The Clay Travis and Buck Sexton Show

"The Truth with Lisa Boothe: How Obamacare’s Subsidy Surge Is Reshaping America’s Healthcare Crisis"

Date: December 6, 2025

Main Theme / Purpose

This episode, hosted by Lisa Boothe with guest Brian Blase (former Trump White House health policy advisor and president of Paragon Health Institute), takes a critical look at recent changes in Obamacare, particularly the Covid-era surge in subsidies. The conversation explores how these enhanced subsidies are impacting premiums, facilitating fraud, creating insurer windfalls, and what reforms could fix the system—especially as policymakers debate the future of these subsidies and the underlying structure of the Affordable Care Act (ACA).

Key Discussion Points & Insights

1. Background on Obamacare and Subsidy Expansion

• Obamacare (ACA) primarily restructured the individual health insurance market with new mandates, regulations, and subsidies. Its central features took effect in 2014.
• Covid-era legislation and the Inflation Reduction Act further expanded subsidies, originally intended as temporary, making government contributions reach up to (or above) 93% of some premiums. These expansions are now the subject of political debate as their expiration approaches.
• Quote:
  “The underlying subsidies continue and are still very large...The issue is, should the taxpayer be paying 93% of the premium?” — Brian Blase [06:13]

2. Premiums, Inflation, and Who Benefits

• Health insurance premiums in the individual market have increased rapidly: initial spike of 50% from 2013 to 2014, and 130% from 2014 to 2026.

  • By comparison, premiums in employer-sponsored plans increased at half this rate.

• Health insurers are lobbying heavily to continue the subsidies, as payments flow directly to their bottom line.

• Enhanced subsidies now reach households earning high incomes.

  • Quote:
    “You have some households that make three, four, even $500,000 that are now getting government subsidies.” — Brian Blase [07:40]

• Government intervention leads to a cycle: subsidies enable insurers to raise prices, much as federal student loans have driven up education costs.

  • Quote:
    “The more the federal government gets involved, you have colleges and universities, they increase the cost because they know it’s going to be covered by the government. And so insurance companies are essentially doing the same thing.” — Lisa Boothe [08:15]

3. Unintended Consequences: Fraud and “Phantom” Enrollees

• The exchange has become fertile ground for fraud, especially following the expansion of “fully subsidized” plans.

• Paragon’s research found 6.4 million more people enrolled in fully subsidized plans in 2025 than were actually eligible.

• Notable fraud schemes:

  • Outlets advertising “Free Obamacare,” enrolling people in plans without their knowledge in exchange for cash/gift cards.
  • Result: a large share of fully subsidized enrollees do not use their insurance at all.
  • Quote:
    “35% of all Obamacare enrollees didn’t use their plan a single time...40% of these fully subsidized enrollees didn’t use their plan a single time. That’s more than twice what you see in a normal health insurance market.” — Brian Blase [19:57]

• Bombshell GAO Report:
  23 out of 24 fake/test applications (missing crucial info) were approved, indicating systematic eligibility failures and vulnerability to abuse.

  • Quote:
    “GAO successfully enrolled 23 of the 24 people in exchange plans with a subsidy that covered the entire amount of the premium. Which shows systematic failures in how the exchanges are processing eligibility.” — Brian Blase [20:54]

4. Political and Policy Stalemate

• Both Republicans and Democrats now acknowledge ACA (Obamacare) failed to make health insurance more affordable.
  • Premium increases have far outpaced inflation and original promises.
• Major structural problems: regulations inflate costs, and subsidy formulas lead to taxpayer exposure to premium increases.
• Congress has struggled to enact further reforms:
  • Both parties repealed the unpopular individual mandate.
  • Trump-era reforms created alternatives outside Obamacare for small businesses and individuals.
  • Democrats’ current approach is to continue or expand insurer subsidies, not redesign the underlying system.

5. Personal Stories and Systemic Dysfunction

• Both Lisa and Brian relate personal or anecdotal experiences:
  • Lisa: as a contractor, faced high prices for modest coverage.
  • Brian: "My premium for next year is going to $33,000 with a $14,000 deductible... a family in Prescott, Arizona, their premium exceeds $50,000." [17:26]

6. Illegal Enrollment and System Loopholes

• The failure of eligibility checks means thousands—perhaps hundreds of thousands—of undocumented immigrants could be (and likely are) enrolled, many without their knowledge, picked up via fraud schemes.
• Quote:
  “The likelihood is 100% that there are illegal aliens on the exchange…probably hundreds of thousands potentially enrolled in the exchanges with subsidies, and many of them may have no idea that they're enrolled as well.” — Brian Blase [22:30]

7. What Should Be Done (According to Guest)

• End enhanced Obamacare subsidies and revert to the original (still generous) subsidy structure to force a policy debate.
• Redirect subsidies to patients—not insurers: Explore direct support to individuals via Health Savings Accounts (HSAs) or similar mechanisms.
• Increase consumer choice and innovation: Allow more options for small employers and individuals to buy coverage outside ACA’s one-size-fits-all model.
• Fundamental regulatory reforms: Adjust ACA rules and subsidies so consumers—not just insurers—have skin in the game regarding premium increases.

Memorable Quotes & Moments (with Timestamps)

• On government program names:
  “The names that they give to these programs are often not reflective of what they actually do.”
  — Brian Blase [09:30]

• On the structure of the ACA subsidies:
  “The way the subsidy structure works is that it caps the amount that enrollee has to pay for a plan. So anything above that amount is paid by the taxpayer...enrollees are held harmless from the premium increase. The taxpayer pays the entire premium increase.”
  — Brian Blase [10:27]

• On the scale of the subsidy surge:
  “For the typical enrollee next year, the government is still going to pay more than 80% of the premium.” — Brian Blase [06:04]

Segment Timestamps for Key Topics

• Introduction of Guest & Topic: [02:36–03:44]
• Obamacare’s Cost and Subsidy Expansion: [03:46–09:15]
• Premium Increases & Insurer Dynamics: [10:54–12:16]
• Congressional Inaction and Policy Alternatives: [12:16–14:21]
• Personal Experiences with the Exchanges: [16:59–18:22]
• Fraud and GAO Report: [18:46–22:09]
• Illegals on the Exchange & Fraud Loopholes: [22:09–22:56]
• What Should Be Done (Reform Proposals): [23:18–25:00]

Tone & Style

The episode maintains a critical, often incredulous tone regarding Obamacare’s structure and results, foregrounding issues of cost, inefficiency, and fraud. Both host and guest use direct, sometimes sardonic language (“It’s unconscionable.”). The focus is on real-world consequences, finger-pointing at government failure and insurer incentives, and calls for market-driven reforms.