December 5, 2025 • 20 mins
In this episode, Lisa welcomes Brian Blase, President of Paragon Health Institute, to break down the evolving state of Obamacare and what enhanced subsidies mean for the future of healthcare in the United States. The conversation explores the growing irony of the Affordable Care Act, the difficulty of reforming an increasingly complex system, and the rising concerns around fraud, abuse, and government-driven cost inflation. Blase examines why premiums remain high, how subsidies distort the market, and what real solutions could rein in spending while improving patient care. The Truth with Lisa Boothe is part of the Clay Travis & Buck Sexton Podcast Network.
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Episode Transcript
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Speaker 1 (00:00):
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
(00:21):
massive insurer windfalls. Also a brand new GAO bombshell showing
fake applications were approved at a ninety six percent rate.
Brian just testified before Congress. We're going to get him
on those enhanced Obamacare premiums. Why are costs going up?
Speaker 2 (00:39):
And also what.
Speaker 1 (00:40):
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.
Speaker 2 (00:54):
Well, Brian, it's great to have you on the show.
Speaker 3 (00:56):
I've been wanting to have you on since Senator Johnson
a name drop you with the beefed up Obamacare premium fight,
So been wanting to have you on and talk about
this issue.
Speaker 2 (01:06):
So appreciate you making time.
Speaker 4 (01:08):
I'm happy to be on. Thanks so much for having me.
Speaker 2 (01:10):
You'll appreciate years ago.
Speaker 3 (01:12):
I actually debated Jonathan Gruber on Box News about Obamacare,
So that was that was interesting. But my objective was
I just like made him really angry at first, and
then he lost his mind and looked like a crazy person.
Speaker 2 (01:27):
But so it worked.
Speaker 3 (01:29):
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
(01:50):
actually a climate bill.
Speaker 1 (01:51):
I had thing to do with reducing inflation. In fact,
added to inflation made it worse.
Speaker 3 (01:56):
But they're 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.
Speaker 2 (02:07):
Like what happened? What do these do? And is that true?
Speaker 4 (02:10):
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 twenty fourteen. They significantly drove up premiums
(02:33):
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
(02:54):
penalty was completely ineffective. It didn't bring people into the market. Unfortunately,
Congress eliminated that tax penalty, and it had very little
effect twenty twenty. Really, from twenty fifteen to twenty twenty,
it was a pretty low performing market. Enrollment was way
below expectations. In twenty twenty one, as you mentioned, the
(03:17):
Democrats used the budget reconciliation process without any Republican support,
to expand upon the original Obamacare subsidies they had extended
them in the Inflation Reduction Act and set them to
expire after twenty twenty five. Now premiums are going up
next year. Premiums are going up because of underlying problems
(03:39):
with Obamacare, not because of the enhanced subsidies expiring. The
enhanced subsidies expiring affect the amounts that the enrolle 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
(04:01):
the typical enrollee next year, the government is still going
to pay more than eighty percent of the premium. The
issue is should the tax payer be paying ninety three
percent of the premium, Because that's it. The enhanced subsidies continue,
the taxpayer is paying virtually all the premium, and for
(04:24):
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 well.
Speaker 3 (04:40):
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.
Speaker 2 (04:56):
Correct, that's right.
Speaker 4 (04:58):
Original obamacareies 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 five hundred thousand dollars that are
now getting government subsidies. And I should say one other
(05:20):
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.
Speaker 3 (05:38):
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
what's going to be covered by the government, and so
insurance companies are essentially doing the same thing.
Speaker 4 (05:52):
I would increase exactly right. I would encourage your listeners
to google chart of the Century put out by the
American Enterprise Institute, and from two thousand to present day.
It shows price increases by major sectors of the economy,
and the prices that have increased the most are healthcare,
(06:16):
and the prices that have increased the second most are education.
Hospital prices have increased three times faster than inflation since
two thousand. It really is bad government policy that is
both inflating demand and restricting supply and has led to
healthcare in the US becoming increasingly unaffordable.
