Episode 987: Obamacare Enrollment Fraud

Summary

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Newt’s World (Episode 987): Obamacare Enrollment Fraud

Date: June 10, 2026
Host: Newt Gingrich
Guest: Elle Manarik, Paragon Health Institute

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Episode Overview

This episode delves deeply into recent findings about widespread fraud in the Obamacare (ACA) marketplace. Guest Elle Manarik from the Paragon Health Institute discusses her organization's new report, “The Persistent Obamacare Enrollment Fraud,” highlighting the scale, mechanisms, and consequences of fraud in ACA enrollments—driven by enhanced subsidies, administrative loopholes, and misaligned incentives for insurance companies and intermediaries. The conversation also explores policy failures, the roles of various actors in the insurance ecosystem, and urgent recommendations for reform.

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Key Discussion Points & Insights

1. Understanding the ACA Marketplace

[07:01–08:00]

• The ACA marketplace is designed for people without employer-sponsored insurance: gig workers, small business owners, seasonal workers, and people above Medicaid eligibility.
• Intended not only for low-income individuals but anyone lacking access to traditional insurance options.

Quote:

“It is not just a program that is intended strictly for those that are low income, but it is really meant to provide health insurance for folks that do not have access to traditional health insurance through their employer.”
– Elle Manarik, [07:22]

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2. The Scale of Enrollment Fraud

[08:00–10:24]

• Report reveals in 2026, there are 6.2 million improper signups for highly subsidized Obamacare plans—more than census data suggests are eligible.
• Enhanced subsidies and the introduction of $0 premium plans during COVID and Biden’s administration triggered unprecedented enrollment increases and open doors for large-scale fraud.

Quote:

“There are 6.2 million people that are enrolled in highly subsidized Obamacare plans than actually even make that income.”
– Elle Manarik, [09:56]

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3. Financial Cost and ‘Zero-Claim’ Enrollees

[10:24–11:43]

• Annual cost of improper enrollment is projected at $25 billion, with $75 billion lost over the past three years alone.
• $40 billion in one year spent on people who never used their insurance—“zero-claim enrollees.”

Quote:

“In just a singular year, we spent $40 billion directly to health insurance companies for health insurance that people did not use a single time.”
– Elle Manarik, [11:21]

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4. Who Benefits? Corporate Welfare vs. Intended Recipients

[11:43–13:09]

• Systemic misalignment of incentives: insurance companies, brokers, and intermediaries are rewarded for higher enrollment, regardless of eligibility.
• Enrollment at any cost: a policy focus on record enrollment numbers over program integrity and preventing fraud.

Quote:

“All of this money simply started flowing to the health insurers... that is the enrollment at any cost.”
– Elle Manarik, [12:29]

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5. How the Fraud Happens

[13:09–18:32]

• Insurance companies pay brokers per enrollee ($125 bonus, plus $25–$70 monthly).
• Easy enrollment processes enable intermediaries to fake information and even enroll individuals without their knowledge or consent.
• Loopholes allow fraudulent enrollments without Social Security numbers.
• Victims, often unaware, can end up with unexpected IRS bills ($7,000–$10,000) when tax forms reveal fraudulent subsidies used in their name.
• Examples include elderly couples unable to get medication or individuals blocked from their actual coverage due to unauthorized plan switches.

Quote:

“Lots of folks have been enrolled in these plans without their knowledge and without their consent because the incentive is for the insurance companies to have more enrollees. And there's an incentive with the intermediaries to have as many people on their books as possible.”
– Elle Manarik, [15:13]

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6. Geographical Hotspots of Fraud

[22:45–26:47]

• Concentration: Florida (2.4 million), Texas (1.54 million), Georgia, South Carolina, North Carolina (combined hold 78% of improper enrollees).
• Non-expansion of Medicaid in these states creates incentives to overreport income and target vulnerable populations.
• In contrast, California sees higher Medicaid fraud rather than ACA fraud.
• Specific counties in Florida have 7–8x more people enrolled in ACA than eligible.

Quote:

“If you are a state that is going to have widespread Medicaid fraud, you're more than likely not going to have widespread ACA fraud because all of your fraudulent individuals are enrolled in the Medicaid program.”
– Elle Manarik, [25:18]

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7. Role of Federal Oversight and Technology

[27:03–33:37]

• Federal oversight and CMS technology are insufficient. Fraudulent applications regularly slip through federal exchange (healthcare.gov).
• States running their own ACA exchanges with stronger tech (multi-factor authentication, data checks, state-level oversight) see far less fraud.
• The Biden administration rolled back Trump-era data matching and program integrity measures to prioritize enrollment growth.
• GAO experiment: 20+ fake applications submitted to healthcare.gov—only 1 denied.

