Breaking the Gridlock Act

Floor Speech

Mr. Speaker, I rise in opposition to $100 billion worth of bailouts for a broken system that is fueled by Democratic mandates.

Mr. Speaker, I rise in opposition to subsidizing insurance plans for wealthy people. Any support for the bill ensures that subsidies go to wealthy families making as much as $600,000 a year.

Mr. Speaker, I rise in opposition to using hard-earned taxpayer dollars to bail Democrats out of their own decision--their own decision--to make this COVID-era spending temporary so that they could give Green New Deal tax breaks to the wealthy for electric vehicles and solar panels.

They had the option. They had the option to make it permanent twice, whether it was in the American Rescue Plan or the Inflation Reduction Act. Instead, they wanted to put their resources into their wealthy environmentalists.

Check the math. Nearly half of all Americans get their insurance from their employer, nearly a quarter from Medicaid, and a bit less than that from Medicare.

Mr. Speaker, only 7 percent of the population relies on ObamaCare marketplace plans. This Chamber should be about helping 100 percent of Americans, and lowering the cost of healthcare and premiums, not just 7 percent.

Mr. Speaker, it is shameful that Democrats are only focusing on 7 percent of the population while ignoring the millions of working families who are struggling to afford healthcare.

Since ObamaCare was enacted, premiums have increased by 80 percent. Since ObamaCare was enacted--let me say that again--the premiums have increased by 80 percent. Deductibles and out-of-pocket costs have skyrocketed. Families worry about medical debt--that is, those who still have access to doctors. In fact, 150 rural hospitals have closed since passage of ObamaCare, and small businesses were crushed under the weight of the new mandates.

Not only did Democrats refuse to fix any of this, but they want to make it permanent at a cost of $400 billion. No thanks, Mr. Speaker.

Mr. Speaker, reverting these tax credits back to the original structure that the Democrats designed means that 93 percent of enrollees will still retain very generous subsidies next year. Mr. Speaker, 60 percent of the enrollees will still have access to a plan at or below $50 a month.

I represent one of the poorest congressional districts in the country, and still, 99.7 percent of my constituents in my district, one of the poorest congressional districts, will be unaffected by this expiration.

This is all about subsidizing the wealthy, so why are we even having this debate? It is because Democrats chose to make these giveaways temporary--not once, but twice, Mr. Speaker--as part of their partisan spending bills. The reason they did so was to shower the rich with Green New Deal subsidies, which they made permanent. We reversed those in the big, beautiful bill.

Mr. Speaker, here is a word you won't hear from Democrats: ``fraud.'' They forced taxpayers to pay up to $27 billion for as many as 6.4 million individuals fraudulently enrolled in the ObamaCare plans. Nearly half of all enrollees--that is, 12 million people--didn't even file one single medical claim, not even a prescription, all year, last year. It sounds like they didn't even know that they had insurance through ObamaCare, but those insurance companies were subsidized, almost half of them, on the exchanges.

If Democrats think that is not a problem, that is pretty scary.

I called on the Government Accountability Office to investigate. They created fictitious ObamaCare applicants with fake documentation, and 100 percent--not some, but 100 percent; not half, but 100 percent--were approved in the first year, and 90 percent are still being subsidized, resulting in checks worth more than $12,000 per month going to insurance companies.

One Social Security number was associated with more than 125 different ObamaCare policies. One Social Security number was tied to more than 125 policies--waste, fraud, abuse. Apparently, the other side doesn't see that. They don't see the truth. In fact, more than 58,000 dead people were being subsidized, according to the Government Accountability Office.

In response, Democrats only brag about higher health insurance enrollment. They are really celebrating. What they are celebrating is subsidizing insurers for people without a pulse. For Democrats, fraud comes first.

Mr. Speaker, Republicans are putting real, living Americans first. Republicans blocked illegal immigrants' access to taxpayer-funded healthcare benefits, then eliminated over $185 billion worth of fraud and waste in the ObamaCare marketplace. For Americans who are eligible, Republicans actually lowered ObamaCare premiums and expanded access to health savings accounts, direct primary care, and telehealth for millions, including ObamaCare enrollees, as part of the Working Families Tax Cuts.

There was $50 billion invested in the healthcare needs of rural communities. The Lower Health Care Premiums for All Americans Act was passed, which also lowered premiums even further, as well as provided more freedom and flexibility for healthcare access and increased competition by negotiating better drug prices for workers.

