Senate Majority Leader John Thune, a Republican from South Dakota, spoke at a press conference after a recent Senate Republican Policy Luncheon held on November 19, 2025, at the U.S. Capitol.
As discussions on the Affordable Care Act’s enhanced premium subsidies continue, Republicans are pointing to reports of fraud in the health insurance sector to argue against extending these tax cuts.
A report from the U.S. General Accounting Office, a nonpartisan body that monitors Congress, has identified issues with ACA subsidy misuse. Thune criticized the Democratic proposal to prolong these ACA enhancements, describing it as “rife with fraud and abuse” and suggesting such problems are widespread.
However, some health policy experts contend that the extent of the fraud isn’t as significant as claimed. Instead, they believe efforts should focus on improving safeguards within Obamacare rather than eliminating the enhanced subsidies.
Michael Gasmano, a health policy professor at Lehigh University, described the fraud findings as “trivial,” suggesting they serve as a scare tactic to limit government support for health insurance. He referred to a study indicating that in 2023, about 58,000 individuals with dead Social Security numbers received premium subsidies—representing just 0.4% of those who received these credits that year.
Republicans Point to ACA Fraud as a Barrier
Senate Democrats are advocating for extending ACA grants for another three years, which help reduce the premiums for ACA members. Research indicates that roughly 22 million people, or around 92% of ACA participants, receive subsidies. Without this support, premiums could more than double for beneficiaries by 2026.
Republicans have suggested allowing the ACA subsidy expansion to lapse instead, proposing direct payments of up to $1,500 for consumers with health savings accounts. Both proposals were blocked in the Senate recently.
House Speaker Mike Johnson stated there would be no vote on extending enhanced ACA subsidies, implying they will likely end as planned.
Senator Bill Hagerty picked up on the fraud narrative when he spoke about the importance of not extending the aid, referring to the GAO’s findings on ACA subsidy-related fraud in the federal marketplace used by around 30 states.
Rep. Jefferson Van Drew emphasized the seriousness of the findings, which align with persistent Republican criticisms of fraud in social services. Notably, Trump has voiced strong opposition to perceived fraud in various programs, mentioning a state with a large Somali population in connection with illicit activities, tying it back to a broader narrative of inefficiency in welfare programs.
Since the ACA’s inception, Republicans have sought to dismantle it. This year, they passed a significant tax cut bill making various administrative alterations to the ACA, with estimates suggesting over 3 million people could lose insurance in the following decade. Previous attempts to repeal and replace the ACA faced defeat in 2017 after key Republican senators opposed the measure.
GAO Report Reveals Subsidy Fraud
GAO conducted tests by submitting fake applications to the federal ACA marketplace in 2024 and 2025. In the first year, it reported approving all four false claims, totals reaching $2,350 in monthly subsidies. In 2025, 20 additional fictitious applications were submitted, with 18 ultimately approved, accumulating over $10,000 monthly in subsidies. The report highlighted weaknesses in enrollment management but also stated those results couldn’t be generalized to all ACA enrollees.
Experts pointed out that while fraud has been an issue since 2014 when the ACA subsidies began, it is not unique when compared to other federal programs. Kay Pestaina from KFF noted the GAO findings are consistent with ongoing problems in large subsidy-based systems.
Concerns Over Fraud Linked to Social Security Numbers
The GAO indicated that more than 58,000 deceased individuals accessed premium deductions in 2023. Gusmano expressed uncertainty about how many were eligible before passing away. He noted cases of multiple uses of Social Security numbers for benefits applications, with thousands recorded in successive years.
Experts argue the statistics can be misleading. The percentage of deceased individuals receiving premium credits is minuscule given the total Medicare beneficiaries. Even those who see significant fraud still advocate for reform rather than outright subsidy cuts.
Nick Fabrizio, a health policy expert, insisted on the necessity to extend the subsidies until at least 2026, but intertwined with reforms aimed at preventing fraud. He stressed the urgency of extending aid while also stabilizing the overall system.
Growing Fraud Risk as ACA Expands
Fabrizio noted that large government initiatives often encounter some level of fraud and corruption. GAO indicated that risks of fraud could increase parallel to the expansion of ACA subsidies. CMS has not reassessed fraud risks since 2018, leading to concerns over compliance as potential costs soar.
Gerald Anderson remarked that fraud has always been a problem and that adjustments need to be made in the ACA system, especially considering zero premium plans identified as risky for fraud. Introducing minimal premiums might mitigate exploitation in the subsidy system.
