Crapo: Americans Should Control Their Own Health Care

Washington, D.C.-Today on the Senate Floor, U.S. Senate Finance Committee Chairman Mike Crapo (R-Idaho) continued to make the case for the Health Care Freedom for Patients Act, legislation to lower health care costs and give money directly to families to control their own care. He also explained why the Democratic plan of extending the Biden COVID bonuses is unsustainable and counterproductive and discussed the massive breadth of fraud in the subsidy program.

On Democrats' Obamacare crisis:

"If there is a crisis coming, it is entirely of the Democrats' making. My colleagues on the other side of the aisle created the premium tax credits as part of the Obamacare system, because they did not trust their own policy to make health insurance affordable without shifting the burden of paying for it from enrollees to taxpayers.

"When the original premium tax credits failed to bring down premiums, they enhanced the tax credits. And then when that did not work, they extended the enhancements. They did all this without a single Republican vote.

"They also chose the current expiration date they now say must be changed. They created the cliff they now oppose. Our colleagues on the other side of the aisle have had years to offer serious suggestions on how to reform the Obamacare subsidies, yet every time a deadline approaches, we are told there is no workable option except to extend them again.

"It seems these subsidies were never truly meant to be temporary. But they should be. We do not have to go along with their last-minute extension, this time at the cost of $83 billion."

On fraud in the Biden COVID Bonuses:

"Of course, Mr. President, unscrupulous insurance brokers have been signing people up for Obamacare plans without their knowledge or consent for profit. Alarmingly, insurers make the most money through these fraudulent credits, because they retain the money even if no payments are made on behalf of patients.

"As just one example, more people are signed up for $0 premium Obamacare plans in Miami-Dade than there are low-income people living there. One woman in Miami said she had been paid five times by brokers to enroll in Obamacare plans.

"These are not isolated incidents. This year, 6.4 million Americans were improperly enrolled in enhanced Obamacare subsidies at a cost of $27 billion. The true cost of fraud was likely even higher, because the GAO also found in its report that tens of billions of dollars of subsidies in 2023 had not been reconciled to enrollees' incomes, meaning they could have misrepresented their incomes to qualify for bigger subsidies."

On the Health Care Freedom for Patients Act:

"Senator Cassidy and I introduced a sound plan earlier this week. Our bill, the Health Care Freedom for Patients Act, is based on an idea endorsed by President Trump and by many of our colleagues: Americans, not insurance companies, should control their own health care spending.

"Americans could use the permanent, original premium tax credits to purchase qualified bronze plans with a Health Savings Account (HSA) attached, and they would then receive monthly contributions into that HSA, totaling $1,000 to $1,500 annually. Instead of lining the pockets of big insurance companies, like these subsidies, our HSA contributions would help patients pay expenses not covered by their insurance plan.

"When patients can control their own care, they seek the most appropriate treatment options for their individual circumstances, incentivizing care providers to compete for patients by improving prices and care outcomes."

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Full remarks as prepared for delivery:

Tomorrow, this chamber will have the opportunity to chart a new path forward on health care in this country. Senators will be given the choice to extend the Biden COVID bonuses for another three years, or to support health care reforms that will actually expand options, reduce premiums and give power to patients instead of insurance companies.

Both sides agree the cost of health care is too high. But we need to address the root causes of the explosive increase in health care costs, rather than mask them with unsustainable spending.

We are told the expiration of the enhanced Obamacare subsidies is a crisis, and that there is no time left to do anything but extend them.

If there is a crisis coming, it is entirely of the Democrats' making. My colleagues on the other side of the aisle created the premium tax credits as part of the Obamacare system, because they did not trust their own policy to make health insurance affordable without shifting the burden of paying for it from enrollees to taxpayers.

When the original premium tax credits failed to bring down premiums, they enhanced the tax credits. And when that did not work, they extended the enhancements. They did all this without a single Republican vote.

They also chose the current expiration date they now say must be changed. They created the cliff they now oppose.