Quote:

“The state-based exchanges have really enhanced tech and policies that make the fraud much more difficult.”
– Elle Manarik, [30:44]

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8. Systemic Incentives & Administrative Choices

[32:22–35:06]

• “Enrollment at any cost” became Biden administration strategy; anti-fraud mechanisms deactivated to boost numbers for political wins.
• Recent attempts to restore integrity rules (Trump, Congress) have been stalled by court injunctions.

Quote:

“They did not care that a lot of it was fraudulent. They did not care that there was a lot of duplicative enrollment or people were being enrolled without their consent. All they cared about was being able to tout high record enrollment numbers.”
– Elle Manarik, [32:54]

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9. Recommendations for Reform

[37:04–38:33]

• Eliminate $0 premium plans: set a minimum monthly premium (e.g., $25) so financial incentives for brokers don’t outpace what enrollees pay.
• Require multi-factor authentication for any plan changes.
• Massive need for “program integrity” focus: improve federal tech, accountability, and make fraud more difficult than legitimate enrollment.
• Structural ACA redesign needed, but immediate changes can still greatly improve oversight.

Quote:

“We need to set a minimum payment at about $25 a month... You can get rid of $0 premium plans, you’re really getting at a major incentive that is on this fraud.”
– Elle Manarik, [37:26]

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10. Worsening Trends & Consequences

[38:33–42:17]

• Zero-claim enrollment on the rise: 35% overall, 40% for $0 premium plan holders use no healthcare at all.
• Increasing trend: more enrollees not filling in applications fully.
• System creates costs for all: higher taxes, higher premiums, and widespread “corporate welfare.”

Quote:

“When you look at enrollees that are in the $0 premium plans, that number jumps to 40%. Almost half of the enrollees that pay nothing for their health insurance did not use it a single time. And that trend is only getting worse.”
– Elle Manarik, [39:45]

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Notable Quotes & Memorable Moments

• On how the system is gamed:

  “We've built this really sick game where the insurance companies hire people to give you an account which you don't even know you have, which the insurance company gets money from the government for whether you use it or not.”
  – Newt Gingrich, [41:15]

• On moral outrage and bipartisan significance:

  “This should be outrageous to anyone that's listening, regardless of the letter that's next to your name.”
  – Elle Manarik, [34:46]

• On summary costs and public consequence:

  “We want healthcare to be high quality and we want everyone to have access. But when we are spending this amount of fraud, all that this is doing is raising costs, it's raising premiums, it's raising what insurers can get away with with. And that is fundamentally degrading the goal that all of us should have, which is having a healthier America.”
  – Elle Manarik, [41:49]

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Key Timestamps for Segments

| Timestamp | Subject/Insight | |-----------|----------------| | 06:24 | Introduction of Elle Manarik and context for report | | 07:01 | Who is supposed to be on ACA plans | | 08:00 | Scale and nature of improper enrollments | | 10:24 | Financial implications: $25B per year in fraud | | 11:43 | Incentives for insurance companies and intermediaries | | 13:09 | How brokers and intermediaries game the system | | 15:45 | Personal consequences for fraud victims | | 22:45 | States and counties with highest fraud | | 27:03 | Role of federal tech and state-based systems | | 32:22 | Administrative choices: Trump vs. Biden approach | | 37:04 | Concrete policy recommendations | | 38:33 | Worsening trends in fraud and utilization | | 41:07 | Broader systemic consequences |

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Conclusion

This episode offers a sobering, eye-opening discussion of ACA enrollment fraud: how perverse incentives at every level have led to billions in waste, policy loopholes, and unintended victimization of regular Americans—while insurance companies and intermediaries profit from the broken system. Elle Manarik makes a strong case for urgent, bipartisan reform—raising the alarm not just for fiscal responsibility, but for the integrity and effectiveness of American healthcare itself.

For more details or to read the report, visit paragoninstitute.org.

