The ObamaCare Insurance Fraud Scandal

With all the discussion, no one in the media is explaining why insurance companies supported ObamaCare. The progressive-socialist vision is of a health care system without "greedy" insurance companies. The president on many occasions called ObamaCare a "transitional step" toward government run "single payer" health care. So, why did insurance companies support a law designed to destroy their industry?

They were promised an unaccountable system ripe for massive fraud.

The U.S. Government Accountability Office estimates that $1 out of every $7 spent on Medicare is fraud.

GAO has designated Medicare and Medicaid as high-risk programs, in part due to their susceptibility to improper payments—estimated to be about $65 billion in fiscal year 2011

ObamaCare was sold to insurance companies as a medicare-like direct payment system. A system where the IRS determines an individual's tax credit at the end of the year...after ObamaCare subsidies have been directly payed to insurance companies. If an individual claims too large of a subsidy, the IRS goes after the individual, not the insurance company, to recoup the money.

Let's walk through this. (As we do, imagine President Obama explaining this to insurance executives with a deceptive "come on guys, this is free money" tone.)

John Insurance Consumer signs up for ObamaCare Silver Plan with ACME Insurance Company. John is not eligible for Medicare, but will get $1000 per month in tax credits through ObamaCare for a plan that costs $1400 per month. ACME Insurance Company bills John $400 per month and Uncle Sam is directly billed $1000 per month.

ACME Insurance Company is directly billing ObamaCare $1000 per month for John. If the IRS determines at the end of the year that John is only eligible for $750 per month in subsidies, they go after JOHN not ACME for the difference.  If John is an illegal immigrant, he is exempt from ObamaCare fines.

Notice, if you will, no one in the media is explaining who pays the $1400 per month premium. A $1400 per month premium is a massive out-of-pocket bill. This is where, remember this term, ADVANCEABLE TAX CREDITS come in.

Per Kaiser Family Foundation:

How will premium subsidies be provided? 

Premium tax credits would be refundable and advanceable. A refundable tax credit is one that is available to a person even if he or she has no tax liability. An advanceable tax credit allows a person to receive assistance at the time that they purchase insurance rather than paying their premium out of pocket and waiting to be reimbursed when filing their annual income tax return

The advanceable tax credits are determined by a series of income percentages. It is impossible to know precisely an individual's income at the beginning of the year or when they sign up for ObamaCare. So, insurance companies must ESTIMATE the amount of subsidy they receive directly from ObamaCare.

Do we need to say more?

No, but to spell it out. Medicare is exposed to massive fraud because its direct payments compensate billed claims. The claims are paid up front and are seldom held accountable.  ObamaCare eliminates the fraudulent claims by making them estimates. They are estimates of advanceable premiums. The insurance company being paid the advanceable premium is not liable for bad estimates, individuals are held accountable by the IRS. This incentivizes individuals to report less income and rely more upon government subsidies AND it promises an unaccountable, uncapped fire hydrant of government payments to ACME insurance.

ObamaCare, aka the PPACA, expands medicaid/medicare fraud from over billing by individuals and doctors to over billing by insurance companies. ObamaCare redefines "Insurance Fraud."

How big is the ObamaCare insurance fraud market as promised to insurance industry?  Per Kaiser Family Foundation:

The Congressional Budget Office (CBO) estimates the direct cost of premium and cost-sharing subsidies to be $350 billion from 2010 to 2019, and $8 billion in indirect costs. The cost of the subsidies is a function of the number of people that are eligible for subsidies, and how generous the subsidies are. 

Consider this...An undocumented or even fictitious health consumer named Jose has never filed a tax return. ACME insurance signs him up with a massive advanceable tax credit...

In the best case, ACME insurance is vilified in an "Insurance Fraud" Sting. The more likely outcome is that the fraud would succeed. Jose would be exempt from fines and the tax payer would pay. The corrupt system would continue until it becomes politically expedient to demonize insurance in favor of Single Payer.

This deception strategy was used in the Fast & Furious scandal. The U.S. Department of Justice & ATF sold machine guns, sniper rifles, grenades and other small arms to Mexican drug gangs. The ensuing crisis was intended to push gun control legislation by blaming "gun proliferation" on American gun owners. The ability to blame opponents for progressive policies was also used during the shutdown to blame Republicans for President Obama's shutdown of the government by refusing to delay the ObamaCare mandate.

The Obama Administration Also Committed Fraud in the Inducement Against Insurance Companies

 OSHA standard 1910.1030(e)(2)(ii)(F)
 “lab coats, gowns, smocks, uniforms, or other protective clothing
shall not be worn outside of the work area…”

Insurance companies were swindled along with the American public. The administration appealed to their greed through fraud. President Obama lied about Americans keeping their health insurance under ObamaCare. This lie is causing the loss of tens of millions of insurance customers according to estimates based on the (Un)Affordable Care Act, page 34,552.

Per a deleted and then revised NBC news expose on ObamaCare (pdf of original story): Obama admin. knew millions could not keep their health insurance

That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them. 

...

George Schwab, 62, of North Carolina, said he was "perfectly happy" with his plan from Blue Cross Blue Shield, which also insured his wife for a $228 monthly premium. But this past September, he was surprised to receive a letter saying his policy was no longer available. The "comparable" plan the insurance company offered him carried a $1,208 monthly premium and a $5,500 deductible.
And the best option he’s found on the exchange so far offered a 415 percent jump in premium, to $948 a month.

"The deductible is less," he said, "But the plan doesn't meet my needs. Its unaffordable."
"I'm sitting here looking at this, thinking we ought to just pay the fine and just get insurance when we're sick," Schwab added. "Everybody's worried about whether the website works or not, but that's fixable. That's just the tip of the iceberg. This stuff isn't fixable." 

This suggests why healthcare.gov does not work. It is intended to be a scapegoat when dealing with insurance companies. When insurance executives question why customers are not materializing as promised, the administration points to the Youtube video...oops... the website.  

So what does this all mean?

Between 15 and 93 million Americans will suffer the loss of health coverage. That doesn't matter to the progressive movement because the ideological ends justify the means. Individuals do not matter in ObamaCare because it is not a health care plan. It is an empty promise designed to fail and swindle us into government controlled "single payer" or "universal medicaid" health care.

ObamaCare is NOT a train wreck. It is a jumbo jet crashing into a skyscraper.

Additional San Diego Local Order of Bloggers articles exploring related topics:

• The ObamaCare Bait and Switch- October 30, 2013
• The Coming Obamacare Recession
• It's pretty clear what this is all about
• Obamacare rolls on
• Socialism is a Euphemism for...
• The Party of No...
• ObamaCare Denied for Gun Owners