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

Summary

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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).

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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.

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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]

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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]

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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.

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Transcript

[A]

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[A]

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[C]

Welcome to the Truth with Lisa Booth where we get to the heart of the issues that matter to you today. We're diving into the real cost of Obamacare with one of its sharpest critics, Brian Blaze. He's a former Trump White House health policy advisor and president of Paragon Health Institute. We're talking skyrocketing premiums, billions in fraud, phantom enrollees and massive insurer windfalls. Also, a brand new GAO bombshell showing fake applications were approved at a 96% rate. Brian just testified before Congress we're going to get him on those enhanced Obamacare premiums. Why are costs going up? And also what reforms could actually fix this mess that President Trump could do and the Trump administration can do. Brian Blaze coming up next. Stay with us.

Well, Brian, it's great to have you on the show. I've been wanting to have you on since Senator Johnson name dropped you with the beefed up Obamacare premium fight. So been wanting to have you on and talk about this issue. So appreciate you making time.

[E]

I'm happy to be on. Thanks so much for having me.

[C]

You'll appreciate. Years ago, I actually debated Jonathan Gruber on FOX News about Obamacare. So that was, that was interesting. But my, my, my objective was I just like made him really angry at first and then he like lost his mind and looked like a crazy person. But so it worked. But. All right. Well, let's talk about the state of Obamacare and healthcare right now. Like, first of all, I mean, Democrats obviously just shut down the government for the longest shutdown in history so far over these enhanced Obamacare premiums that were always supposed to be temporary. They were approved under the Inflation Reduction act, which we all know was actually a climate bill. Like had nothing to do with reducing inflation. In fact, added to inflation made it worse. But they were always supposed to be temporary. And now they're telling us that if we don't extend them, then premiums are going to drive up for a lot of Americans across the country. Like, what happened? What do these do? And is that true?

[E]

Yeah. So to take a step back, Obamacare primarily affected the individual market for health insurance, which is where people go that don't have an employer plan and aren't enrolled in Medicare or Medicaid. It's key regulations, mandates, price controls took effect in 2014. They significantly drove up premiums in the individual market. Obamacare included two other provisions to stabilize that market. Large subsidies for people to afford the coverage that the government regulations had made more expensive and the individual mandate tax penalty, which assessed a fine on individuals that didn't buy the required coverage. Now, the tax penalty was completely ineffective. It didn't bring people into the market. Unfortunately, Congress eliminated that tax penalty and it had very little effect. 2020, really, from 2015 to 2020, it was a pretty low performing market. Enrollment was way below expectations. In 2021, as you mentioned, the Democrats used the budget reconciliation process without any Republican support to expand upon the original Obamacare subsidies. They then extended them in the inflation Reduction act and set them after 2025. Now premiums are going up next year. Premiums are going up because of underlying problems with Obamacare, not because of the enhanced subsidies expiring. The enhanced subsidies expiring affect the amount that the enrollee pays versus the amount that the taxpayer pays. I think the first essential point for everyone to know is that the underlying subsidies continue and are still very large. So for the typical enrolle next year, the government is still going to pay more than 80% of the premium. The issue is, should the taxpayer be paying 93% of the premium? Because that's it. The enhanced subsidies continue. The taxpayer is paying virtually all the premium. And for about half of enrollees because of these Covid era enhanced subsidies, they're paying zero. And what that has done is create a climate where fraud and abuse have been able to flourish in the exchanges.

[C]

Well, and also for the enhanced Obamacare, as you mentioned, this was a Covid era thing that happened, which is why it was supposed to be temporary. But it's also not for lower income people. I mean, the enhanced premiums impacted higher income earners as well, correct?

[E]

That's right. Original Obamacare subsidies limited the government financial assistance to people with income less than four times the poverty line. The COVID credits lifted that cap. So you have some households that make three, four, even $500,000 that are now getting government subsidies. And I should say one other thing about these government subsidies. They are direct payments from the US treasury to health insurance companies, which is why health insurance companies, you know, they're spending more money this year than they ever have. Lobbying to try to get these handouts from the federal government continued.

[C]

Basically, it's the same thing we see with student loans, that 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.

[E]

I would enc. Exactly right. I would encourage your listeners to Google chart of the century. It's put out by the American Enterprise Institute. And from from 2000 to present day, it shows price increases by major sectors of the economy. And the prices that have increased the most are health Care and the prices that have increased. The second most are education. Hospital prices have increased three times faster than inflation since 2000. It really is bad government policy that is both inflating demand and restricting supply and has led to, you know, health care in the US becoming increasingly unaffordable.