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Transcript

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[Newt Gingrich]

Welcome to News World podcast and the iHeart podcast network. You know the very interesting symbolic vote by the House where four Republicans, only four, joined all the Democrats in voting to invoke the War Powers Act. Now, in theory, the War Powers act would force the President to come back to the Congress for approval. This is something which grew up during the fight over Vietnam. But the fact is the President can veto it. And if he vetoes it, there's no possibility they're going to override it. And so, other than being psychological, the vote has no functional meaning and the President can continue to do what he's doing to try to bring Iran into disarming and giving up its nuclear weapons. Totally different story. China barred four New Zealand lawmakers because they had visited Taiwan. I actually went through this when I was speaker because I insisted if I came to Beijing, I would also go to Taiwan. And they said, well, if you do that, we're not going to invite you to Beijing. We said, fine, we'll just go to Taiwan. At which point they said, well, you know, now that we're thinking about it, as long as you agree to go through Tokyo and not go direct, we'll tolerate it. But as you can tell, they're putting pressure on. They really hate the idea that people go to Taiwan and continue to want to try to find some way to isolate Taiwan. And since Taiwan now makes over 70% of the computer chips in the world, it's ultimately hopeless. But it's an example of how determined the Chinese Communists are to try to isolate it. Coming up, I'm joined by El Minarik from Paragon Health Institute and we're going to discuss Obamacare enrollment fraud. That's next.

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[Elle Manarik]

with

[Parent]

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Oh, as an avid camper, I know all about this. We'll pack up the RV and know this is either going to be the trip of a lifetime or a complete disaster.

Which is why we load up the iPads with Lingokids before we even pull out of the driveway.

It's what dreams are made of. Lingokids keeps kids engaged and quiet with over 4000 interactive games, songs and shows that kids simply cannot get enough of.

You can pack whatever you think you'll need, but Lingokids is the only entertainment you'll need for a stress free car ride.

Or really any ride, plane, train, hovercraft, whatever.

Download Lingokids for free today or unlock

even more amazing content with LingoKids.

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[Newt Gingrich]

I'm really pleased to welcome my guest Hel Menarg from the Paragon Health Institute. She is joining me to discuss their new report, the Persistent Obamacare Enrollment Fraud, which details fraudulent enrollment in ACA exchange plans driven by enhanced subsidies and administrative actions and it's truly a remarkable story. El, welcome and thank you for joining me on Newts World.

[Elle Manarik]

Walt, thank you for having me here today. I'm really excited to bring some more light to this really outrageous issue that is currently plaguing the ACA market.

[Newt Gingrich]

El, can you help us understand who actually are the target of the Obamacare plans? Who's supposed to be on them?

[Elle Manarik]

Sure. The ACA marketplace is constituted of a variety of different people. The vast majority of enrollees make between 100 and 400% at the federal poverty level. But beyond that, this is also constituted of a lot of gig workers, folks that are not offered health insurance at work, small business owners, folks who have different types of jobs, or even seasonal workers. And so this is really the individual marketplace. It is folks that are not receiving Medicare, Medicaid or employer sponsored insurance. It is not just a program that is intended strictly for those that are low income, but it is really meant to provide health insurance for folks that do not have access to traditional health insurance through their employer.

[Newt Gingrich]

Yeah, I was really surprised at the scale of it and the work that you all had done. I mean, one headline said that there are 6.2 million signups in 2026 that could have been improper. Can you put all that in some kind of perspective for us?

[Elle Manarik]

Sure. I think to really understand this you have to go back a little bit. So you have to kind of set the table on what we know about the Obamacare exchanges. So folks that are enrolled in Obamacare plans typically do not have employer sponsored insurance. So it's individual market that allows folks to be able to have access to insurance plans. How this works is the lower the income that you have, the larger the subsidy that you get. And to put that in more context, what We've seen since the introduction of the Affordable Care act was that before COVID the enrollment into the ACA plans was actually about 60% below projections, right at about 10 million people. And this is because these plans have really narrow, narrow networks, really large deductibles that often make them low quality and very unaffordable for people to enroll. Then you saw during COVID and during the Biden administration, really the creation of really enhanced subsidies. They juiced them up. And what that meant is, what we saw is that a lot of people really don't value their Obamacare coverage. So the only way to get people enrolled in these plans was to make them practically free. So there was the introduction of the enhanced premium tax credits, which, which led to the widespread availability of $0 premium plans. And so what we did in our analysis is actually really quite simple. We took a look at the amount of people, according to the census data, by state that would be in the lowest income band. That lowest income band is 100 to 150% at the federal poverty level. What we did was compared that census data of how many people have that income and to how many people got the largest amount of subsidy in the ACA. And what that found was there are 6.2 million people that are enrolled in highly subsidized Obamacare plans than actually even make that income.

[Newt Gingrich]

That's wild. What do you think we are spending on subsidies we shouldn't be paying?

[Elle Manarik]

So this is the third year that we have done this analysis and the fraud has actually only gotten worse every single year that we've done it. So in 2026, we project that about $25 billion will be spent on an annual basis to pay for improper Obamacare enrollment.

