GAO flags ACA subsidy errors, fake enrollments
The Government Accountability Office reported last week that the ACA marketplace paid enhanced premium tax credits in error to tens of thousands of accounts in 2023–2024, including duplicate coverage within a single plan year, payments tied to deceased SSNs, and benefits to 18 of 20 fictitious applicants it created. GAO also said it could not identify evidence of reconciliation for more than $21 billion in APTC for plan year 2023 enrollees with SSNs, while emphasizing the findings are preliminary and represent less than 1% of users, as Congress debates whether to extend the expiring COVID‑era subsidy enhancements.
📌 Key Facts
- GAO identified over 29,000 SSNs in 2023 and nearly 68,000 SSNs in 2024 receiving more than one year’s worth of APTC coverage in a single plan year.
- Of 20 fictitious applicants, 18 remained actively covered as of Sept. 2025, with APTC totaling over $10,000 per month.
- GAO could not identify evidence of reconciliation for over $21 billion in 2023 APTC tied to enrollees with SSNs and found about $94 million paid to SSNs associated with deceased recipients.
📊 Relevant Data
In 2024, among ACA marketplace enrollees who reported race or ethnicity (50% of total), 53% were White non-Hispanic, 22% were Hispanic/Latino, 9% were Black non-Hispanic, and 11% were Asian non-Hispanic, compared to U.S. population percentages of approximately 59% White non-Hispanic, 19% Hispanic, 13% Black, and 6% Asian.
Health Insurance Marketplaces 2024 Open Enrollment Report — Centers for Medicare & Medicaid Services (CMS)
In 2023, uninsured rates in the US were 6.5% for White people, 9.7% for Black people, 17.9% for Hispanic people, 5.8% for Asian people, 18.7% for American Indian or Alaska Native people, and 12.8% for Native Hawaiian or Pacific Islander people.
In 2023, poverty rates in the US were 9.5% for White non-Hispanic people, 20.6% for Black non-Hispanic people, 16.6% for Hispanic people, 10.0% for Asian/Native Hawaiian or Pacific Islander non-Hispanic people, and 24.2% for American Indian or Alaska Native non-Hispanic people, with a total population poverty rate of 12.5%.
Poverty Rate by Race/Ethnicity — KFF State Health Facts
In 2024, 92% of ACA marketplace enrollees received Advance Payments of the Premium Tax Credit (APTC), with 44% having household incomes between 100% and 150% of the Federal Poverty Level.
Health Insurance Marketplaces 2024 Open Enrollment Report — Centers for Medicare & Medicaid Services (CMS)