Speaker 3 (06:39):
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 eighty percent, which is what you had previously said.
Speaker 4 (06:53):
Yeah, I mean, and the Inflation Reduction Act increased inflation
as well, So I mean. The name that they give
to these programs are often not reflective of what they
actually do. And it is now it's agreed. Republicans the
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
(07:17):
would reduce premiums by twenty five hundred dollars for 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 prices and premiums for the vast majority
of Americans. The subsidy structure is also independent of the regulations,
(07:39):
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 and
rollees are held harmless from the premium increase, the taxpayer
pays the entire premium increase. And what that does is
(07:59):
given Sure's enormous pricing power because they know that the
enrollee is insensitive to the price increase, that it's all
going to be paid by that So it has led
to independent of the regulations and inflationary aspect of Obamacare.
Speaker 1 (08:18):
I mean, just how much has Obamacare increased premiums.
Speaker 4 (08:22):
From twenty thirteen to twenty fourteen. The initial increase was
about fifty percent. From twenty fourteen to twenty twenty six,
premiums have gone up another almost one hundred and thirty percent.
And to put that in comparison to employer plan premiums,
since twenty fourteen, Obamacare plan premiums have increased about twice
(08:45):
as fast as employer plan premiums.
Speaker 1 (08:48):
Was the whole point of Obamacare to move us closer
to a single pair system.
Speaker 4 (08:53):
I mean, I think they wanted to expand health insurance coverage.
They did that primary through a dramatic expansion of the
Medicaid program, which has its own set of problems, and
they were hoping to create a robust individual market centered
on this new regulatory regime, the individual mandate to bring
(09:14):
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 a single payer system because
(09:35):
of how poorly Obamacare has borne out in reality.
Speaker 2 (09:40):
Why hasn't Congress fixed it? Then?
Speaker 3 (09:42):
You know, you had mentioned that both Democrats and Republicans
acknowledged that things aren't working, that costs have been driven up.
Speaker 2 (09:48):
So why haven't they done anything about it? Is it the.
Speaker 1 (09:51):
Complexity, the lack of being able to work together.
Speaker 2 (09:55):
All of it. You know what's behind that?
Speaker 4 (09:58):
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 twenty
seventeen during President Trump's first term, when Republicans were in
(10:19):
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 ten million people from
having to pay government penalties for not purchasing the coverage.
And the Trump administration also, and I was involved with this,
(10:39):
we opened up alternatives to Obamacare, so if the coverage
was really unaffordable for individuals, 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
(11:01):
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
(11:25):
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.
Speaker 1 (11:44):
Got to take a quick commercial break more with Brian
on the other side. 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.
Speaker 3 (12:00):
It's on the exchange. We 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.
Speaker 4 (12:17):
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 an 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
(12:40):
to thirty three thousand dollars with a fourteen thousand dollars deductible.
I mean that 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
fifty and I mean that is just it's unconscionable. We
(13:02):
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.
Speaker 3 (13:13):
Yeah, I know I need to look and slutch my
plan for next year, and I'm afraid to do it.
Speaker 2 (13:17):
I've been so busy traveling.
Speaker 1 (13:19):
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.
Speaker 4 (13:37):
Sure, So I'll start with a paragon's research on this
We dug into the improper enrollment back in the summer
of twenty twenty four, and what we looked at is
the number of enrollees signing up claiming income in a
narrow band that qualifies for a fully subsidized plan with
(13:57):
the actual number of people in a state that would
be eligible for that plan. And we found in twenty
twenty four there were five million more people enrolled in
a fully subsidized plan than were eligible, and in twenty
twenty five that increased to six point four million people.
