As Congress continues to debate next steps on the Affordable Care Act’s (ACA’s) enhanced subsidies, insurers are urging legislators to consider an extension with additional program integrity measures in place.
AHIP said in a statement Wednesday that “common sense” steps to promote integrity can help mitigate the risks related to fraudulent enrollment in ACA plans or subsidies. The commentary comes after analysts at the Government Accountability Office (GAO) were largely able to enroll in coverage and in the tax credits using fake profiles.
The GAO notes in the report that the Centers for Medicare & Medicaid Services (CMS) took steps to address fraudulent enrollments by improving identity verification and implementing three-way calls to stymie broker misbehavior, which have already had an impact on reducing unauthorized activity, AHIP said.
“With open enrollment underway and 24 million Americans facing the largest-ever spike in healthcare costs in 2026, Congress should take bipartisan action to preserve the health care tax credits and further strengthen program integrity,” AHIP said.
Between the One Big Beautiful Bill Act and program integrity measures the CMS implemented in rulemaking, there is already enhanced income verification protocols and stronger oversight of broker and agent activity, AHIP said.
The organization said additional measures that its members have supported include broader use of multifactor authentication for enrollees, which is in place for state-based marketplaces, as well as stronger eligibility checks for individuals who are shifting between exchange and Medicaid coverage.
AHIP said it also supports bipartisan reforms on the table in Congress to further enhance program integrity.
Legislators have a rapidly closing window to take action for people on the exchanges who are set to see a massive spike in their premiums on Jan. 1. Democrats have pushed for a “clean” extension that mitigates the cost surge for 2026 and buys time for lawmakers to dive fully into broader reform, while Republicans have favored a reform-first approach.
Senate Minority Leader Chuck Schumer, D-N.Y., introduced a plan on Thursday to extend the subsidies for three years, and was promised a vote on the measure by Majority Leader John Thune, R-N.D., to end the lengthy government shutdown.
Other bipartisan plans that include changes to subsidy calculations and other updates have been floated in the House.