Mr. Speaker, I will take greater access to affordable healthcare any day over shoveling more tax dollars into Democrats' healthcare fraud schemes. I oppose this legislation, and I reserve the balance of my time.

Mr. SMITH of New Jersey. Mr. Speaker, I thank my good friend for yielding.

Mr. Speaker, Hyde amendment protections need to be added to this bill. Taxpayer funds should not be forced to subsidize the killing of an unborn child by dismemberment or by baby poison pills.

The Hyde amendment was not--I will say it again, was not--included when the ACA was enacted in 2010, nor was it included when President Biden significantly expanded subsidies during COVID.

It has gotten so bad, Mr. Speaker, that, according to a 2025 article by the Kaiser Family Foundation, 12 States, including my own State of New Jersey, absolutely require all plans on the ACA marketplace to cover abortion on demand. We permit abortion until birth in my State, as do many others. That is all covered by ObamaCare.

The House has passed my bill, the No Taxpayer Funding for Abortion Act, on four separate occasions beginning in 2011. It is pending again in this Congress, but every time it has gone over to the Senate, it got nowhere, sadly.

I remember the day, Mr. Speaker, when my friend and colleague, the author of the amendment, Henry Hyde, first learned that about 1 million children were alive because of his amendment. He was overcome with joy. He had a tear in his eye. I was there when it happened, when he found out that 1 million mothers were spared the agony of post-abortion pain, and 1 million children were alive and well, growing up, going to school, playing sports, dating, marrying, and having kids of their own.

Today, that number is estimated at over 2.6 million children not aborted, all because abortion subsidies have been prohibited by the Hyde amendment in Federal Medicaid programs and other HHS programs.

It is time to add the Hyde amendment to the ACA.

I believe it is time, as well, for all of us to face the harsh reality of what abortion does to children and look beyond the slogans and the surface appeal arguments.

The so-called abortion pill, mifepristone, is baby poison. It kills the unborn child by how? Starving the innocent child to death. That is its operation. They can't get food, so they die. Then, the body of that baby is often flushed down the toilet.

We know, however, now, that mifepristone is extremely dangerous to women. A big study, the biggest study ever done, found that 1 in 10 women experienced serious adverse events.

Mr. Speaker, that is not what you hear from the abortion lobby. You hear about how safe it is. It ain't safe. They suffer things like sepsis, infection, and hemorrhaging, all within about 45 days.

Let me also say to my colleagues, another method of aborting a baby is dismemberment. It tears the child's fragile body to pieces and includes decapitation. Until rendered unconscious or dead by this hideous procedure, the baby feels pain with every cut of the knife.

It is no wonder that the polling shows that the majority of Americans do not want public funding for abortion. Abortion is the polar opposite of healthcare.

Mr. SMITH of New Jersey. Mr. Speaker, abortion is not healthcare unless one construes the life of an unborn child to be analogous to a tumor to be excised or a disease to be vanquished.

I appeal to my colleagues: Don't ignore or trivialize the battered victim in the womb. Unborn babies need Members of Congress to be their friends and advocates, not powerful adversaries.

Abortion violence must be replaced with compassion and empathy for women and respect for the weakest and most vulnerable.

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Mr. SMITH of Missouri. Mr. Speaker, I remind this body that the reason why these COVID-era tax credits expired is because the Democrats focused all their resources on helping their wealthy environmentalists with permanent tax credits for electric vehicles and solar panels.

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Mr. SMITH of Missouri. Mr. Speaker, I include in the Record a bombshell GAO report documenting evidence of widespread fraud, with billions of dollars going to fraudulent enrollees, including as many as 58,000 dead people. U.S. Government Accountability Office, Washington, DC, December 3, 2025. Patient Protection and Affordable Care Act: Preliminary Results from Ongoing Review Suggest Fraud Risks in the Advance Premium Tax Credit Persist Hon. Brett Guthrie, Chairman, Committee on Energy and Commerce, House of Representatives. Hon. Jim Jordan, Chairman, Committee on the Judiciary, House of Representatives. Hon. Jason Smith, Chairman, Committee on Ways and Means, House of Representatives.