(14:18):
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 are also social
media campaigns where they advertise cash or gift cards if
(14:38):
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
that a're enrolled is that they're not going to use
(14:59):
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 twenty nineteen to twenty
twenty four, and what it revealed is that in twenty
twenty four, thirty five percent of all Obamacare and rolies
didn't use their plan a single time. Forty percent of
(15:22):
these fully subsidized enrolies 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. Go came out with rely's bombshell report
yesterday where they created fictitious applications. They created over the
(15:47):
course of the late twenty twenty four through early twenty
twenty five, twenty four fake applications, and so they were
missing social Security information, wage information, all this information that
you need in order to get that you're supposed to
need in order to get coverage. And GEO successfully enrolled
(16:09):
twenty three of the twenty four people in exchange plans
with a subsidy that covered the entire amount of premium.
So it 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
(16:32):
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
(16:57):
just become a cesspool for fraud and abuse.
Speaker 3 (17:00):
Okay, so Jo, if twenty three out of twenty four
fictitious applications were approved, Joe Biden just let in millions
of illegal aliens into the country on top of the
millions more that we're already here. What is the likelihood
or what do we know about illegal aliens being able
to get on the exchange.
Speaker 4 (17:21):
Well, I mean, I would say the likelihoods one hundred
percent 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
(17:43):
enrolled as well, they were just picked off in these
fraud schemes.
Speaker 2 (17:47):
Before we go, what should Republicans do?
Speaker 1 (17:50):
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.
Speaker 2 (18:00):
Hard to calm back. But what is your hope for healthcare?
Speaker 1 (18:03):
What could Republicans do that would actually drive down costs
for Americans?
Speaker 4 (18:09):
So the first thing I would recommend is to allow
these enhanced subsidies to health insurance companies to expire. I
then think you can 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
(18:29):
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,
(18:53):
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
(19:14):
purchase coverage. And I gave testimony before the Senate Finance
Committee two weeks ago where I lay out several options
like this. And then third, I think there are Alabamacare
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
(19:39):
so that we have enrollees sensitive to the premium changes
over time and don't put the entire amount of responsibility
on the federal tax payer when premiums go up.
Speaker 2 (19:51):
Brian, thank you so much for coming on the show.
Really appreciate it.
Speaker 1 (19:54):
Thank you very much those Brian Blaze appreciate him from
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. I also want to thank
my producer John Cassio for putting the show together.
Speaker 2 (20:06):
Until next time,
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
(00:21):
massive insurer windfalls. Also a brand new GAO bombshell showing
fake applications were approved at a ninety six percent rate.
Brian just testified before Congress. We're going to get him
on those enhanced Obamacare premiums. Why are costs going up?
Speaker 2 (00:39):
And also what.
Speaker 1 (00:40):
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.
Speaker 2 (00:54):
Well, Brian, it's great to have you on the show.
Speaker 3 (00:56):
I've been wanting to have you on since Senator Johnson
a name drop you with the beefed up Obamacare premium fight,
So been wanting to have you on and talk about
this issue.
Speaker 2 (01:06):
So appreciate you making time.
Speaker 4 (01:08):
I'm happy to be on. Thanks so much for having me.
Speaker 2 (01:10):
You'll appreciate years ago.
Speaker 3 (01:12):
I actually debated Jonathan Gruber on Box News about Obamacare,
So that was that was interesting. But my objective was
I just like made him really angry at first, and
then he lost his mind and looked like a crazy person.
Speaker 2 (01:27):
But so it worked.
Speaker 3 (01:29):
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
(01:50):
actually a climate bill.
Speaker 1 (01:51):
I had thing to do with reducing inflation. In fact,
added to inflation made it worse.
Speaker 3 (01:56):
But they're 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.
Speaker 2 (02:07):
Like what happened? What do these do? And is that true?
