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October 31, 2025 14 mins
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Speaker 1 (00:00):
Right now, I want to go to Nicholas Kleinworth. Nicholas
is a policy analyst at the Paragon Health Institute Paragoninstitute
dot org. They do a lot of fantastic research on
healthcare policy, and they got a couple of things out
and all this, by the way, is up on my blog,
so you can go read it yourself. But they've done
some very very interesting research just this month, published just

(00:22):
at the beginning of this month about ACA, also known
as the Affordable Care Act, also known as Obamacare, about
fraud within this program.

Speaker 2 (00:31):
And I will note just.

Speaker 1 (00:32):
Before we get to the fraud, fraud is just one
of the reasons that the Affordable Care Act now turns
out to be one of the worst named pieces of
legislation ever.

Speaker 2 (00:43):
I mean, and this many of us knew this was
going to happen.

Speaker 1 (00:46):
We called it at the time the Unaffordable Care Act,
but I think a lot of more people are figuring
it out now.

Speaker 2 (00:51):
Anyway. Nicholas, welcome to KOWA. It's good to have you here.

Speaker 3 (00:54):
Yes, Ross, thank you for having me on the Unfortunately,
it seems like we're just in your audience with back
to back topics that I'll make their heads hurt.

Speaker 2 (01:05):
That's right.

Speaker 1 (01:05):
What happens if you have a one thirty appointment on
Sunday morning?

Speaker 2 (01:08):
Yeah, I don't know what happens. I don't know.

Speaker 1 (01:11):
All right, So let's talk about your piece for Paragon
ghost busting ACA fraud. Millions who don't use their health
insurance expose abuse in the program.

Speaker 2 (01:25):
So there's a lot to talk about here.

Speaker 1 (01:27):
So what is this about people who don't use health insurance?

Speaker 2 (01:30):
Is that a common thing? Is it not a common thing?

Speaker 1 (01:33):
But you know you, but you have health insurance, but
you don't get sixy don't use it. How do you
get from there to saying at least some of that
represents fraud.

Speaker 3 (01:44):
Well, you have to think about the fact that when
you use your health insurance, you're not just using it
for going to the doctor. You're not just using it
for going and seeing your primary care physician. You're also
using it to cover things like prescription drugs and other
of those small things. It's actually kind of impressive that
twelve million people who are enrolled in the Affordable Care

(02:05):
Act plans aren't using their coverage at all. And for
perspective on how big this is, this is about twenty
six percent of all Affordable Care Act and rollees.

Speaker 4 (02:16):
Wow, And I mean.

Speaker 3 (02:19):
It's a pretty substantial number nationally. Incomparable plans. The Heiser
Family Foundation estimates that about fifteen percent is normal.

Speaker 4 (02:33):
For people to not use their health insurance.

Speaker 3 (02:36):
And so what we're seeing, though, is that the number
of people who aren't using their coverage is going up
substantially since the passage of the Biden Codd credits or
those additional subsidies that create a lot of free plans
for people on the program.

Speaker 1 (02:57):
So does that mean that a lot of people are
getting the insurance because it's quote unquote free and they
feel like they might as well. That's what that sounds
like you were saying. But then there's this whole other
thing about I mean, there's a reason you put the
word ghostbusting in the title of this article, so let's
get to that as well.

Speaker 3 (03:15):
Yes, so keep in mind that phantom enroll is we're
referring to a very small, smaller subset of these people
who don't use their plans. These are people who aren't
on the plants or aren't using their coverage, but they
it's usually because of fraud. They don't actually know that

(03:37):
they even have coverage. So what we're seeing is these
fraud rings are getting enough information on people and then
rolling them in Obamacare plans and then collecting commissions or
collecting the subsidies, and these people just get.

Speaker 4 (03:54):
Enrolled in health insurance.

Speaker 3 (03:55):
There's zero costs because they're enrolled in the zero cost
plan through and COVID credits, so there's no pay for
until you get the tax time and you find out
that you have a penalty that you have to pay,
or you go and try to use your normal health
insurance you find out that your plan was canceled and
you can't actually access to health benefits you wance have.

Speaker 2 (04:18):
Is that quantifiable? Yet? How many people? You know? How
many cases there are?

Speaker 1 (04:22):
Like this?

Speaker 2 (04:22):
Is it thousands? Is it millions? What is it?

Speaker 3 (04:26):
So? The Paragon Health Institute released a report just this year.
We estimated that six point four million people were improperly.

