The Majority Report with Sam Seder

Episode 3534—November 28, 2025
Main Guests:

Maureen Tkacik (Investigations Editor at The Prospect)
Dean Fuleihan (NYC Deputy Mayor-Elect), Interviewed by Gino Rady

Episode Overview

This episode dives into two major interviews. First, host Sam Seder and reporter Maureen Tkacik discuss the alarming rise of scams and abusers operating within the Affordable Care Act ("Obamacare") marketplaces, particularly in non-Medicaid expansion states like Texas and Florida, as extended subsidies are set to expire and health care costs skyrocket for millions. Second, Gino Rady sits down with incoming NYC deputy mayor Dean Fuleihan to talk about the historic win of Zohran Kwame Mamdani and the transition agenda for New York City, with special emphasis on immigrant representation and movement-driven governance.

Key Discussion Points & Insights

1. Obamacare's Boiler Room Scams and the ACA's Future

[Segment Start: 09:38]

ACA Subsidies in Jeopardy

We are weeks away from Congress's last chance to extend COVID-era enhanced ACA subsidies.
Without extension, premiums on ACA exchanges may rise up to 115%—and in some cases, up to 300% for higher-income brackets in certain states (Maureen Tkacik, 11:53).

ACA Structure Refresher

The ACA built "a supposed marketplace," but Tkacik argues, "In neoliberalism, we always have to create the illusion of markets, even where nothing resembling a market really exists." (Maureen Tkacik, 10:48)
- Three pillars: patient protections, Medicaid expansion (optional at state level), and exchanges for those not qualifying for employer or public insurance.
Subsidies originally capped at 400% of poverty line ($62k for singles, $128k for family of four as of now); COVID-era rules removed this cap and limited maximum premium to 8.5% of income.

Catastrophic Premium Increases Looming

Example: A family of four in certain high-cost states could face $4,000 monthly premiums if their income exceeds $128,000—"that’s half of the income that your family is generating." (Sam Seder, 16:09)
The subsidy cliff is "not like progressive taxation... If you make $129,000 in 19 states, your premiums are going to triple" (Maureen Tkacik, 13:40).

The Scam Economy in ACA Enrollment

Non-Medicaid-expansion states (especially Florida and Texas) aggressively purged rolls after the pandemic’s public emergency lapsed.
Predatory brokers/brokers’ street teams—like those from the Fiorella Insurance Agency, acquired by a major private equity firm—exploited the newly uninsured.
- "They were going to bus stops, homeless shelters, and motels and basically bribing people with booze and gift cards to sign up for their Obamacare plans." (Maureen Tkacik, 22:38)
- Sometimes coaching applicants to falsify proof of income to get ACA plans (which paid brokers $30/mo per enrollee).
- "Some of these people had commercial insurance policies and were finding out that they were enrolled in the ACA... CMS actually had last year, 200,000 complaints about this very type of fraud." (Maureen Tkacik, 25:22)

Shifting Demographics and Perverse Incentives

ACA signups have more than doubled since 2020, clustering heavily in TX, FL, and GA—states that didn't expand Medicaid.
Median premiums, especially among lower-income and newly enrolled minorities (especially Latinos), have plummeted (from ~$65 to ~$20 in some brackets).
- Zero-premium plans are easy bait for scams, and recipients often don't know they’ve been enrolled until coverage is needed.

The Private Insurance/Mega-Corp Angle

Companies like Centene (a Medicaid/ACA giant) are profiting handsomely as enrollment swells—"Their stock is up today on the idea that Trump might extend these subsidies. They're up 6%." (Maureen Tkacik, 27:42)
Government now pays significantly more, via subsidies for private insurance, than Canada does for its public system:
- "In 2025, American taxpayers paid $11,352 per person per year to subsidize the private insurance policies of Vermont ACA enrollees, who themselves pay an additional $11,000... In Canada, citizens pay $9,100 per person per year to fund their whole entire national health system." (Sam Seder quoting Mo Tkacik's piece, 35:15)

Systemic Problems and Policy Paralysis

Maureen: “The system is asinine. We knew it when it passed... It was completely predictable... there are so many different ways that the big companies have milked Obamacare's loopholes and its fine print to just make extraordinary sums, but your average physician hates it, is making less money, is seeing more patients.” (36:53)
Sam: “[Pelosi] would not allow an expansion of Medicare... and instead, they subsidized COBRA for people who had lost their jobs, which is literally the most expensive version of health insurance until now... So if I’m receiving it, it’s great, it’s free. But in terms of the efficiency of government, it was the least possible efficient way to do this.” (39:53)
Both agree the only solution is direct public coverage: "Expand Medicare, expand Medicaid... outlaw Medicare Advantage." (Sam and Maureen, 41:51-42:19)