Speaker 4 (02:10):
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 twenty fourteen. They significantly drove up premiums
(02:33):
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
(02:54):
penalty was completely ineffective. It didn't bring people into the market. Unfortunately,
Congress eliminated that tax penalty, and it had very little
effect twenty twenty. Really, from twenty fifteen to twenty twenty,
it was a pretty low performing market. Enrollment was way
below expectations. In twenty twenty one, as you mentioned, the
(03:17):
Democrats used the budget reconciliation process without any Republican support,
to expand upon the original Obamacare subsidies they had extended
them in the Inflation Reduction Act and set them to
expire after twenty twenty five. Now premiums are going up
next year. Premiums are going up because of underlying problems
(03:39):
with Obamacare, not because of the enhanced subsidies expiring. The
enhanced subsidies expiring affect the amounts that the enrolle 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
(04:01):
the typical enrollee next year, the government is still going
to pay more than eighty percent of the premium. The
issue is should the tax payer be paying ninety three
percent of the premium, Because that's it. The enhanced subsidies continue,
the taxpayer is paying virtually all the premium, and for
(04:24):
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 well.
Speaker 3 (04:40):
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.
Speaker 2 (04:56):
Correct, that's right.
Speaker 4 (04:58):
Original obamacareies 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 five hundred thousand dollars that are
now getting government subsidies. And I should say one other
(05:20):
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.
Speaker 3 (05:38):
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
what's going to be covered by the government, and so
insurance companies are essentially doing the same thing.
Speaker 4 (05:52):
I would increase exactly right. I would encourage your listeners
to google chart of the Century put out by the
American Enterprise Institute, and from two thousand to present day.
It shows price increases by major sectors of the economy,
and the prices that have increased the most are healthcare,
(06:16):
and the prices that have increased the second most are education.
Hospital prices have increased three times faster than inflation since
two thousand. It really is bad government policy that is
both inflating demand and restricting supply and has led to
healthcare in the US becoming increasingly unaffordable.
Speaker 3 (06:39):
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 eighty percent, which is what you had previously said.
Speaker 4 (06:53):
Yeah, I mean, and the Inflation Reduction Act increased inflation
as well, So I mean. The name that they give
to these programs are often not reflective of what they
actually do. And it is now it's agreed. Republicans the
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
(07:17):
would reduce premiums by twenty five hundred dollars for 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 prices and premiums for the vast majority
of Americans. The subsidy structure is also independent of the regulations,
(07:39):
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 and
rollees are held harmless from the premium increase, the taxpayer
pays the entire premium increase. And what that does is
(07:59):
given Sure's enormous pricing power because they know that the
enrollee is insensitive to the price increase, that it's all
going to be paid by that So it has led
to independent of the regulations and inflationary aspect of Obamacare.
Speaker 1 (08:18):
I mean, just how much has Obamacare increased premiums.
Speaker 4 (08:22):
From twenty thirteen to twenty fourteen. The initial increase was
about fifty percent. From twenty fourteen to twenty twenty six,
premiums have gone up another almost one hundred and thirty percent.
And to put that in comparison to employer plan premiums,
since twenty fourteen, Obamacare plan premiums have increased about twice
(08:45):
as fast as employer plan premiums.
Speaker 1 (08:48):
Was the whole point of Obamacare to move us closer
to a single pair system.
Speaker 4 (08:53):
I mean, I think they wanted to expand health insurance coverage.
They did that primary through a dramatic expansion of the
Medicaid program, which has its own set of problems, and
they were hoping to create a robust individual market centered
on this new regulatory regime, the individual mandate to bring
(09:14):
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 a single payer system because
(09:35):
of how poorly Obamacare has borne out in reality.
Speaker 2 (09:40):
Why hasn't Congress fixed it? Then?
Speaker 3 (09:42):
You know, you had mentioned that both Democrats and Republicans
acknowledged that things aren't working, that costs have been driven up.
Speaker 2 (09:48):
So why haven't they done anything about it? Is it the.
Speaker 1 (09:51):
Complexity, the lack of being able to work together.
Speaker 2 (09:55):
All of it. You know what's behind that?
Speaker 4 (09:58):
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 twenty
seventeen during President Trump's first term, when Republicans were in
(10:19):
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 ten million people from
having to pay government penalties for not purchasing the coverage.