The Patient Protection and Affordable Care Act (PPACA) provides premium tax credits to those who purchase private health insurance plans and meet certain income and other requirements. Individuals may have the federal government pay this credit to their health insurance issuers in advance on their behalf, known as the advance premium tax credit (APTC), which lowers their monthly premium payments.

Millions of consumers have purchased health insurance plans through the marketplaces established under PPACA. The Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services (HHS), is responsible for maintaining the federal Marketplace and overseeing state- based marketplaces. Under PPACA, states may elect to operate their own state-based marketplace or to use the federal Marketplace. These marketplaces determine eligibility for APTC, based in part on income, and allow individuals to compare and choose among insurance plans offered by participating private health care coverage issuers. CMS estimated it paid nearly $124 billion in APTC for about 19.5 million enrollees for plan year 2024.

Consumers can enroll in health insurance coverage through a marketplace independently or with assistance, such as from an insurance agent or broker. As discussed later in this report, agents and brokers can help a consumer apply for coverage, including for related financial assistance, and enroll in a plan. Assistance from an agent or broker is of no cost to a consumer. Rather, agents and brokers are allowed to receive compensation directly from health insurance issuers in accordance with agreements with those issuers and any applicable state requirements.

Indictments from December 2024 and February 2025 highlight concerns about agent and broker practices in the federal Marketplace. Specifically, the indictments allege that bad actors enrolled consumers in insurance through the federal Marketplace by falsifying information on their applications. Additionally, according to CMS, the agency received approximately 275,000 complaints between January and August 2024 that consumers were enrolled in a plan or had their plan changed without their consent. Such practices can result in wasteful federal spending on APTC for enrollees who are not eligible. 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.

We previously reported that APTC is at risk of fraud. For example, in September 2016, we found that federal and state marketplaces approved coverage for our fictitious applicants. Nearly all of these fictitious applicants remained covered after we sent fictitious documents or no documents to resolve issues with our applications. Further, in July 2017, we found that CMS did not design processes to verify eligibility for APTC, including preventing duplicate coverage.

You asked us to review issues related to fraud risk management in APTC. This report is based on preliminary results and analyses from that ongoing work. Specifically, this report addresses preliminary results from our

1. covert testing of federal Marketplace enrollment controls for plan years 2024 and 2025,

2. analyses of federal Marketplace enrollment data for plan years 2023 and 2024, and

3. evaluation of CMS's fraud risk assessment and antifraud strategy for APTC.

To perform covert testing of federal Marketplace enrollment controls, we created 20 fictitious identities and submitted applications for individual health care coverage in the federal Marketplace. We submitted applications for four of these fictitious identities in October 2024 for coverage through December 2024, which was the remainder of that plan year. We pursued coverage for plan year 2025 for all 20 fictitious identities, including the four identities for which we already submitted applications. Our covert testing for plan year 2025 is ongoing, since the plan year is not yet complete. As a result, we will describe additional details of the 2025 applications in a future report.

Our covert testing included applications submitted independently through HealthCare.gov, which is the federal Marketplace's website, and applications submitted with assistance from an insurance agent or broker. For all our applicant scenarios, we sought to act as an ordinary consumer would in attempting to make a successful application. For example, if, during online applications, we were directed to make phone calls to complete the process, we acted as instructed.

For applications for plan year 2024, our covert tests included fictitious applicants who provided invalid (i.e., never issued) Social Security numbers (SSN). Additionally, we stated income at a level eligible to obtain APTC. As appropriate, we used publicly available information to construct our applications for coverage and subsidies. We also used publicly available hardware, software, and materials to produce counterfeit documents that we submitted, if appropriate for our testing, when instructed to do so. We then observed the outcomes of the document submissions, such as any approvals received or requests to provide additional supporting documentation. The results of our covert testing, while illustrative of potential enrollment control weaknesses, cannot be generalized to the overall enrollment population.

To examine federal Marketplace enrollment for plan years 2023 and 2024, we obtained and analyzed federal Marketplace enrollment and payment data, including APTC information, from CMS. We also matched enrollee SSNs in the data to two additional data sources: (1) Social Security Administration's (SSA) full death file, a database containing records of death that have been reported to SSA, as of November 2024 and (2) April 2025 data from the Internal Revenue Service (IRS) on APTC reconciliation from tax forms filed for tax year 2023. We assessed the reliability of all data sets by performing electronic tests to determine the completeness and accuracy of key fields. We also reviewed agency documentation and interviewed knowledgeable agency officials about the reliability of the data. Overall, we found that the data were reliable for our purposes.