Notable Quotes

"When you allow an insurance company to pay commissions to brokers... you allow the insurance companies to provide all these incentives—gift cards, free groceries, booze, and probably drugs—that's... going to create perverse incentives." — Maureen Tkacik [33:00]
"All of this sort of like rent seeking and that runs from rent seeking to fraud with this industry... we are now looking as this system is getting super, super creaky." — Sam Seder [35:15]

2. Interview: Dean Fuleihan, NYC Deputy Mayor-Elect (with Gino Rady)

[Segment Start: 43:17]

Representation & Immigrant Experience

Gino Rady asks about inspiring young Arabs/Lebanese to serve. Fuleihan emphasizes the Mandani campaign's message of inclusion—"representing all the communities in New York City, the communities that have not... felt left out. It speaks to... the Lebanese community, the Arab community, the Muslim community, but it also speaks to all New Yorkers." (Dean Fuleihan, 44:25)
Fuleihan shares personal experience: "It's not a natural thing for... It's not always a natural [fit for immigrants to serve], but it's important." (46:55)

Transition Period—Building a Movement Government

Outlines the vast scale: 370,000 city employees.
The "transition" period runs from election day to January 1. During this time, "We need that same excitement, that same energy" as the campaign. (48:44)
50,000 resumes received for city posts (50:00).

On Food and Culture

Conversation blends in cultural references—the importance of Lebanese food, family, and identity. (50:21-51:15)

NYC Budget Priorities

The city budget is $118 billion. Fuleihan: "The budget is the document that says, here are the priorities... It says, these are the principles we stand for. It is the policy document of this administration." (51:38)
Affordability, housing, and public services will be reflected in the first budget rollout.

Delivering Real Change & "Is It Possible?"

"Everywhere you go, someone is going to tell you it can't be done... That can't be the understanding. The understanding is that he [Zohran Mamdani] ran on an agenda that said: you're going to see change and you're going to see it immediately." (Dean Fuleihan, 54:06)
Offers past NYC example: universal Pre-K for 4-year-olds, achieved in two years despite skepticism. (55:41)

The First Deputy Mayor’s Role

Operational chief—ensuring day-to-day NYC functions, structuring city hall to deliver policy, responding to crises, and collaborating across government levels.
Willingness to adapt: "It's a good foundation, but... this is a different mayor for a different time; with different challenges and different opportunities." (Dean Fuleihan, 58:24)

Gauging Success: Affordability & Hope

Gino asks: “A year from now, what’s the one thing New Yorkers should feel different about?”
- Fuleihan: “You see in a practical way a change in affordability... you feel that sense of hope... and you actually, it's a requirement that you feel that.” (63:33)
- Practical markers: childcare, transit, rent relief.

Addressing the Naysayers

For skeptics at a Thanksgiving table: “Judge us, of course, but we're going to show you that we can improve the lives of New Yorkers. And what part of that agenda seems inappropriate? Child care? Universal child care? … The argument keeps coming back, 'Oh, you can't afford it.' ... Show me the data.” (65:40-66:41)
He emphasizes the campaign's approach: breaking down complicated policies for people leads to broad support once truly explained.

Notable Quotes & Moments

"We want people to stay involved. We've received 50,000 resumes." — Dean Fuleihan [50:00]
"What part of that agenda is wrong? ... It's hard to imagine... what is the argument? The argument keeps coming back, 'Oh, you can't afford it.' ... Show me the numbers." — Dean Fuleihan [66:41]
Cultural interlude: Kibbeh recipes and tabbouleh—“I made sure before leaving Lebanon that I made my great aunt teach me our, like, recipes.” — Dean Fuleihan [50:45]
"It's about the hope—you're going to see it immediately and you're going to see it in that budget." — Dean Fuleihan [54:06]