[C]

Do you find it ironic that something is called the Affordable Care act.

But is not affordable? And we know it's not affordable because the government has to subsidize it up to 80%, which is what you had previously said.

[E]

Yeah, I mean, and the Inflation Reduction act increased inflation as well. So I mean, the, the name that they give to these program are often not reflective of what they actually do. And it is now it's agreed, Republicans and Democrats agree that the Affordable Care act did not make health insurance more affordable. Like if you go back to President Obama's original promise that they would reduce, that Obamacare would reduce premiums by $2,500 per family, like that's patently untrue. Premiums have escalated and you cannot have a system. The regulations in Obamacare are inflationary. They put upward pressure on, on prices and premiums for the vast majority of Americans. The subsidy structure is also independent of the regulations. It's inflationary. 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. So as premiums go up over time, enrollees are held harmless from the premium increase. The taxpayer pays the entire premium increase. And what that does is give insurers enormous pricing power. And because they know that the enrollee is insensitive to the price increase that it's all going to be paid by, you know that. So it has led to independent of the regulations and inflationary aspect of Obamacare.

[C]

I mean, just how much has Obamacare.

[E]

Increased premiums from 2013 to 2014, the initial increase was about 50%. From 2014 to 2026, premiums have gone up almost 130%. And to put that in comparison to employer plan premiums, since 2014, Obamacare plan premiums have increased about twice as fast as employer plan premiums.

[C]

Was the whole point of Obamacare to move us closer to a single payer system?

[E]

I mean, I think they, they wanted to expand health insurance coverage. They did that primarily through a dramatic expansion of the Medicaid program, which has its own set of problem. And they were hoping to create a robust individual market centered on this new regulatory regime. The individual mandate to bring people in and subsidies to help lower Income people have coverage be more affordable. I don't think that they were intending, the authors were intending on moving to a single payer system. I think, though, that their central planning has utterly failed. And the reality is that they have moved this more to a central single payer system because of how poorly Obamacare has borne out in reality.

[C]

Why hasn't Congress fixed it then? You know, you had mentioned that both Democrats and Republicans acknowledged that things aren't working, that costs have been driven up. So why haven't they done anything about it? Is it the complexity, the lack of being able to work together, all of it? You know, what's behind that?

[E]

So it's a great question and I don't have a perfect answer for this. I would say that some aspects of Obamacare have been repealed and probably aspects that made the whole thing less popular have been repealed. So the individual mandate, like I mentioned, that was repealed in 2017 during President Trump's first term when Republicans were in control of both chambers of Congress. And repealing the individual mandate did take pressure, political pressure, off of the overall program because you were then freeing, you know, 10 million people from having to pay government penalties for not purchasing the coverage. And the Trump administration also, and I was involved with this, we opened up alternatives to Obamacare. So if the coverage was really unaffordable for individuals, we there were ways for small businesses and individuals to purchase coverage outside of Obamacare. I think the Democrats just haven't grappled with the reality of the law. And rather than looking to reform the program and address some of the key structural flaws, they decided to just increase the subsidies that go directly to insurance companies. And you see that their reform preference now is just to continue the underlying subsidies to health insurance companies that they boosted in Covid without any reforms. They're not talking about a single actual structural reform to the law, just increasing subsidies to health insurance companies. My hope from what happens is that Congress allows the enhanced subsidies to expire and that forces a rational conversation about the flaws in Obamacare and a way to improve both the regulatory structure and the subsidy structure.

[C]

Gotta take a quick commercial break. More with Brian on the other side.

[B]

Ten athletes will face the toughest job interview in fitness that will push past physical and mental breaking points.

You are the fittest of the fit. Only one of you will leave here with an IFIT contract for $250,000.

[A]

This is where mindset comes in.

[B]

Someone will be eliminated.

[C]

Pressure is coming down.

[B]

This is Trainer Games.

[D]

Watch it on prime video starting January 8th.

[B]

Then the space hamster flew his hot air balloon all the way to the.

[A]

Bottom of the ocean.

[B]

Where did that story come from? Book Dream? Nope. It came from a conversation. Meet Mikomini, the AI companion that co creates personalized story adventures with your child in real time. What color was the hamster's cape and what did he pack for lunch? Unlock your child's imagination. Discover Miko Mini plus and the Magic of AI Exclusively at Costco. Come for the Black Friday seasonal savings Stay for the award winning Reporting for a limited time access to the Washington Post is just 99 cents. That's unlimited access to all of the posts for only 99 cents every four weeks. That's a great deal for the first year. After that it'll cost $12 every four weeks. You can cancel anytime. But don't wait. This Black Friday seasonal offer won't be here for long. Go to washingtonpost.com iheart and grab this deal before it's gone. That's washingtonpost.com iheart.com bring incredible sound into.