[Newt Gingrich]

Wow. So over 10 years that could be like a quarter trillion dollars.

[Elle Manarik]

Correct. And I mean we've at least seen 75 billion just over the last three years. So if you put that in the context of COVID I mean we are talking about a large stark increase in the amount that we are paying. And it get concerning when you take a look at how this fraud is paying out. So CMS released some data in 2024 and that data took a look at zero claim enrollees, meaning folks that were enrolled in a plan but did not use their health insurance a single time. And we found there was that in just a singular year, we spent $40 billion directly to health insurance companies for health insurance that people did not use a single time in the year.

[Newt Gingrich]

Did Obamacare become more of a pro health insurance company package rather than a pro poor people package.

[Elle Manarik]

Absolutely. I think it's an admirable goal to want people to have coverage. But unfortunately, what has happened over the past few years, especially since COVID and especially during the Biden administration, was what we have coined the enrollment at any cost policy. And so what we've seen is that they were so focused on increasing enrollment numbers that they did not care about the level of fraud that permeated through the programs or any of the consequences that were paying out. And so ultimately, the core problem here is incredibly simple. When the government changes who pays. So instead of changing it from an enrollee paying a premium that goes to the health insurance and making sure that they have skin in the game and make something free, it does not eliminate that cost. It simply changes who is paying and who it changes the incentive there for then an abuse of that policy. So in the ACA exchanges, these subsidies were so generous, making these $0 premium plans, that all of this money simply started flowing to the health insurers. And in order for the health insurers to get more money, they simply needed to increase enrollment. So that is the enrollment at any cost.

[Newt Gingrich]

Are the improper enrollments as much a function of how aggressive the insurance companies are?

[Elle Manarik]

Yes, I think it's overall truly a good picture here into the importance of rightly aligned incentives. And so there is an incentive here for the insurance companies to have as many people enrolled as possible, because how they're paid is through direct cash transfers from the federal government to the insurance companies on a monthly basis for every enrollee that they have have. So not only is there an incentive here for the insurance companies to have as many people enrolled as possible to continue to receive as many monthly direct cash transfers from the federal government, but there's also bad incentives for all of the other players that are involved. So the insurance companies also enter into employment contracts with enrollment intermediaries. These are agents, brokers. Oftentimes there are things like call centers, marketing companies, and lead generation companies, and these are all enrollment subsidiaries that exist in the pipeline to be able to get an enrollee to an insurance company. And there are really bad incentives here for them as well. If I am a health insurance broker and I am enrolling you, depending on how I enroll you, I could receive $125 as a bonus payment for enrolling you during open enrollment. Then from there I will receive anywhere from 25 to $70, depending on the carrier in the state, for every month that you are enrolled in that plan. So on the intermediary aspect, as a health insurance broker. I also have an incentive to make sure that I have as many people as possible enrolled and has me assigned as their agent because I make a monthly commission payment that for every single enrollee that we have. And you have to understand here that when you use a magnifying glass and understand that for many of these enrollees, they're paying a $0 premium, meaning they don't have to pay anything. So when I'm enrolling you, it's really easy. It's also really easy for those intermediaries to kind of make up that personal information. So what we've seen is lots of folks have been enrolled in these plans without their knowledge and without their consent because the incentive is for the insurance companies to have more enrollees. And there's an incentive with the intermediaries to have as many people on their books as possible.

[Newt Gingrich]

So let me get this straight. We're paying people to go out and enroll people who in fact may not be eligible, but it doesn't really matter because as long as they get cleared, the government's going to pay for them. So the insurance company pays somebody to go find somebody who in fact shouldn't be in the program, and we pay for it.

[Elle Manarik]

Correct. I have a great blog that we put out last year and it talks about the victims of the Biden administration's enrollment at any cost policy. Because the reality is here, the only people that pay actual consequences when it comes to the great Obamacare enrollment fraud is one the American taxpayer that is continuing to finance over $25 billion a year in fraud and waste. But it's also the victims that have been enrolled in these plans without their knowled happens is that they get enrolled without their knowledge. Because you really only need basic information to be able to get enrolled into an ACA plan. You need your name, your birth date. You also need an address. You're supposed to have a Social Security number that's attached with your application. But what we found is that during the Biden administration, there were a lot of loopholes that really didn't actually mean that you had to have a Social Security number. So what happens is you get enrolled without your knowledge, and then come tax time, you file your tax return and your tax return gets denied. And you're wondering what is going on here. And the IRS tells you that you did not file your 1095A form, which is the form that the federal government uses to reconcile the enhanced premium tax credits and the subsidies in the aca. At that point, you then become liable for every single dollar in unrighteous subsidy that you received. And so we have detailed the heartbreaking stories of hardworking American citizens who at the end of the year get saddled with 7,000 to $10,000 in tax bills because a fraudulent intermediary signed them up for health insurance without their knowledge. An insurance company got a direct cash transfer from the federal government. The insurance company doesn't in practice actually really have to pay that back because in reality, it's kind of like an interest free loan that they get from the government. The insurance broker just made a ton of money in commissions, over thousands of dollars for you throughout the year, and now you are paying a $7,000 penalty. Even worse, that looks like getting shut down for healthcare that you're supposed to need. There are awful stories of elderly couples who aren't able to get the medications that they needed because their plan had been switched, or their plan that they had through work had denied their coverage because they had actually been signed up for an ACA plan.

