple the roughly 21 million Americans with subsidized Obamacare coverage. The child tax credit also had a larger fiscal consequence; a permanent extension would have cost nearly $1.6 trillion over ten years, or more than four times as much as a $350 billion permanent revival of the enhanced Obamacare subsidies.

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“Congress Is BOUGHT AND PAID FOR!” — Rep. Tim Burchett ERUPTS After 17 “GUTLESS” GOP Members Join Democrats to Hand BILLIONS to Big Insurance Under Obamacare

During a fiery appearance on The Matt Gaetz Show, Rep. Tim Burchett (R-TN) unleashed a blistering indictment of Washington corruption.

The latest betrayal comes as 17 “gutless” House Republicans crossed the aisle to join Democrats in a move that effectively hands billions of taxpayer dollars to massive insurance companies under the umbrella of Obamacare, a system Republicans have campaigned on repealing for over a decade.

On Thursday, the House of Representatives voted 230 to 196 to extend expired Obamacare subsidies for three years.

17 defiant Republicans joined the Democrats and voted in favor of the three-year extension.

  • Brian Fitzpatrick (R-PA)
  • Mike Lawler (R-NY)
  • Rob Bresnahan (R-PA)
  • Ryan Mackenzie (R-PA)
  • Mike Carey (R-OH)
  • Monica De La Cruz (R-TX)
  • Andrew Garbarino (R-NY)
  • Will Hurd (R-CO)
  • Dave Joyce (R-OH)
  • Tom Kean Jr. (R-NJ)
  • Nick LaLota (R-NY)
  • Max Miller (R-OH)
  • Zach Nunn (R-IA)
  • Maria Salazar (R-FL)
  • Dave Valadao (R-CA)
  • Derrick Van Orden (R-WI)
  • Rob Wittman (R-VA)

Host Matt Gaetz pressed Burchett on why Congress can’t use reconciliation to cut spending and advance conservative priorities without begging Democrats for permission.

During the interview, Matt Gaetz questioned Burchett on the lack of progress regarding a reconciliation bill that would allow for massive spending cuts, including slashing funds currently flowing to the Taliban. Gaetz noted that while Senator John Kennedy (R-LA) has been pleading for action, the GOP leadership seems content to “beg” Democrat staffers for crumbs.

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The Balance Between Incentivizing Death and Saving the Lives of Veterans, as Hundreds of Millions Are Paid Out to Families for Their Loss

When veterans take their own lives, their families may receive financial support if the veteran was covered by Veterans’ Group Life Insurance (VGLI).

The real question isn’t whether families should receive these payments, but rather if more could be done to prevent such tragic losses without encouraging financial motives.

It’s a delicate balance to strike, and it’s an issue that deserves careful, thoughtful consideration.

A recent article from The Gateway Pundit highlighted a question posed by the Veterans’ Group Life Insurance (VGLI) program, which has raised concerns for Sonny Fleeman, a combat veteran and federal whistleblower. That is, “Is there a suicide exclusion?”

The response is, “No—claims related to suicide are not excluded.” For this reason, Fleeman contended that this might incentivize veterans to take their own lives in order to secure financial benefits for their families.

The combat veteran is not suggesting that the families of service members should be denied this financial benefit. What he previously expressed is that “the current design quietly weaponizes despair in a population already on the edge.”

His primary desire is for veterans to prioritize seeking help for their conditions rather than focusing on financial rewards for their families.

On October 28, 2025, Fleeman submitted a Freedom of Information Act request concerning VGLI death claims, suicides, and payout data. Once considered “not public interest,” the results are now in.

“Based on VA’s own totals from 1999 to 2023, 2,602 suicide-classified death claims out of 66,593 total claims—about 4%, or roughly one out of every 25—show that suicide is a meaningful and recurring share of VGLI payouts,” Fleeman told The Gateway Pundit.

“From 2004 to 2023,” he said, “those suicide-related claims accounted for more than $370 million, averaging tens of millions of dollars each year.”

The federal whistleblower emphasized that the dataset alone cannot determine whether VGLI’s experience is typical or uniquely elevated compared to private sector group life insurance.

“That requires apples-to-apples actuarial benchmarks—age and risk adjustments and comparable cause-of-death definitions—that aren’t publicly available to my knowledge,” he explained.

“Given that VGLI serves a known high-risk population and has no suicide exclusion,” Fleeman argued, “it’s reasonable to suspect the suicide share may be elevated, but confirming that is beyond me and requires independent benchmarking against private sector.”

Ultimately, he stated, it is “essential to find a solution” that prevents veterans from feeling as though the message conveyed by the policy is: “The only way to support your family is through your death.”

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Check Out Rep. McBride’s Vulgar Dismissal of Massive Obamacare Fraud

Last week, a watchdog group reported on “large-scale systemic failures” that led to massive Obamacare subsidy fraud, including the use of a single Social Security number to get subsidies for more than 70 people. The U.S. Government Accountability Office (GAO) ran a test of fake applicants and found that “100% of fake applicants were approved by Obamacare’s marketplace as recently as late 2024. 90% of fake applicants continue to receive coverage in 2025.”

The report also found no mechanism for income verification, meaning millions of subsidies were going to people who aren’t poor or in need. It all spells massive waste. You would think Democrats would take that seriously, right?

Apparently not.

Rep. Tim McBride (D-DE) seems to think such studies are “bulls**t,” and said as much as he’s pushing to extend Obamacare programs.

“I don’t think the American people feel that it’s failed the American people,” McBride said. “That ‘study’…sounds like bullsh**t…sounds like a bulls**t study with a bullsh**t methodology,” he continued. “Sounds like the methodology is pretty questionable.”

When the study’s reporting was shown, McBride doubled down. “First of all, that’s not what that says, and you’ve mischaracterized what the report says. But that’s not what it says. It does not say there’s a 90 percent fraud rate.”

Despite the reporter’s push on the subject, McBride kept insisting that Obamacare is fine. “If they [Speaker Johnson and Senate Majority Leader John Thune] want to work with us and add in measures around verification for the ACA tax credits, we’re ready to negotiate,” McBride said.

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