Speaker 4 (04:34):
Enrolled in the Affordable Care Act.

Speaker 3 (04:36):
Now keep in mind that this is people who either
deliberately misrepresented their income so that they can get a
bigger subsidy, or these were people who were enrolled in
these plans unknowingly. And this cost pact pair is about
twenty seven billion dollars.

Speaker 1 (04:55):
Okay, yeah, so that's where That's where I'm going next,
like how much is this actually costing? This figures into
the overall concept that I started in my introduction of
this segment that the Unaffordable Care Act is really a
massive financial burden, and this is becoming a big part
of the conversation in the government shutdown right now because

(05:17):
there are these temporary, temporary governments designed by Democrats to
be temporary government subsidies for people earning over four hundred
percent of the federal poverty level, which by the way,
does not make you rich.

Speaker 2 (05:31):
The poverty level is very low.

Speaker 1 (05:33):
Four times the poverty level is probably not even middle class.

Speaker 2 (05:37):
But still.

Speaker 1 (05:39):
These people are getting temporary, very large subsidies, and now
Democrats are wanting to keep the government shut until Republicans
cave in and extend those subsidies at massive, massive cost.
Do you want to say anything about that, even though
it's a little bit off the topic of fraud.

Speaker 3 (06:00):
Well, I think that people need to keep in mind
that the Democrats had the ability to do this a
few years ago. They had control, They had the ability
to pass it in perpetuity if they really wanted to,
not a single Republican voted at the time to extend
these subsidies to this point. And so I think that

(06:20):
the fact that the Democrats didn't do it before they
saw that temporary COVID era programs should be restricted to
the COVID era, and I would say that.

Speaker 4 (06:31):
Were well passed covid right.

Speaker 1 (06:33):
And the other thing there is that the reason they
didn't make them permanent is they couldn't get a favorable
scoring on the bill if they did that, because it
would make the whole thing so expensive. Right, So they
had and this is a thing that the politicians do commonly.
They put something in a bill that expires theoretically in
the bill after period of time, but their intention isn't
actually to let it expire. So what is to be

(06:57):
done about this Obamacare fraud?

Speaker 3 (07:01):
I would actually say it's one of the easier policy
decisions to make. The solution here is to actually not
pass any extensions to the Biden COVID credits.

Speaker 4 (07:13):
So the solution would be to do nothing on that
particular policy.

Speaker 3 (07:18):
But even if there has to be some degree of negotiation,
the redline absolutely has to be no zero dollar plans
in the Affordable Care Act, because you'd not be getting
on the plans for free, and there has to be
some sort of a cost to that, But it's also
a revelation to just how low value these plans are.

(07:39):
Studies have come out that shows people will still deliberately
choose to not enroll in Affordable Care Act coverage even
if the premium was less than ten dollars. And I'm sorry,
but a lot of subscription services and other things cost
a lot more than ten dollars, and the fact that
they value those things more than health insurance tells you

(08:00):
just how important these programs are to that subset of people.

Speaker 2 (08:05):
Right.

Speaker 1 (08:06):
And also, I'm guessing that most of the population that
would answer that way or probably in their twenties, right,
who think they're invulnerable, And they're probably right, Like most
people in their twenties won't need health insurance or or
won't have health expenses that exceed what the insurance would
cost them, and.

Speaker 2 (08:23):
They're better off doing cash pay, not.

Speaker 4 (08:25):
All of them.

Speaker 2 (08:26):
You know, you can get in an accent, you can
get sick.

Speaker 1 (08:28):
But I mean, I remember when I was in my
twenties and I thought health insurance.

Speaker 2 (08:31):
Is a waste of time, and I was probably.

Speaker 1 (08:33):
Right, you know, and especially with what it costs now,
health insurance was cheap then it's expensive Now, well it's
expensive unless you can get the government to make other
people pay for it.

Speaker 3 (08:43):
Well, and keep in mind too, this is actually the
leftist argument right now for behind the phantom that role lease.
So the Paragon came out, we showed how many people
were not using their coverage and it really does show
the degree of fraud in the program. Opposition arguments were that, well,
this is because the subsidies were encouraging young healthy people
who don't use their coverage to enroll in these plans.

(09:06):
But what we found out in our ghostbusting piece was
that the proportion of phantom and role is far exceeded
the proportion of young healthy people that got onto the
program after the passage of those subsidies. So that's not
the reason, right.