[Newt Gingrich]

Let me get this straight. I'm sitting out here, Somebody enrolled me without my knowing it. At the end of the year, the government can come to me to have me pay the government while the government had been paying the insurance company and the person who did the fraudulent enrollment took the cash and left?

[Elle Manarik]

Correct. It's awful. And it's gotten so complicated. There are so many different things. So when we talk about call centers, there are entire places that exist that all they do is call people on the phone trying to get them to sign up for health insurance. If you go on Facebook right now, you can find a slew of online ads that advertise your enrollment in the ACA as like a cash gift card. They take the subsidy amount, equate that to what that is in normal nominal dollars, and then advertise that. They say, do you want $651 to help with gas and groceries? Who doesn't want that? And so you click on the ad and you fill out your personal information and you say, yes, I want a Visa gift card to help me with cash and groceries and all of the other things that are plaguing my family. And they take that information that you submitted while you filled out that ad and sign you up for an Obamacare plan. And on top of that, it's so difficult to go after the, the fraud. And we went through an entire administration that did not care about the fraud because they wanted to simply prioritize enrollment numbers. You know, the Biden administration touted historic enrollment numbers for three out of the four years that they were in in office when in reality these people had their health insurance and their personal information stolen and they were enrolled in all of these insurance plans without their consent.

[Newt Gingrich]

When we come back, we'll discuss how fraud is happening and the incentives that might be driving it.

[America 250 Announcer]

This July 4th come celebrate at America's Block Party hosted by America 250, America's Block Party is a can't miss 4th

of July concert happening at the Los Angeles Memorial Coliseum. Experience music, performances from major artists, patriotic

tributes and the kickoff to giving 4th,

helping to make July 4th the largest

day of giving in American history.

It's more than just fireworks.

Learn more about this landmark [e-mail]

[Parent]

with my mom and dad living in Orange county, when we bring my five and seven year old to visit, we are sometimes in for a two hour drive that could feel like 10.

Oh, as an avid camper, I know all about this. We'll pack up the RV and know this is either going to be the trip of a lifetime or a complete disaster.

Which is why we load up the iPads with Lingokids before we even pull out of the driveway.

It's what dreams are made of. Lingokids keeps kids engaged and quiet with over 4000 interactive games, songs and shows that kids simply cannot get enough of.

You can pack whatever you think you'll need, but Lingokids is the only entertainment you'll need for a stress free car ride.

Or really any ride, plane, train, hovercraft, whatever.

Download Lingokids for free today or unlock

even more amazing content with LingoKids.

Plus choose the yearly plan and save up to 60%. Search LingoKids in the app Store or

Google Play Lingokids everything kids love Professional wrestling fans.

[Wrestling Announcer]

The action continues every week.

This is total non stop action.

TNA Thursday night impact every week on AMC. For showtimes and more information visit tnarrestling.com

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[Newt Gingrich]

As I understand it, and correct me if I'm Wrong, there are five states with the highest number of improper enrollees in 2026 Florida at 2.4 million, Texas at 1.54 million then you drop down to Georgia at about a half million, South Carolina down about 190,000, and then North Carolina, 180,000. Now, those five states have 78% of all the improper enrollees. But two of them, Florida and Texas, have 63% of all the improper enrollment in the entire country. How can that be true?

