Senate Panel to Probe Eligibility Verification Process for ACA Subsidies

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The Senate’s Permanent Subcommittee on Investigations (PSI) has launched an inquiry into government subsidies under the Affordable Care Act available primarily in the form of advance premium tax credits. According to PSI’s letter to Secretary Burwell, the premium subsidies for last year were approximately $15 billion and are expected to reach $849 billion over the next ten years. Prompting the inquiry are concerns of improper over-payments with the goal of preventing government waste.

According to the letter, “to ensure proper oversight, the U.S. Senate Permanent Subcommittee on Investigations is initiating an independent review of the Department’s efforts to assess eligibility and prevent improper payments through the health insurance exchanges established pursuant to the ACA.” Federal law requires the Department of Health and Human Services (HHS) to verify eligibility for the available subsidies.

In July 2014 it was revealed that the GAO, as the result of its undercover investigation of the federal exchange, was able to be obtain subsidies through the federal exchange 11 out of 12 times when utilizing false identities. The state-based exchanges have also struggled with eligibility verification acknowledging that they faced with shifting resources to processing applications instead of attempting to resolve the reported eligibility inconsistencies.

The PSI letter sets forth 15 questions to the Department seeking responses by May 29, 2015. The letter cites Senate Resolution 73 (114th Cong.) which empowers the Subcommittee to ensure “the efficiency and economy of operations of all branches of the Government” for its authority.

Read the full contents of the letter here.