Timestamps for Major Segments

[09:38] Start of ACA discussion with Maureen Tkacik
[13:40] Subsidy cliff explanation: 300% premium spike
[22:38] Details of ACA enrollment scams ("boiler room" tactics)
[27:42] Centene profits and enrollment boom in non-expansion states
[35:15] Comparing US vs Canadian government health care spending
[41:51] Policy solutions & need to expand public insurance
[43:17] Start of Dean Fuleihan/Gino Rady interview
[48:44] NYC transition period & movement energy
[51:38] What NYC's budget says about city priorities
[54:06] Commitment to rapid, tangible change
[63:33] One-year-on: Affordability as a test of success
[65:40] Talking to naysayers about "impossible" promises

Memorable Moments

Maureen’s takedown of ACA’s reliance on “illusion of markets” (10:48)
Sam’s analogy of the US subsidizing COBRA as “the least possible efficient way to do this” (39:53)
Dean’s cultural warmth—food, family, and immigrant solidarity (throughout the Rady interview)
The ambitious tone: “The understanding is that you’re going to see change and you’re going to see it immediately and you’re going to see it in that budget." (Dean Fuleihan, 54:06)

Takeaways

The ACA faces a looming crisis, with enhanced subsidies expiring and a flourishing economy of fraud stemming from systemic incentives.
Massive government spending subsidizes private profits, to the public’s detriment; genuine reform means direct public provision.
In NYC, the incoming administration promises urgency, inclusion, and big-tent affordability reforms with a grassroots energy—while acknowledging skepticism and complexity, the leadership team is determined to deliver tangible progress.

For more details on these discussions, check out the linked piece by Maureen Tkacik at The American Prospect and Gino Rady’s blog on Substack.

The Majority Report with Sam Seder

Episode 3534—November 28, 2025
Main Guests:

Maureen Tkacik (Investigations Editor at The Prospect)
Dean Fuleihan (NYC Deputy Mayor-Elect), Interviewed by Gino Rady

Episode Overview

Key Discussion Points & Insights

1. Obamacare's Boiler Room Scams and the ACA's Future

[Segment Start: 09:38]

ACA Subsidies in Jeopardy

We are weeks away from Congress's last chance to extend COVID-era enhanced ACA subsidies.
Without extension, premiums on ACA exchanges may rise up to 115%—and in some cases, up to 300% for higher-income brackets in certain states (Maureen Tkacik, 11:53).

ACA Structure Refresher

The ACA built "a supposed marketplace," but Tkacik argues, "In neoliberalism, we always have to create the illusion of markets, even where nothing resembling a market really exists." (Maureen Tkacik, 10:48)
- Three pillars: patient protections, Medicaid expansion (optional at state level), and exchanges for those not qualifying for employer or public insurance.
Subsidies originally capped at 400% of poverty line ($62k for singles, $128k for family of four as of now); COVID-era rules removed this cap and limited maximum premium to 8.5% of income.

Catastrophic Premium Increases Looming

Example: A family of four in certain high-cost states could face $4,000 monthly premiums if their income exceeds $128,000—"that’s half of the income that your family is generating." (Sam Seder, 16:09)
The subsidy cliff is "not like progressive taxation... If you make $129,000 in 19 states, your premiums are going to triple" (Maureen Tkacik, 13:40).

The Scam Economy in ACA Enrollment

Non-Medicaid-expansion states (especially Florida and Texas) aggressively purged rolls after the pandemic’s public emergency lapsed.
Predatory brokers/brokers’ street teams—like those from the Fiorella Insurance Agency, acquired by a major private equity firm—exploited the newly uninsured.
- "They were going to bus stops, homeless shelters, and motels and basically bribing people with booze and gift cards to sign up for their Obamacare plans." (Maureen Tkacik, 22:38)
- Sometimes coaching applicants to falsify proof of income to get ACA plans (which paid brokers $30/mo per enrollee).
- "Some of these people had commercial insurance policies and were finding out that they were enrolled in the ACA... CMS actually had last year, 200,000 complaints about this very type of fraud." (Maureen Tkacik, 25:22)

Shifting Demographics and Perverse Incentives

ACA signups have more than doubled since 2020, clustering heavily in TX, FL, and GA—states that didn't expand Medicaid.
Median premiums, especially among lower-income and newly enrolled minorities (especially Latinos), have plummeted (from ~$65 to ~$20 in some brackets).
- Zero-premium plans are easy bait for scams, and recipients often don't know they’ve been enrolled until coverage is needed.