[Elle Manarik]

Well, ultimately this comes down to bad policymaking and a flaw that deeply plagues the aca. Now, there are a lot of fundamental flaws that are within the aca, but one of the original designs was essentially that in order to receive an ACA subsidy, you had to make above 100% of the federal poverty line. And that is because the ACA also expanded Medicaid. So in states, states that did not expand Medicaid, you do have individuals in which do not qualify for Medicaid and they do not qualify for an ACA subsidy because the law says that you have to make above 100% of the federal poverty line in order to receive an ACA subsidy. So in these states, like Florida, Texas and other red states that have not expanded Medicaid, there is a large incentive all around to misestimate income to be able to qualify for an ACA subsea. On top of that, there is an enhanced incentive for the insurance companies and their intermediaries, brokers and agents to target these low income folks that are below 100% of the federal poverty line to be able to get them covered. But also because there is no way for these individuals to be able to pay this money back, they do not file taxes. So they do not have to reconcile their subsidy at the end of the year, which makes them a very easy target for the insurance companies and the subsidiaries in order to juice up their enrollment numbers and get more government money.

[Newt Gingrich]

I mean, I have to tell you, when I look at this, I am shocked that California isn't on the list.

[Elle Manarik]

Well, Newt, you have to think about this in a little bit of a bigger picture here. While California may not be our largest offender in ACA fraud, California is one of the worst offenders in Medicaid fraud. Medicaid fraud is another aspect that Paragon has done quite a lot of research on, and we have condemned California for the different tactics that they use and the amount of illegal immigrants and other unauthorized individuals that they enroll into their Medicaid programs. And so it's kind of like a scale or a little bit of a give and take here. If you are a state that is going to have widespread Medicaid fraud, you're more than likely not going to have widespread ACA fraud because all of your fraudulent individuals are enrolled in the Medicaid program. So that's why in Texas and in Florida, you see kind of this surge in ACA fraud. And so really out here in the way that we have designed our government healthcare programs, it's all of them, fraud is by design, it is not a flaw. And if the ACA fraud doesn't work in your state, the Medicaid fraud definitely does. So California is a leak leading offender there. Meanwhile, you have Florida, which I will also just caveat and say that there is no state that does healthcare fraud quite like the state of Florida. And so you do see in Florida there's this immense amount of ACA fraud. You have certain counties in Florida, which we've done a county by county analysis, where there are over seven to eight times the amount of people enrolled in these plans than are actually eligible according to the census.

[Newt Gingrich]

Why do you have either a culture of theft or a system of theft? Maybe it's both in Florida, on a scale in terms of population that is almost unimaginable.

[Elle Manarik]

A lot of it goes back down to those incentives that I was talking about before without Medicaid expansion. The other reality, and it kind of goes into that joke I just said about how no one does has healthcare fraud quite like Florida. There are a lot of call centers and fraudulent intermediaries that are focused in South Florida. When you talk to brokers and agents, which many of them are really incredible people that are constantly trying to help people navigate the health care system. They often talk about the hotbed that South Florida is, and oftentimes that just comes down to really bad federal oversight. CMS and other federal agencies are really struggling to come up with who has the proper authority into things like lead generation companies and marketing agencies. And Newt, this is going to blow your mind. But what a lead generation company is, is basically a private entity that simply only sells personal healthcare data. So it will have thousands and thousands of names, addresses, Social Security numbers, what their income is, and they sell them out to all of these different marketing companies, all of these different call centers, and their entire job is to simply call all of these people, send them text messages, send them emails, send them targeted ads to try to get them to sign up for health insurance again. And it's really lagging in the federal arena on who has the authority to properly go after these entities. Earlier this year, the gao, the Government Accountability Office, came out with a study that really took a look at the ACA exchanges. And they submitted over 20 fraudulent applications through healthcare.gov which is the federal website that is used to enroll in the ACA. And of those 20 plus applications that they submitted, only one of them got denied. Several of those did not have a Social Security number. Several of those did not have the proper documentation to support their immigration status or their income. And the federal government let those applications go through anyways.

[Newt Gingrich]

Is that because they don't have adequately modern computer systems or just the nature of big bureaucracies? Why is this actually happening?

[Elle Manarik]

