Obamacare exchanges vulnerable to fraud: GAO
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Federal auditors used fictitious identities and Social Security numbers to obtain subsidized Affordable Care Act coverage in 2024 and this year for almost two dozen individuals who didn't exist, the Government Accountability Office reported on Wednesday.
Why it matters: Republicans in Congress have cited waste, fraud and abuse in ACA coverage as a justification for not renewing enhanced tax credits that expire at the end of this year.
- The report gives GOP policymakers new fodder as they resist a faltering effort to extend the enhanced subsidies.
- The congressional watchdog agency told three House Republican committee chairs that fraud risks it first identified in 2015 were still plaguing systems the government uses to determine eligibility for ACA coverage.
What they found: Auditors used fake identities to successfully obtain ACA coverage worth about $2,300 a month for four fictitious applicants from November through December 2024.
- They obtained subsidized coverage for 18 of 20 other fictitious applications as of September 2025. Advance premium tax credits for those enrollees total more than $10,000 per month.
- The applications were made directly through the federal HealthCare.gov portal or with the help of an insurance broker.
- Republican lawmakers requested the investigation, but GAO has conducted similar testing of ACA coverage in the past, prior to COVID-era subsidy enhancements.
Zoom in: The investigation also found that nearly 66,000 Social Security numbers were used multiple times to receive more than one year's worth of health insurance in the marketplace during the 2024 plan year.
- At least 160,000 applications in 2024 saw likely unauthorized coverage changes by brokers or agents, GAO said.
- The Centers for Medicare and Medicaid Services' fraud risk assessment for the subsidies hasn't been updated since 2018, and the last update may not align with best practices, GAO added.
What they're saying: "The concerning findings from GAO's report further confirm that Republican efforts to strengthen, secure and sustain our federal health programs are critical and necessary," House Energy and Commerce Committee Chair Brett Guthrie (R-Ky.) said in a statement.
- A Health and Human Services spokesperson said the department has been continuously evaluating and implementing ways to root out waste, fraud and abuse. "This remains a high priority so that we are good stewards of taxpayer dollars," the spokesperson told Axios in response to the report.
The other side: Congressional Democrats said the findings were concerning, but threw the blame back at Republicans. The Trump administration should stop signaling that fraudsters will get pardons, Rep. Lloyd Doggett (D-Texas) said in a statement.
What we're watching: CMS plans to update its fraud risk assessment practices for ACA subsidies by the end of 2025, GAO said in the report.
- CMS also told auditors that it will develop a new antifraud strategy for the subsidies.