The Private Insurance/Mega-Corp Angle

Companies like Centene (a Medicaid/ACA giant) are profiting handsomely as enrollment swells—"Their stock is up today on the idea that Trump might extend these subsidies. They're up 6%." (Maureen Tkacik, 27:42)
Government now pays significantly more, via subsidies for private insurance, than Canada does for its public system:
- "In 2025, American taxpayers paid $11,352 per person per year to subsidize the private insurance policies of Vermont ACA enrollees, who themselves pay an additional $11,000... In Canada, citizens pay $9,100 per person per year to fund their whole entire national health system." (Sam Seder quoting Mo Tkacik's piece, 35:15)

Systemic Problems and Policy Paralysis

Maureen: “The system is asinine. We knew it when it passed... It was completely predictable... there are so many different ways that the big companies have milked Obamacare's loopholes and its fine print to just make extraordinary sums, but your average physician hates it, is making less money, is seeing more patients.” (36:53)
Sam: “[Pelosi] would not allow an expansion of Medicare... and instead, they subsidized COBRA for people who had lost their jobs, which is literally the most expensive version of health insurance until now... So if I’m receiving it, it’s great, it’s free. But in terms of the efficiency of government, it was the least possible efficient way to do this.” (39:53)
Both agree the only solution is direct public coverage: "Expand Medicare, expand Medicaid... outlaw Medicare Advantage." (Sam and Maureen, 41:51-42:19)

Notable Quotes

"When you allow an insurance company to pay commissions to brokers... you allow the insurance companies to provide all these incentives—gift cards, free groceries, booze, and probably drugs—that's... going to create perverse incentives." — Maureen Tkacik [33:00]
"All of this sort of like rent seeking and that runs from rent seeking to fraud with this industry... we are now looking as this system is getting super, super creaky." — Sam Seder [35:15]

2. Interview: Dean Fuleihan, NYC Deputy Mayor-Elect (with Gino Rady)

[Segment Start: 43:17]

Representation & Immigrant Experience

Gino Rady asks about inspiring young Arabs/Lebanese to serve. Fuleihan emphasizes the Mandani campaign's message of inclusion—"representing all the communities in New York City, the communities that have not... felt left out. It speaks to... the Lebanese community, the Arab community, the Muslim community, but it also speaks to all New Yorkers." (Dean Fuleihan, 44:25)
Fuleihan shares personal experience: "It's not a natural thing for... It's not always a natural [fit for immigrants to serve], but it's important." (46:55)

Transition Period—Building a Movement Government

Outlines the vast scale: 370,000 city employees.
The "transition" period runs from election day to January 1. During this time, "We need that same excitement, that same energy" as the campaign. (48:44)
50,000 resumes received for city posts (50:00).

On Food and Culture

Conversation blends in cultural references—the importance of Lebanese food, family, and identity. (50:21-51:15)

NYC Budget Priorities

The city budget is $118 billion. Fuleihan: "The budget is the document that says, here are the priorities... It says, these are the principles we stand for. It is the policy document of this administration." (51:38)
Affordability, housing, and public services will be reflected in the first budget rollout.

Delivering Real Change & "Is It Possible?"

"Everywhere you go, someone is going to tell you it can't be done... That can't be the understanding. The understanding is that he [Zohran Mamdani] ran on an agenda that said: you're going to see change and you're going to see it immediately." (Dean Fuleihan, 54:06)
Offers past NYC example: universal Pre-K for 4-year-olds, achieved in two years despite skepticism. (55:41)

The First Deputy Mayor’s Role

Operational chief—ensuring day-to-day NYC functions, structuring city hall to deliver policy, responding to crises, and collaborating across government levels.
Willingness to adapt: "It's a good foundation, but... this is a different mayor for a different time; with different challenges and different opportunities." (Dean Fuleihan, 58:24)

Gauging Success: Affordability & Hope

Gino asks: “A year from now, what’s the one thing New Yorkers should feel different about?”
- Fuleihan: “You see in a practical way a change in affordability... you feel that sense of hope... and you actually, it's a requirement that you feel that.” (63:33)
- Practical markers: childcare, transit, rent relief.

Addressing the Naysayers

For skeptics at a Thanksgiving table: “Judge us, of course, but we're going to show you that we can improve the lives of New Yorkers. And what part of that agenda seems inappropriate? Child care? Universal child care? … The argument keeps coming back, 'Oh, you can't afford it.' ... Show me the data.” (65:40-66:41)
He emphasizes the campaign's approach: breaking down complicated policies for people leads to broad support once truly explained.

