Republicans on the House Judiciary Committee have subpoenaed eight insurers for documents outlining their measures to head off fraud related to Affordable Care Act subsidies.
The information demands follow an attempt from the Trump administration over the summer to enact new guardrails on improper enrollments, which was paused by the courts amid ongoing litigation. The Republican committee heads said their inquiries could help unstuck that regulatory effort.
Concerns over incentivizing enrollment fraud have been central to Republicans’ argument against extending the advanced premium tax credits (APTC) that expired at the end of last year. That position was galvanized in December when a Government Accountability Office (GAO) report outlined the ease with which its researchers were able to receive approvals for fake coverage applications.
Monday’s subpoenas are an escalation for the committee’s Republicans, who had requested the insurers provide such information voluntarily back in December. Individual cover letters to the insurers accompanying the subpoenas, which were shared by the committee, describe insurers’ varying levels of compliance to the initial information requests.
The insurers who were sent a subpoena are: Blue Shield of California, Centene Corporation, CVS Health, Elevance Health, GuideWell, Health Care Service Corporation, Kaiser Permanente and Oscar Health.
Reps. Jim Jordan (R-Ohio), chairman of the House Judiciary Committee, and Scott Fitzgerald (R-Wisconsin) and Jeff Van Drew (R-New Jersey), who chair relevant subcommittees, wrote that the insurers’ responses would “inform potential legislative reforms” to the Administrative Procedure Act (APA), the law a federal judge said the administration likely ran afoul when finalizing new regulations back in June.
That final rule would have introduced various hurdles to address “the surge of improper enrollments” on ACA exchanges. These included the elimination of special enrollment periods that allowed people earning 150% or less of the federal poverty level to secure coverage, new calculations around plan tiers and requirements for pre-enrollment eligibility checks for special enrollment periods and a $5 premium penalty on auto-enrollments.
After multiple large cities and other organizations sued to block the regulation, Judge Brendan Hurson, of the Maryland District Court and an appointee of President Joe Biden, issued a preliminary injunction against several of the measures in August. Hurson determined that plaintiffs were likely to succeed in challenging seven of the regulation’s provisions under the APA, yielding at least a short-term pause that the administration has appealed.
The committee lawmakers, in their subpoena letters, said the information from insurers would help determine “whether reforms are needed to the APA to allow for effective implementation of regulations that address Obamacare fraud.”
The GAO, in its December report and an accompanying letter to lawmakers, said it identified at least 30,000 applications submitted in plan year 2023 and at least 160,000 applications for 2024 that likely included changes made by brokers or agents that were not authorized. The watchdog also found that more than 29,000 numbers in 2023 and 68,000 numbers in 2024 were used to receive more than a single year's worth of coverage, including tax credits.
The GAO noted that the Centers for Medicare and Medicaid Services received approximately 275,000 complaints between January and August 2024 that consumers were enrolled in an ACA plan or had coverage adjusted without their consent. The office also pointed to Justice Department indictments from late 2024 and early 2025 alleging bad actors enrolling consumers by falsifying information on their applications.
“Such practices can result in wasteful federal spending on APTC for enrollees who are not eligible,” the GAO wrote to lawmakers. “Further, such practices can result in harm and unexpected costs for consumers. These can include loss of access to medical providers and medications, higher copayments and deductibles, or repayment of APTC if income or other eligibility was misrepresented.”
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