What to know about ACA 'phantom enrollees' GOP talking point

Contributing sentiments towards policy:

59% : Pages from the Affordable Care Act insurance marketplace on Aug. 19, 2025.
59% : And with the enhanced ACA subsidies, more people signed up for marketplace coverage.
58% : News stories show how simple it could be for insurance brokers in certain states to sign people up for zero-cost ACA insurance plans, unbeknownst to the consumers.
57% : (AP) The idea that Affordable Care Act marketplaces are riddled with fraud has become a major talking point among Republicans, as lawmakers in Congress argue about whether to extend the enhanced tax credits that are helping offset the cost of health care marketplace coverage for low- and middle-income people.
56% : "The tax credits go to some people deservedly.
56% : "We want to make sure that the tax credits go to the people who need them.
56% : " Blase and his team say they have quantified the percentage of zero-claim enrollees in the ACA marketplace by analyzing Centers for Medicare & Medicaid Services data released in August.
56% : The federal data that Paragon analyzed could count enrollees twice if they've switched plans during the year, said Cynthia Cox, a vice president and the director of the Program on the ACA at KFF, a health information nonprofit that includes KFF Health News.
55% : In 2021, former President Joe Biden signed into law the American Rescue Plan Act, which included enhanced ACA subsidies that made plans available at low or no cost to certain low-income individuals and expanded eligibility for subsidies to some middle-income people.
53% : The report focuses on "phantom enrollees" in the ACA marketplaces.
50% : Some enrollees also may have been on an ACA plan for only part of the year, which would make them less likely to make a claim.
46% : Those ACA subsidies expire at the end of the year and have become a flash point in the government funding showdown.
43% : Now, the ACA is center stage in the ongoing federal government shutdown, with Democrats pushing for Congress to extend the current ACA subsidies, which are set to expire at the end of the year.
42% : It's a subsidy for insurance companies," Speaker Johnson said of the ACA subsidies at a shutdown press conference last week.
40% : It indicates, they say, that rogue insurance brokers are signing up people who don't exist, don't qualify, or have other insurance and don't need ACA coverage.
37% : And we think the tax credits actually go to a lot of waste and fraud within the insurance industry," said Vice President JD Vance during a recent interview on CBS News.
31% : During the negotiations over the One Big Beautiful Bill, Republican lawmakers insisted Medicaid wouldn't be cut to pay for the tax cuts, but that "waste, fraud, and abuse" in the health program would be eliminated.

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