To examine CMS's fraud risk assessment and antifraud strategy for APTC, we reviewed documentation of CMS's policies and fraud risk management activities related to APTC. This included CMS's 2018 fraud risk assessment for APTC. Additionally, we interviewed agency officials about CMS's fraud risk management activities in this program. We reviewed relevant reports from GAO and HHS's Office of the Inspector General. We evaluated information from relevant documentation and interviews of agency officials against relevant leading practices in GAO's A Framework for Managing Fraud Risks in Federal Programs (Fraud Risk Framework).

To support all three objectives, we interviewed CMS officials and representatives from seven stakeholder organizations that represent agents and brokers, state insurance regulators, researchers, and one of the entities that CMS approved to host a non-marketplace website where consumers can apply for and enroll in a plan offered through the federal Marketplace.

The ongoing work upon which this report is based is being conducted in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our preliminary findings and conclusions based on our audit objectives. Additionally, our related investigative work is being conducted in accordance with standards prescribed by the Council of the Inspectors General on Integrity and Efficiency. Background APTC ELIGIBILITY AND ENROLLMENT PROCESSES APTC Eligibility

To qualify for a premium tax credit, individuals must be enrolled in a qualified health plan offered through a marketplace and meet certain criteria. These tax credits can be paid in advance through APTC.

The amount of the premium tax credit varies based on household income and the cost of a benchmark plan. The credit limits what the consumer would pay for that plan to be no more than a certain percentage of their household income. The American Rescue Plan Act of 2021 made temporary changes to premium tax credits by expanding eligibility to higher-income individuals and increasing premium tax credits for lower- income individuals for tax years 2021 and 2022. For example, the law increased the premium tax credit amounts for eligible individuals and families, resulting in access to plans with no premium contributions for those earning 100 to 150 percent of the federal poverty level. It also expanded eligibility for premium tax credits to include certain individuals and families with incomes at or above 400 percent of the federal poverty level. Public Law 117-169--commonly known as the Inflation Reduction Act of 2022--extended these provisions through the end of tax year 2025.

In 2013, CMS developed the Data Services Hub (Hub) to help verify applicant eligibility in an automated manner. To do so, the Hub matches applicant information, such as SSN and estimated income, against trusted data sources. These sources include records from SSA and IRS. In the federal Marketplace, the system generates an inconsistency when data matching processes are not able to verify applicant information against the Hub's trusted sources. When an inconsistency is generated, applicants are instructed to provide documentation to support information on their applications that cannot be verified by the Hub's data matching. Marketplaces and Enrollment Pathways

States, along with the District of Columbia, may elect to rely on the federal Marketplace or operate their own health insurance marketplace.

The federal Marketplace offers multiple pathways to enroll in health insurance coverage and receive APTC. Consumers in states that use the federal Marketplace may enroll in coverage through the pathway known as HealthCare.gov or an enhanced direct enrollment (EDE) pathway, among others. Role of Agents and Brokers

Consumers seeking to obtain health insurance through the federal Marketplace may receive assistance from agents and brokers who help them apply for coverage, including related financial assistance, and enroll in a health plan. In return, agents and brokers receive payment (commissions or salaries) from the issuers of the health plans. Agents and brokers must be licensed in the state in which they sell plans and registered with CMS to sell plans through the federal Marketplace. According to CMS, most enrollments in the federal Marketplace are assisted by an agent or broker through the EDE and direct enrollment pathways.

CMS is responsible for oversight of agents and brokers in the federal Marketplace and ensuring that they comply with federal rules. Agents and brokers are required to, among other things, obtain and document consumers' consent before assisting them with applying for and enrolling in coverage through the federal Marketplace. For example, consumer consent is required before the agent or broker can

collect or use any personally identifiable information, such as name, date of birth, and SSN;

help a consumer apply for coverage or financial assistance by completing an eligibility application on their behalf; and

actively enroll a consumer in a plan offered through the federal Marketplace.