Well that is just all of the above. CMS definitely does not have the right technology to be able to have enhanced program integrity with the aca. Our analysis actually goes into a deep dive comparing between states that use healthcare.gov or states that are state based exchanges and what a state based exchange is. Essentially the state owns the enrollment process, the verification, etc, which is kind of like the definition of federalism here. Right. The states themselves have made their own exchange and they do not run off of the healthcare.gov, which is the federal exchange. And it is simply stunning the lack of fraud that is in state based exchanges. And ultimately what that boils down to is that the state based exchanges have really enhanced tech and policies that make the fraud much more difficult. So new, if you've ever kind of ordered dinner on DoorDash, or maybe you've used a food ordering app that goes directly through McDonald's or Taco Bell. When you log into those apps, they have what's called two factor authentication. You have to verify who you are. They'll send that post notification to your phone, you put the code in and then you're able to go because you're going to use your credit card. Well, the federal government doesn't do that for health insurance. So what happens is all of these brokers and intermediaries can log on through healthcare.gov and make changes to your health insurance. And you don't even have to approve it. They don't have to ask you for your permission first. There's no code that gets sent to your phone. That happens in state based exchanges. State based exchanges are able to use their state data and state death files. Right. So when someone passes away in their state, automatically they are taken off the rolls. When their tax data changes, they're automatically flagged in their system. And I will give credit to the Trump administration. Last year they were able to identify a lot of duplicate enrollment. And what duplicate enrollment is, is folks that were enrolled in the ACA and in Medicaid, folks that were enrolled in several states or folks thought even had employer sponsored insurance and ACA coverage. And the Trump administration was able to step in and turn back on the data matching systems that the Biden administration had turned off and find millions of people that had been duplicatively enrolled. But overall, CMS in the federal government and the bureaucracy here does need to have stronger program integrity. They need to update the tech systems that they have and they need to just in general find the authority to be able to conduct oversight on these call centers and marketing agencies and enhanced direct enrollment entities that are wreaking havoc on the ACA marketplace.

[Newt Gingrich]

Let me carry back to something you just said. Why would the Biden administration have turned off those kind of protections?

[Elle Manarik]

Well, Newt, that is because they took the enrollment at any cost strategy. As I said before, before COVID the ACA marketplace was really underperforming expectations. They only had about 60% of the people enrolled. They thought they would at that point. Then you get to the Biden administration and Covid happens and the enhanced subsidies happen and all of a sudden Joe Biden and Kamala Harris are at press conferences saying we have the highest recorded enrollment in the ACA than we ever had. And that is no mistake. And that's correct. That was no mistake because they pursued enrollment at any cost. They did not care that a lot of it was fraudulent. They did not care that there was a lot of duplicative enrollment or people were being enrolled without their consent. All they cared about was being able to tout high record enrollment numbers. And what we've seen through our research and a $25 billion a year in fraud is there's been a lot of success in that. And now we have 6.2 million people enrolled in these plans that shouldn't be.

[Newt Gingrich]

It's an amazing story. It's almost like any government was good, no matter how crooked the government was. Because at least it was government right.

[Elle Manarik]

At least there was something right. And we've seen a lot of that get turned off. And I think to the Trump administration's credit, their CMS has taken a lot of steps to try and increase program integrity in the ACA exchanges. Last year they came out with a program integrity rule, but unfortunately a Biden appointed liberal activist judge created a preliminary injunction onto that rule and it never got to go into effect. Congress did follow up and codified a lot of those provisions in the reconciliation bill, but those provisions just haven't gone into effect yet. So in general, there is a lot more to be done to make the ACA marketplace much more secure. And it's necessary. This should be outrageous to anyone that's listening, regardless of the letter that's next to your name. And I think that it's important that we understand that there are so many individuals that are not only enrolled without their consent, but that turns to billions of dollars that we are sending to insurance companies. That is corporate welfare. We should be taking policies and we should be taking all of that money that's being used on this fraud and finding ways to make healthcare more shoppable and more consumer focus. And before we can do that, then we really need to focus on program integrity.

[Newt Gingrich]

Coming up, what should leaders in Congress do to fix the problem of Fraud

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[Child]

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[Parent]

When did we become the Lingokids house?

[Elle Manarik]

No idea.

[Parent]

Last week it was dinosaurs.

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This week it's Lingokids.

[Parent]

Why Lingokids?

[Child]

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[Newt Gingrich]

We have these problems and they're big problems. I've always thought part of the trick is to redesign the system so you preempt the fraud. You don't chase it. But what do you believe that congress should do in order to really begin to solve this?

[Elle Manarik]

Well, neat. We definitely need to eliminate $0 premium plans. There is always going to be an incentive for fraud when the insurance companies and the intermediaries are receiving more money monthly than the enrollee is paying. So Paragon would go as far to say that we need to set a minimum payment at about $25 a month.

[Child]

Month.

[Elle Manarik]

Because that payment would mean that that is higher than the commissions of these intermediaries that are enrolling these folks. You can get rid of $0 premium plans. You're really getting at a major incentive that is on this fraud. Beyond that, you absolutely need to have multi factor authentication for plan enrollment. Any change in my health insurance plan, I need to verify before it happens, and a broker or an intermediary shouldn't be able to do that on my behalf. And in the meantime, before we can address some of the deep structural flaws, which I agree with you, Newt, and I think Paragon would agree at large that we need a fundamental redesign of the aca. But until then, we really need to make sure that we focus on program integrity and make it harder for these fraudsters to simply take advantage of all of our money.

