These days, the cost of healthcare is on everyone’s mind. Since the passage of Obamacare in 2010, the cost of health insurance on the individual marketplace has increased nearly 170%, placing a significant financial strain on families and businesses. Despite advancements in medical technology and treatment, many people are finding it increasingly difficult to afford the care they need. This trend is particularly troubling as it disproportionately affects the most vulnerable populations, including the elderly, low-income individuals, and those with chronic conditions. However, rather than lower healthcare costs for Americans, Democrats want to simply extend a COVID-era Affordable Care Act (ACA) subsidy, rife with fraud, to the tune of $400 billion over the next ten years.
A clean three-year extension of the Enhanced Premium Tax Credits (PTCs) is unacceptable. It is important to note that the enhanced subsidies are paid as advance premium tax credits directly to insurance companies on behalf of enrollees, rather than solely to consumers.
Instead, Republicans in Congress should pass commonsense reforms, such as Pharmacy Benefit Manager Reform and Association Health Plans, that would lower healthcare costs for Americans without increasing government spending.
The PTCs were never meant to be permanent. Democrats in Congress created them during the COVID-19 pandemic as a temporary measure in 2021, and they subsequently extended them for another three years in 2022, with zero Republican support. Prior to the pandemic, ACA premium subsidies were only available to people with incomes up to 400% of the federal poverty level. In today’s dollars, that is approximately $62,500 for a single person and $128,600 for a family of four. With PTCs, individuals with incomes above 400% of the federal poverty limit were able to receive subsidies that cap their premium contributions at 8.5% of their income. I think most Americans would agree that taxpayers should not be subsidizing the health insurance of someone making $250,000.
The PTCs are also rife with fraud. A recent Government Accountability Office (GAO) report exposed the extent of fraud in this program. According to the Centers for Medicare and Medicaid Services, the agency tallied roughly 275,000 complaints between January and August of 2024 from Americans who were enrolled in an Obamacare plan without their consent or had their plan changed. In one instance, fraudsters used a Social Security number to receive insurance subsidies for over 127 insurance policies. The GAO itself conducted an experiment to determine how easy it was to defraud the government using fake Social Security numbers. Over 90% of the fake applicants created were approved to receive insurance coverage in 2025. Given the recent revelations concerning widespread welfare fraud in Minnesota and other states, it is simply unacceptable to extend a program with massive fraud for another three years without any significant changes or reforms.
Unfortunately, a small number of Congressional Republicans have chosen to support a clean extension of PTCs without including fraud-prevention measures. I urge my Republican colleagues to remember the words of President Reagan who said, “The closest thing to eternal life on earth is a government program.” Republicans have an opportunity to let a temporary entitlement program expire. We cannot let this opportunity pass.
While I think PTCs are bad policy, it is clear Americans need Congress and the Trump Administration to take actions to lower healthcare costs. This Congress, I have proudly cosponsored both the Pharmacy Benefit Manager (PBM) Reform Act and the Association Health Plans Act. These bills would lower Americans’ healthcare costs without increasing government spending.
The PBM Reform Act, H.R. 4317, would prevent middlemen from raising drug prices and taking money that should be used to lower pharmaceutical costs for patients. The bill would increase price transparency in the healthcare industry, and it would ensure that the benefits of PBMs go to the patients and not shareholders.
The Association Health Plans Act, H.R. 2528, would help lower healthcare costs for small businesses, who often pay disproportionately high health insurance costs for their employees. Specifically, the bill would allow small businesses and self-employed workers to come together and buy health insurance as a larger group, lowering costs and increasing choice in the process by using their increased negotiating power. Premiums are more stable and affordable when spread across more people, and it gives workers and small business owners more flexibility in choosing the right health care plans for their employees.
I remain committed to lowering healthcare costs and addressing the root issues driving up healthcare prices for Americans. However, I cannot accept the simple extension of a program that will line the pockets of insurers and is riddled with fraud at the expense of the American taxpayer. President Trump and Congressional Republicans remain committed to delivering healthcare solutions to every American.
Ken Calvert currently represents the 41st District in the U.S. House of Representatives. He is running for re-election in the 40th District which covers portions of Orange and Riverside Counties.
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