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Posted on 10/18/2025 6:51:20 AM PDT by MtnClimber
The Democrats are pretending this shutdown is about your health care.
It’s not—it’s about fraud.
They want you to believe the sky is falling—your health care is going to double in cost (or go away completely, depending on the day), and low-income ObamaCare enrollees are going to get left out in the rain.
These are scare tactics, designed to cover up for the proposal they’re really pushing: an extension of temporary COVID-era subsidies, riddled with fraud they’d rather not admit exists.
As many Americans know, ObamaCare operates by households purchasing health insurance through the exchange. Based on the enrollee’s income, the insurance premium is offset by a federal subsidy, paid directly from the government to the insurer. In nearly every case, this results in a big discount on the monthly premium.
In 2021, President Biden and Democrats in Congress included a massive sweetener to these ObamaCare credits at every income level, including those making hundreds of thousands of dollars.
For as many as half of ObamaCare enrollees, that meant a $0 out-of-pocket premium, fully covered by the taxpayer subsidies. This, predictably, led to a surge of enrollments—and very real incentives for fraud and bad actors.
That’s because ObamaCare isn’t just individual people logging on to find health insurance. Today, nearly 80 percent of all ObamaCare enrollees are signed up by an insurance agent or broker, who receive a commission for every sign-up. Their incentives are clear—sign up as many people as possible, no matter what it takes. The result: a blind eye turned toward eligibility; unwanted or unrequested insurance changes; and insurance that the taxpayers are funding but the recipient doesn’t need.
The Wall Street Journal recently exposed some of the deceitful tactics used by brokers to trick low-income Americans into signing up for these plans: fraudulent Facebook and Snapchat ads, empty promises of gift cards, and even agents switching enrollees’ plans without their knowledge. According to the Journal, “CMS has received more than 208,000 complaints this year of unauthorized ACA insurance sign-ups,” and 200 agents and brokers have been suspended on suspicion of fraud.
A shocking number of these customers never even use the health care they signed up for.
In 2024, a full 40 percent of fully subsidized (zero premium) enrollees had no health care claims whatsoever. No annual visit, no blood work, no prescriptions, nothing.
These “no-claim enrollees” are an ongoing profit stream for the insurance company paid by the taxpayers—at least $35 billion for people who pay zero and never use their plan.
During the housing market bubble of the early 2000s, unscrupulous mortgage brokers made a killing selling mortgages to “NINA” and “NINJA” borrowers: “No Income, No Asset” or “No Income, No Job, No Asset.” The broker’s incentive in this case, again, wasn’t about verification of eligibility or long-term consequence—it was sales, no matter who they were sold to. When these mortgages understandably failed and the housing market collapsed, hindsight made it clear how dangerous those loans were and how predatory these brokers were.
But the Democrats created a system to bring those same mistakes to health care. In the same way that unscrupulous mortgage lenders didn’t bother with verification, ObamaCare brokers have the same incentives today—boosted by the extra subsidies the Democrats just shut down the government to protect. And once again, the taxpayers have to bail them out in the end.
Today, as many as 6.4 million ObamaCare enrollees are receiving zero-premium plans they aren’t eligible for, at an estimated fraud cost of $27 billion per year. A staggering 1.6 million are also enrolled in Medicaid at the same time as ObamaCare, meaning the taxpayers are paying twice for health coverage the recipient may not even be using.
Most Republicans rightly want these temporary credits to expire as intended. They are backed by an overwhelming majority of voters from every party: Republican (67 percent), Democratic (67 percent), and Independent (66 percent).
And for the real people stuck in the middle of this government showdown, the real-world result is nowhere near the Democrats’ “sky is falling” rhetoric. When these credits return to pre-COVID levels, households at the poverty level will still have 98 percent of their monthly premium cost covered, paying about $3.45 a week on average in premiums.
This is hardly the first COVID-era program to expire according to the Democrats’ own sunset date. The Democrats didn’t shut down the government to protest the end of the Paycheck Protection Program, or enhanced unemployment benefits, or the Restaurant Revitalization Fund. So why won’t the Democrats allow these enhanced COVID-era credits to expire?
Maybe it’s because they know that ObamaCare doesn’t work without massive subsidies, so they don’t want to give an inch. The Washington Post recently hit the nail on the head: “The real problem is that the Affordable Care Act was never actually affordable.”
Maybe it’s because this subsidy hits all three of the Democrats’ biggest issues today: ObamaCare, COVID spending, and opposition to Trump.
No matter what is really behind the Democrats’ shutdown, the truth is clear.
The Democrats shut down the government to protect fraud—not your health care.
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Time to burn down 0bammyScare ... completely to the ground.
Ain’t Nationalized Healthcare wonderful.
Always follow the money. Our money.
The biggest reason for the shut down is Schumer trying to save his old hide. Schumer has to appear to “fight” Trump or he’s toast in the Dem primary. I suspect Schumer doesn’t have a chance anyway, and AOC will oust him.