After a consumer has applied or is enrolled, the agent or broker can also update a consumer's eligibility application or plan selection on their behalf, if the initial consent authorized the agent or broker to do so, or if they obtained subsequent consent for any new actions. Agents and brokers are required to make documentation of consumer consent available to CMS upon request in response to monitoring, audit, and enforcement actions. Fraud Risk Management

The objective of fraud risk management is to ensure program integrity by continuously and strategically mitigating both the likelihood and effects of fraud, while also facilitating a program's mission. The Fraud Risk Framework provides a comprehensive set of leading practices that serve as a guide for agency managers to use when developing efforts to combat fraud in a strategic, risk-based manner. As depicted in figure 2, the framework organizes the leading practices within four components: (1) Commit, (2) Assess, (3) Design and Implement, and (4) Evaluate and Adapt.

In June 2016, the Fraud Reduction and Data Analytics Act of 2015 (FRDAA) required the Office of Management and Budget (OMB) to establish guidelines for federal agencies to create controls to identify and assess fraud risks to design and implement antifraud control activities. The act further required OMB to incorporate the leading practices from the Fraud Risk Framework in the guidelines. The Payment Integrity Information Act of 2019 repealed FRDAA but maintained the requirement for OMB to provide guidelines to agencies in implementing the Fraud Risk Framework.

In its 2016 Circular No. A-123 guidelines, OMB directed agencies to adhere to the Fraud Risk Framework's leading practices. In October 2022, OMB issued a Controller Alert reminding agencies that they must establish financial and administrative controls to identify and assess fraud risks. In addition, the alert reminded agencies that they should adhere to the leading practices in the Fraud Risk Framework as part of their efforts to effectively design, implement, and operate an internal control system that addresses fraud risks. The Federal Marketplace Approved Subsidized Coverage for Nearly All of Our Fictitious Applicants in Plan Years 2024 and 2025, Suggesting Weaknesses Persist

Our covert testing of enrollment controls in the federal Marketplace suggests weaknesses have persisted since our tests in plan years 2015 through 2016. All four of our fictitious applications received subsidized coverage through the federal Marketplace in late 2024. Additionally, although our work is ongoing, as of September 2025 18 of our 20 fictitious applications for plan year 2025 were receiving subsidized coverage. We will continue to monitor the status of these applications during plan year 2025. All Four of Our Fictitious Applicants Received Subsidized Coverage in Late 2024

To test enrollment controls, we developed and submitted four fictitious applications to obtain insurance coverage with APTC through the federal Marketplace. We applied for coverage for these four applicants in October 2024. We submitted the applications outside of the open enrollment period, using a special enrollment period for low-income applicants. In two cases, we applied for coverage directly through HealthCare.gov. In the other two cases, we applied via telephone with assistance from an insurance broker. The brokers that assisted us used EDE systems to submit our applications.

The federal Marketplace approved fully subsidized insurance coverage for all four of our fictitious applicants for November through December 2024. The combined total amount of APTC paid to insurance companies for all four fictitious enrollees was about $2,350 per month. While our fictitious enrollees are not generalizable to the universe of enrollees, they suggest weaknesses in enrollment controls--such as identity proofing and income verification--in the federal Marketplace through both HealthCare.gov and EDE systems.

The results of our covert testing for plan year 2024 are generally consistent with results of similar testing we conducted for plan years 2014 through 2016.

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Mr. SMITH of Missouri. Mr. Speaker, I am prepared to close, and I reserve the balance of my time.

Mr. Speaker, I will remind the body that the reason why these enhanced subsidies are expiring is because the Democrats are the only ones in this Chamber who voted for them to expire on December 31. Apparently, they regret that vote because they focused most of their dollars on making permanent environmental tax policy in the Green New Deal.

Mr. Speaker, they are the only ones who have voted to take away these subsidies. It is laughable, Mr. Speaker, when you hear Members on the other side say that the Republicans created this healthcare crisis.

Guess what. It was the Democrats who wrote the Affordable Care Act that is being debated on the floor right now. They are upset because, as of December 31, it reverted back to the Affordable Care Act, which they have championed, what they passed, not Republicans, Democrats.

Mr. Speaker, the healthcare crisis is clearly created by the Democrats.

We have highlighted the fraud and waste within the exchanges. More than half of the people on the exchanges did not even file one medical claim last year, but those insurance companies were being subsidized.

I want to remind the American people that not $1 goes to them. It all goes to the big health insurance companies that have been doing very well, while premiums for every single American have been rising for the last decade and a half.

Mr. Speaker, with that, I urge this body to vote ``no.''

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