[D]

Every corner of your home this holiday with the new Whimsound Smart speaker. Get high resolution Audio with a 1.8-inch touchscreen, smart control and modern design in one powerful speaker for just $299. From Quiet Mornings to lively holiday gatherings, Wim Sound makes every moment sound better and feel better too. Get the gift of the season for the music enthusiast in your life or for yourself. Whim Sound Beautifully designed, effortlessly connected. Shop now at Amazon and search Whim Sound. That's wiimsound.

[A]

Hear that? It's the sound of truly immersive audio thanks to Vizio's new 4.1 soundbar and it's now available at Walmart. Powered by Dolby Atmos and DTS X Experience rich cinematic sound with two wireless surround speakers and a compact wireless subwoofer that puts you in the center of your entertainment, all without the clutter of cables. Stream your favorite music radio and podcasts with the iHeartRadio app and trust us, your music has never sounded this good. Head to Walmart.com and upgrade your sound game today.

[C]

You know, I've had to deal with this for a long time because even though I'm employed, I'm a contractor, more or less, and so I've had to, you know, get health insurance on the exchange. You pay a lot, you don't get a lot. It's very frustrating.

And then at one point I rolled the dice when I was younger with not having insurance and then you had the penalty. But my understanding is it never really had teeth. And then obviously it was repealed. But so I've kind of been subject to all of this, unfortunately.

[E]

So I've actually Paragon offers something called an individual coverage health reimbursement arrangement, which was an option opened by the Trump administration. And you take that to buy a Obamacare compliant plan in the individual market. So I've had Obamacare coverage myself for four years. And, you know, we just got noticed that our premium for next year is going to $33,000 with a $14,000 deductible. I is a sign that a program is totally off the rails and in need of reform. You know, I also highlighted in my testimony of a family of five in Prescott, Arizona, where their premium next year exceeds $50,000. I mean, that is just on. It's unconscionable. We can't, we can't, we can't just continue to throw more good money after bad that has led to a program that has produced such high premiums for coverage.

[C]

Yeah, I know I need to look and select my plan for next year and I'm like, afraid to do it. I've been so busy traveling. I keep putting it off, but I'm afraid to look. I feel like it's not going to be pretty. You know, talk about. You had mentioned the fraud before. Walk us through the fraud. And then I know there was also a new GAA report report as well. So walk us through the fraud that we have seen.

[E]

Sure. So I'll start with Paragon's research on this. We dug into the improper enrollment back in the summer of 2024, and what we looked at is the number of enrollees signing up, claiming income in a, in a narrow band that qualifies for a fully subsidized plan with the actual number of people in a state that would be eligible for that plan. And we found in 2024, there were 5 million more people enrolled in a fully subsidized plan than were eligible. And in 2025, that increased to 6.4 million people. The second, a lot of these, there's been good news articles that have really gone through these fraud schemes. And you may have seen, you drive around, you see these signs, Free Obamacare. Call this number.

There were also social media campaigns where they advertise cash or gift cards. If you call the number, people would call this number and they would ask for a gift card or cash and they would get signed up into health insurance instead. So a lot of these people that were signed up for health insurance had no idea that they were being enrolled. And One of the things you would expect is if you're signing up a lot of people who don't know they're enrolled is that they're not going to use their health insurance plan. So in August, CMS put out data on people that didn't use the plan a single time, and they put it out from 2019 to 2024. And what it revealed is that in 2024, 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 and what you saw in Obamacare before.

The enhanced subsidies. GAO came out with this bombshell report yesterday where they created fictitious applications. They created, over the course of the late 2024 through early 2025, 24 fake applications. And so they were missing Social Security information, wage information, all this information that in order to get. That you're supposed to need in order to get coverage. And Gao successfully enrolled 23 of the 24 people in exchange plans with a subsidy that covered the entire amount of the premium. So. Which shows systematic failures in how the exchanges are processing eligibility and really just shows the ease with which bad actors have been able to manipulate applications, sign people up again, they sign people up. The payments go directly from the treasury to the health insurance company. So the insurance companies are reaping windfalls, and then these unscrupulous agents and brokers get a monthly commission for every month that the individual is enrolled. So, unfortunately, you know, because of bad policy, really negligent Biden administration oversight, the exchanges have just become a cesspool for fraud and abuse.