Speaker 1 (09:20):
And that it does make sense in the sense that,
as I was saying, if a young person feels invulnerable,
you know, even if health insurance is close to zero cost,
they're just not even going to spend their time signing
up for it. It's just like why bother Right, We're
talking with Nicholas Kleinworth from the Paragon Health Institute, Paragon

(09:42):
Institute dot org. All right, as long as I've got
a real health expert here, I want to ask you
this other question. There's all this talk about this massive
increase in Health Obamacare insurance premiums for some people when
these subsidies expire, and you see numbers out there, you know,

(10:03):
premiums going from ten thousand to twenty thousand or some
crazy numbers like that.

Speaker 2 (10:10):
And my question for you.

Speaker 1 (10:12):
And this is probably something that would take hours to
really do a justice, or a whole book to do
a justice. Why is health insurance so expensive?

Speaker 2 (10:22):
I don't really know. I'm tired of subsidizing people.

Speaker 1 (10:25):
I also think subsidizing people drives up the cost of
health care. But why is health insurance so so expensive?

Speaker 2 (10:32):
Last thing, and then I'll ut you answer.

Speaker 1 (10:34):
I saw on a news report yesterday that the average
health expenditure per American is something like thirteen thousand dollars
a year.

Speaker 2 (10:44):
How can the average cost of.

Speaker 1 (10:47):
Health insurance exceed the average expenditure by such a large amount.

Speaker 4 (10:55):
You're asking all the right questions.

Speaker 3 (10:57):
Let me start by saying this, The reason why health
insurance costs are going out this year is not because
of the subsidies. Paragon just released a figure earlier this
week or last week, and that showed that only three
point three percent of the increase that we are seeing
is actually attributed at all to the expiration of the

(11:20):
Biden COVID credits, but the Affordable Care Act itself. This
is another figure that Paragon Health Institute release. It went
viral on x It showed how before Obamacare, health insurance
was and within reach back in twenty fourteen. But a

(11:41):
lot of the subsidization of the market, a lot of
the additional regulations, coverage mandates and things like that are
driving up the cost.

Speaker 4 (11:51):
As Democrats say, oh.

Speaker 3 (11:52):
Well, we need to regulate insurance companies, they need to
cover X, Y and Z services, and you find them
more and more people are buying plans that cover things
that they'll never need.

Speaker 4 (12:03):
For example, why do I need.

Speaker 3 (12:06):
Maternal healthcare services on my particular health plan if I'm
just an individual and I'm obviously not females. So those
things just don't make sense and it raises the cost
for everybody across the board. We could go into other
things too that drive the cost that it's all tied
back to the Affordable Care Act.

Speaker 2 (12:28):
Yeah, well, I'm glad you said that.

Speaker 1 (12:30):
It makes me feel a little bit smarter in the
sense that a few days ago this came up on
the show and one of the things I was talking
about was these mandates, and I said, how much do
you think car insurance would cost if the government said
that your auto insurance had to cover new tires, new
windshield wipers, knew absolutely everything, Because then you know that
not only will claim well, there'd be claims for more things,

(12:52):
but more people will get new tires and new windshield
wipers and knew everything sooner than they otherwise would. So
actually the real results will end up being even worse
than the results in the pro forma model that the
people put together to.

Speaker 2 (13:07):
Design the plan.

Speaker 1 (13:08):
Looks like you want to say something, so I'll give
you the last few seconds.

Speaker 3 (13:11):
So I just wanted to make sure to mention though
the increase that we're seeing in the ACA coverage costs
for the premiums, it's actually largely born by the tax payer.
And this is very unfair to the people who have
to pay for their health insurance out of their paycheck
through their employer, and then they also have to pay
for everyone else's health insurance through the additional taxes to
subsidize this program, and so this needs to stop.

Speaker 1 (13:34):
Nicholas, can you email me the link for the report
you mentioned that talks about what percentage of the current
increase is from the expiration of the credits and what
percent is from other stuff.

Speaker 2 (13:46):
Can you send me that bad Yeah, that'd be great,
all right.

Speaker 1 (13:49):
Nicholas Kleinworth is an analyst and writer over at Paragon
Health Institute. Some great, great reports that he's done. Check
out Paragoninstitute dot org. This stuff is up on my blog,
so you can check out Nicholas and his work as well.

Speaker 2 (14:04):
It's great conversation. Thanks for your time, Thank you for
having me.

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