Our colleagues on the other side of the aisle have had years to offer serious suggestions on how to reform the Obamacare subsidies, yet every time a deadline approaches, we are told there is no workable option except to extend them again.

It seems these subsidies were never truly meant to be temporary. But they should be. We do not have to go along with their last-minute extension, this time at the cost of $83 billion.

Even our Democratic colleagues recognize our health care system needs reform. Leader Thune recently quoted many of them here on the Senate Floor.

They said, and I quote: "We did fail to bring down the cost of health care." They also said, and I quote again: "Now, right now, we have a broken health care system."

And it is not just rising premiums that prove Obamacare is broken.

We cannot ignore the pervasive fraud in this subsidy program.

The rules governing eligibility for these credits are often flaunted. In September, the Wall Street Journal reported that the rule barring people who can access affordable insurance through their employers is "barely enforced."

Based on the Government Accountability Office's recent audit, income and citizenship verification rules are being ignored, too. Of their 24 fake applications for enhanced tax credits, 22 are receiving subsidies despite submitting falsified paperwork, or no paperwork at all.

One of their applicants even received an email specifically confirming his income verification was approved, even though he never submitted any proof of income in the first place.

The law prohibiting dual enrollment in Obamacare and Medicaid was broken 1.6 million times last year. Of course, Mr. President, unscrupulous insurance brokers have been signing people up for Obamacare plans without their knowledge or consent for profit.

Alarmingly, insurers make the most money through these fraudulent credits, because they retain the money even if no payments are made on behalf of patients.

As just one example, more people are signed up for $0 premium Obamacare plans in Miami-Dade than there are low-income people living there. One woman in Miami said she had been paid five times by brokers to enroll in Obamacare plans.

These are not isolated incidents. This year, 6.4 million Americans were improperly enrolled in enhanced Obamacare subsidies at a cost of $27 billion. The true cost of fraud was likely even higher, because the GAO also found in its report that tens of billions of dollars of subsidies in 2023 had not been reconciled to enrollees' incomes, meaning they could have misrepresented their incomes to qualify for bigger subsidies.

This is the program our colleagues on the other side of the aisle are prepared to extend without changes.

We cannot afford to do so. We cannot afford the $83 billion price tag of their proposal, and we cannot afford to tacitly consent to this fraud. Nor can we afford to tell the hundreds of millions of Americans who are insured through means other than Obamacare that we are uninterested in their rising premiums.

While Republicans did not create this crisis-we did not create Obamacare, we did not create these subsidies and we did not create this expiration date-we have plans to address it.

Senator Cassidy and I introduced a sound plan earlier this week. Our bill, the Health Care Freedom for Patients Act, is based on an idea endorsed by President Trump and by many of our colleagues: Americans, not insurance companies, should control their own health care spending.

Americans could use the permanent, original premium tax credits to purchase qualified bronze plans with a Health Savings Account (HSA) attached, and they would then receive monthly contributions into that HSA, totaling $1,000 to $1,500 annually.

Instead of lining the pockets of big insurance companies, like these subsidies, our HSA contributions would help patients pay expenses not covered by their insurance plan.

When patients can control their own care, they seek the most appropriate treatment options for their individual circumstances, incentivizing care providers to compete for patients by improving prices and care outcomes.

Our plan would also provide funding for cost-sharing reduction payments, which will reduce out-of-pocket costs for low-income patients, save taxpayers money and reduce premiums for benchmark marketplace plans by 11 percent.

Additionally, our bill would ensure federal health funding is spent for the benefit of Americans by strengthening citizenship verification requirements and discouraging states from providing taxpayer-funded health care to illegal aliens.

Some of our Republican colleagues have offered plans of their own this week, which are also worth considering in the future.

We welcome bipartisan cooperation on these proposals, as with the pharmacy benefit manager reforms I recently introduced with Senator Wyden and many of our Finance Committee colleagues.

But we must not simply kick the can down the road yet again. Every time we spend tens of billions of dollars for unsupervised and poorly designed subsidies, as our colleagues are asking us to do, we worsen the health care crisis we all want to solve.