[C]

Okay, so Gao, if 23 out of 24 fictitious applications were approved, Joe Biden just let in millions of illegal aliens into the country on top of the millions more that were already here. What is the likelihood, or what do we know about illegal aliens being able to get on the exchange?

[E]

Well, I mean, I would say the likelihood is 100% that there are illegal aliens on the exchange. I mean, the precise number, I'm not sure of that. Like, you know, if I would guess, I would say probably hundreds, hundreds of thousands potentially enrolled in the exchanges with subsidies, and many of them may have no idea that they're enrolled as well. They were just picked off in these fraud schemes.

[C]

Before we go, what should Republicans do? Like, how do we. You know, it's often very difficult to put the genie back in the bottle once these government programs we have a history as a country of once these programs get created, it's very hard to claw them back. But what is your hope for health care? What could Republicans do that would actually drive down costs for Americans?

[E]

So the first thing I would recommend is to allow these enhanced subsidies to health insurance companies to expire. I then think you could look at three different sets of policies. One is how can we redirect subsidies away from insurers and funding the system to funding the patient instead? And there are proposals out there that would redirect some of these subsidies away from the system and to the patient. Because what we want is a health sector that's more responsive to the patient. Paragon put out a proposal called the HSA option three and a half years ago that is a practical policy for how we could start moving subsidies away from insurers and to individuals. I think second, people need to have more control over their healthcare dollars. They need more options for the types of coverage to purchase. And we need more innovation on the financing side rather than sort of one size fits all comprehensive insurance plans. So more options for small employers and for individuals to purchase coverage. And I gave testimony before the Senate Finance Committee two weeks ago where I lay out several, several options like this. And then third, I think Obamacare needs within it fundamental reforms. There are regulations that push up premiums and the subsidy design, like I mentioned, is inflationary. There should be a way to redesign the subsidy structure so that we have enrollees sensitive to the premium changes over time. And don't put the entire amount of responsibility on the federal taxpayer when premiums go up.

[C]

Brian, thank you so much for coming on the show. Really appreciate it it.

[E]

Thank you very much.

[C]

That was Brian Blaze. Appreciate him for making time to come on the show. Appreciate you guys at home for listening every Tuesday and Thursday, but you can listen throughout the week. Also want to thank my producer John Casio for putting the show together. Until next time.

[B]

10 athletes will face the toughest job interview in fitness that will push past physical and mental breaking points.

You are the fittest of the fit. Only one of you will leave here with an IFIT contract for $250,000.

[A]

This is where mindset comes in.

[B]

Someone will be eliminated.

[C]

Pressure is coming down.

[B]

This is trainer games.

[D]

Watch it on prime video starting January 8th.

[B]

Then the space hamster flew his hot air balloon all the way to the.

[A]

Bottom of the ocean.

[B]

Where did that story come from? Book dream? Nope. It came from a conversation. Meet Mikomini, the AI companion that co creates personalized story adventures with your child in real time. What color was the hamster's cape and what did he pack for lunch? Unlock your child's imagination. Discover Miko Mini plus and the Magic of AI Exclusively at Costco. Come for the Black Friday seasonal savings. Stay for the award winning Reporting for a limited time access to the Washington Post is just 99 cents. That's unlimited access to all of the posts for only 99 cents every four weeks. That's a great deal for the first year. After that it'll cost $12 every four weeks. You can cancel anytime, but don't wait. This Black Friday seasonal offer won't be here for long. Go to washingtonpost.com iheart and grab this deal before it's gone. That's washingtonpost.com iheartra bring incredible sound into.

[D]

Every corner of your home this holiday with the new Whim Sound Smart speaker. Get high resolution Audio with a 1.8-inch touchscreen, smart control and modern design in one powerful speaker for just $299. From Quiet Mornings to lively holiday gatherings, Wii Sound makes every moment sound better and feel better too. Get the gift of the season for the music enthusiast in your life or for yourself. Whim Sound Beautifully designed, effortlessly connected. Shop now at Amazon and search whimsound. That's wiimsound.

[A]

Hear that? It's the sound of truly immersive audio thanks to Vizio's new 4.1 soundbar and it's now available at Walmart. Powered by Dolby Atmos and DTS X. Experience rich cinematic sound with two wireless surround speakers and a compact wireless subwoofer that puts you in the center of your entertainment, all without the clutter of cables. Stream your favorite music radio and podcasts with the iHeartRadio app app and trust us, your music has never sounded this Good. Head to Walmart.com and upgrade your sound game today. This is an iHeart podcast. Guaranteed Human.