Oh no Healthcare is going to be without money soon.
Can we change the laws to force the health system to be competitive again?
And get rid of the 3.8% Net Investment Income Tax (NIIT) which is used to fund Obamacare. Although it only applies to individuals with higher incomes, it can easily be triggered on people with moderate incomes, especially those who live in high cost of living states.
Yep, just like the income tax.
Democrats Didn’t Shut Down the Government Over Health Care -They Did It to Protect ObamaCare Subsidies Fraud.
That pile is going to steam on a hot day and a long time.
“Medicare Premium Bill....Current Premium Due...Total Amount Due $555.00 by 10/25/2025”
That’s from a document that came on the 6th.
That’s $185/month.
My American dentist pays $1600/month for health insurance.
How will that work, they can’t keep it shut forever.
The future of the PPACA is up in the air.
12 million pre-Biden Takers - average risk $500/month/person
12 million Biden-era Newbys - average risk $50/month/person
you get
24 million Recipients - average risk $275/month/person
Unless the Newbys are retained by paying almost all their premiums, the Newbys will bow out and the risk per person and the premiums per covered person will almost double.
The insurance companies have to set their premiums for November marketing and they need to know what the average risk per person per age group is going to be real soon.
Would you, Mr. Healthy, like health insurance for less than $10/month?
The answer is probably going to be yes, even if the health insurance is junk.
Would you, Mr. Healthy, like health insurance for less than $100/month?
The answer might well be no. Mr. Healthy is very unlikely to benefit from health insurance, but he will get zapped with late fees if he doesn’t pay his bills. He will very likely get evicted if he falls behind on his rent.
Here are three major faults of the PPACA:
1. lack of strong measures for cost control
2. excessive coverage mandates
3. excessive subsidies at the lower ranges
Perhaps in exchange for saying capping SNAP benefits at $2/day/person, paid in daily so there is no monthly feast & famished cycle, the PPACA might have the original subsidy formula Obamacare the first six months of 2026, then Chuck’s subsidy formula the last six months of 2026.
Then phase Chuck’s formula out one month per subsequent year.
December 2032 would be the last month for Chuck’s formula.
Within a few months of eliminating SNAP, the demand and federal spending for insulin and Ozempic would drop sharply.
Note for $28 (the weekly $2/day amount for two people), one can buy:
two pounds of chicken for ~$5,
four pounds of pasta for ~$4,
seven cans of vegetables for ~$5,
a gallon of milk for ~$3,
two loaves of bread for ~$3,
a box of cereal (or a bag of fruit) for ~$3,
and still have ~$5 left over for say buying
a 10-pound bag of potatoes one week
a bag of sugar and 100 tea bags another week
a pound of butter and two boxes of store brand macaroni & cheese another week
12 eggs and two boxes of cake mix yet another week.
Of course.
“Follow the money”, always tells the tale.
👍
The democrats plan all along was that it would fail, but would morph into a Euro-style single-payer NHS.
The GOP promised to kill Obamacare in 2015, not long after the rats shoved it down our throats late in the evening Christmas Eve 2010. When everyone was distracted, feeling warm & fuzzy.
Strangle this little monster in its cradle. Now.
“Can we change the laws to force the health system to be competitive again?”
Drug coverage should be separated out. The drug companies should not be able to financially piggyback on the possible need for emergency surgical care. Because federal patents allow drugs to be so extravagantly priced, the federal government is in my opinion going to have to subsidize drug coverage to at least the 300% of FPL level. If you take such a subsidy after age 23, your share-related capital gains and tort winnings based partially or wholly on you probably should be forever subject to a drug subsidy funding tax on them, perhaps initially at the 20% level.
Separating out drug coverage would allow hospital systems to be complete providers of care. They could then financially tell insurance companies where to go.
Hospitals should generally be broken into two, so they no longer are local monopolies. The union contracts of each should have to be substantially offset (by two months or as much time as possible) and no union should be allowed to have a contract with both.
If a hospital is too small to be broken into two, it should be converted into a real estate entity renting out space to medically licensed individuals and partnerships of medically licensed persons.
I would impose these premium minimums, whichever is the higher:
1. 1/65th of the Medicare Part B premium amount per insured year of age as of the start of coverage
2. a percentage of the premium amount equal to the household income percentage of FPL - 70% divided by 3
3. a monthly minimum equal to the state tax, or median state tax if less, on 30 packs of cigarettes for insureds over age 23 at the start of the policy coverage
For a 5-year-old, 7-year-old, 32-year-old and 34-year-old, the ages would sum to 88 and the monthly absolute minimum premium amount would be a (88/65)*$185 or $250.46.
For a 5-year-old kid and a 27-year-old mom the ages would sum to 32 and the monthly absolute minimum premium amount would be (32/65)*$185 or $91.07.
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