[Newt Gingrich]

When you look at the patterns, are the trend lines getting worse?

[Elle Manarik]

Yes, absolutely. And so I think I'm going to talk about zero claim enrollment here in 2024. CMS released data and that's when I talked about the 35% of the ACA marketplace that had not used their health insurance. Now, new health insurance is not like car insurance. When you have car insurance, you're really just getting that, or even homeowner's insurance, you're really just getting that for peace of mind. When something happens, an accident happens, you're going to be protected. But that is not how health insurance is designed. Health insurance is designed to be used. And when you look at all of the different rules and regulations that we have put on Obamacare, there are a lot of free services that are in ACA plans, free physicals, etc. And so in a normal health insurance market, you would expect about about 15% of enrollees to not use their health insurance. And that makes sense. Sometimes you have busy families and parents are only taking their kids to the doctor and not taking themselves. Maybe you're a healthy college student that doesn't want to go and get lectured in their monthly physical. Right? These are normal reasons why someone wouldn't go to the doctor or use anything in their health insurance in a year. But in the ACA, that number is 35%. When you look at enrollees that are in the $0 premium plans, that number jumps to 40%. Almost half of the enrollees that pay nothing for Their health insurance did not use it a single time. And that trend is only getting worse. And that's concerning. So when we look at improper enrollment, which may not all be fraud, the first thing that you would expect is that people would not use their health insurance. And that is what we have seen since COVID and since 2020. Not only is there more estimated improper enrollment, but there are more and more people that are not using their health insurance. On top of that, there are more and more people that are not fully filling out their application. So another thing that we saw was that there are more people now not filling out what their rate, race and ethnicity is. And all of these trends almost perfectly mirror each other. And so, yes, when we take a look at all of these trends put together, the trends are getting worse. And it is really important that we step in and fix this.

[Newt Gingrich]

I think this is extraordinarily important because as you're pointing out, it's not just a money thing, although this level of corruption, I think is really dangerous for the country at large. But it's also the implications for healthcare and for whether or not people have a sense that they're responsible. In a way, we've built this really sick game where the insurance companies hire people to give you an account which you don't even know you have, which the insurance company gets money from the government for whether you use it or not. I mean, the whole system has been corrupted to such a degree that it seems to me we need to profoundly rethink how we're going to do this.

[Elle Manarik]

Absolutely. This is an issue that should enrage everyone. We all want healthcare to be affordable. We want healthcare to be high quality and we want everyone to have access. But when we are spending this amount of fraud, all that this is doing is raising costs, it's raising premiums, it's raising what insurers can get away with with. And that is fundamentally degrading the goal that all of us should have, which is having a healthier America.

[Newt Gingrich]

Hill, thank you for joining me. I have to say the work you've done is extraordinary. And your new report, the Persistent Obamacare Enrollment Fraud, is a fascinating study on just how corrupt the system is. I really encourage our listeners to take a look at it. It they can find the [e-mail] and it's really important for the country's future. So, Elle, thank you very, very much.

[Elle Manarik]

Thank you for having me on.

[Newt Gingrich]

Thank you to my guest, Elle Manarik. Newts World is produced by Gingrich360 and iHeartMedia. Our executive producer is Garnesey Sloan. Our researcher is Rachel Peterson. Special thanks to the team at Gingrich360. If you've been enjoying Newtsworld, I hope you'll go to Apple Podcast and both rate us with five stars and give us a review so others can learn what it's all about. Join me on [e-mail] I'm Newt Gingrich. This is Newtsworld.

[America 250 Announcer]

This July 4th, come celebrate at America's Block Party hosted by America 250. America's Block Party is a can't miss

4th of July concert happening at the Los Angeles Memorial Coliseum. Experience music, performances from major artists, patriotic

tributes and the kickoff to giving 4th,

helping to make July 4th the largest

day of giving in American history.

It's more than just fireworks.

Learn more about this landmark [e-mail]

[Elle Manarik]

mom,

[Child]

can I have Lingokids? Dad, Lingokids, please.

[Parent]

When did we become the Lingokids House?

[Elle Manarik]

No idea.

[Parent]

Last week it was Dinosaurs.

[Child]

This week it's Lingokids.

[Parent]

Why Lingokids?

[Child]

Because it's the best thing ever. We can play games with astronauts, wild animals and superheroes.

[Lingokids Narrator]

With more than 4,000 interactive games, songs and shows, LingoKids is the number one entertainment platform for young kids.

[Parent]

So no dinosaurs and dinosaurs, Mango kids, everything kids love.

Download it for free.

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