And the Trump administration also, and I was involved with this,
(10:39):
we opened up alternatives to Obamacare, so if the coverage
was really unaffordable for individuals, 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
(11:01):
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
(11:25):
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.
Speaker 1 (11:44):
Got to take a quick commercial break more with Brian
on the other side. 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.
Speaker 3 (12:00):
It's on the exchange. We 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.
Speaker 4 (12:17):
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 an 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
(12:40):
to thirty three thousand dollars with a fourteen thousand dollars deductible.
I mean that 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
fifty and I mean that is just it's unconscionable. We
(13:02):
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.
Speaker 3 (13:13):
Yeah, I know I need to look and slutch my
plan for next year, and I'm afraid to do it.
Speaker 2 (13:17):
I've been so busy traveling.
Speaker 1 (13:19):
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.
Speaker 4 (13:37):
Sure, So I'll start with a paragon's research on this
We dug into the improper enrollment back in the summer
of twenty twenty four, and what we looked at is
the number of enrollees signing up claiming income in a
narrow band that qualifies for a fully subsidized plan with
(13:57):
the actual number of people in a state that would
be eligible for that plan. And we found in twenty
twenty four there were five million more people enrolled in
a fully subsidized plan than were eligible, and in twenty
twenty five that increased to six point four million people.
(14:18):
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 are also social
media campaigns where they advertise cash or gift cards if
(14:38):
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
that a're enrolled is that they're not going to use
(14:59):
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 twenty nineteen to twenty
twenty four, and what it revealed is that in twenty
twenty four, thirty five percent of all Obamacare and rolies
didn't use their plan a single time. Forty percent of
(15:22):
these fully subsidized enrolies 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. Go came out with rely's bombshell report
yesterday where they created fictitious applications. They created over the
(15:47):
course of the late twenty twenty four through early twenty
twenty five, twenty four fake applications, and so they were
missing social Security information, wage information, all this information that
you need in order to get that you're supposed to
need in order to get coverage. And GEO successfully enrolled
(16:09):
twenty three of the twenty four people in exchange plans
with a subsidy that covered the entire amount of premium.
So it 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
(16:32):
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
(16:57):
just become a cesspool for fraud and abuse.
Speaker 3 (17:00):
Okay, so Jo, if twenty three out of twenty four
fictitious applications were approved, Joe Biden just let in millions
of illegal aliens into the country on top of the
millions more that we're already here. What is the likelihood
or what do we know about illegal aliens being able
to get on the exchange.
Speaker 4 (17:21):
Well, I mean, I would say the likelihoods one hundred
percent 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
(17:43):
enrolled as well, they were just picked off in these
fraud schemes.
Speaker 2 (17:47):
Before we go, what should Republicans do?
Speaker 1 (17:50):
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.
Speaker 2 (18:00):
Hard to calm back. But what is your hope for healthcare?
Speaker 1 (18:03):
What could Republicans do that would actually drive down costs
for Americans?
Speaker 4 (18:09):
So the first thing I would recommend is to allow
these enhanced subsidies to health insurance companies to expire. I
then think you can 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
(18:29):
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,
(18:53):
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
(19:14):
purchase coverage. And I gave testimony before the Senate Finance
Committee two weeks ago where I lay out several options
like this. And then third, I think there are Alabamacare
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
(19:39):
so that we have enrollees sensitive to the premium changes
over time and don't put the entire amount of responsibility
on the federal tax payer when premiums go up.
Speaker 2 (19:51):
Brian, thank you so much for coming on the show.
Really appreciate it.
Speaker 1 (19:54):
Thank you very much those Brian Blaze appreciate him from
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. I also want to thank
my producer John Cassio for putting the show together.
Speaker 2 (20:06):
Until next time,
The Clay Travis and Buck Sexton Show News
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Clay Travis
Buck Sexton
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