Notable Quotes & Moments

"We want people to stay involved. We've received 50,000 resumes." — Dean Fuleihan [50:00]
"What part of that agenda is wrong? ... It's hard to imagine... what is the argument? The argument keeps coming back, 'Oh, you can't afford it.' ... Show me the numbers." — Dean Fuleihan [66:41]
Cultural interlude: Kibbeh recipes and tabbouleh—“I made sure before leaving Lebanon that I made my great aunt teach me our, like, recipes.” — Dean Fuleihan [50:45]
"It's about the hope—you're going to see it immediately and you're going to see it in that budget." — Dean Fuleihan [54:06]

Timestamps for Major Segments

[09:38] Start of ACA discussion with Maureen Tkacik
[13:40] Subsidy cliff explanation: 300% premium spike
[22:38] Details of ACA enrollment scams ("boiler room" tactics)
[27:42] Centene profits and enrollment boom in non-expansion states
[35:15] Comparing US vs Canadian government health care spending
[41:51] Policy solutions & need to expand public insurance
[43:17] Start of Dean Fuleihan/Gino Rady interview
[48:44] NYC transition period & movement energy
[51:38] What NYC's budget says about city priorities
[54:06] Commitment to rapid, tangible change
[63:33] One-year-on: Affordability as a test of success
[65:40] Talking to naysayers about "impossible" promises

Memorable Moments

Maureen’s takedown of ACA’s reliance on “illusion of markets” (10:48)
Sam’s analogy of the US subsidizing COBRA as “the least possible efficient way to do this” (39:53)
Dean’s cultural warmth—food, family, and immigrant solidarity (throughout the Rady interview)
The ambitious tone: “The understanding is that you’re going to see change and you’re going to see it immediately and you’re going to see it in that budget." (Dean Fuleihan, 54:06)

Takeaways

The ACA faces a looming crisis, with enhanced subsidies expiring and a flourishing economy of fraud stemming from systemic incentives.
Massive government spending subsidizes private profits, to the public’s detriment; genuine reform means direct public provision.
In NYC, the incoming administration promises urgency, inclusion, and big-tent affordability reforms with a grassroots energy—while acknowledging skepticism and complexity, the leadership team is determined to deliver tangible progress.

For more details on these discussions, check out the linked piece by Maureen Tkacik at The American Prospect and Gino Rady’s blog on Substack.

3534 - The Obamacare Boiler Room; Zohran's Deputy Mayor w/ Maureen Tkacik, Dean Fuleihan

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Summary

The Majority Report with Sam Seder

Episode Overview

Key Discussion Points & Insights

1. Obamacare's Boiler Room Scams and the ACA's Future

ACA Subsidies in Jeopardy

ACA Structure Refresher

Catastrophic Premium Increases Looming

The Scam Economy in ACA Enrollment

Shifting Demographics and Perverse Incentives

The Private Insurance/Mega-Corp Angle

Systemic Problems and Policy Paralysis

Notable Quotes

2. Interview: Dean Fuleihan, NYC Deputy Mayor-Elect (with Gino Rady)

Representation & Immigrant Experience

Transition Period—Building a Movement Government

On Food and Culture

NYC Budget Priorities

Delivering Real Change & "Is It Possible?"

The First Deputy Mayor’s Role

Gauging Success: Affordability & Hope

Addressing the Naysayers

Notable Quotes & Moments

Timestamps for Major Segments

Memorable Moments

Takeaways

Summary

The Majority Report with Sam Seder

Episode Overview

Key Discussion Points & Insights

1. Obamacare's Boiler Room Scams and the ACA's Future

ACA Subsidies in Jeopardy

ACA Structure Refresher

Catastrophic Premium Increases Looming

The Scam Economy in ACA Enrollment

Shifting Demographics and Perverse Incentives

The Private Insurance/Mega-Corp Angle

Systemic Problems and Policy Paralysis

Notable Quotes

2. Interview: Dean Fuleihan, NYC Deputy Mayor-Elect (with Gino Rady)

Representation & Immigrant Experience

Transition Period—Building a Movement Government

On Food and Culture

NYC Budget Priorities

Delivering Real Change & "Is It Possible?"

The First Deputy Mayor’s Role

Gauging Success: Affordability & Hope

Addressing the Naysayers

Notable Quotes & Moments

Timestamps for Major Segments

Memorable Moments

Takeaways