THE SET-UP: “Waste, fraud and abuse.” If we all got a dollar every time we heard Republicans chant that mantra in the lead-up to passing Trump’s “One Big Beautiful Bill,” all the Medicaid recipients slated to lose their health insurance after the 2026 midterms … still wouldn’t be able to afford health insurance.
And they are not alone in that predicament.
That’s because the GOP didn’t just single-out millions of poverty-level Americans who got health insurance thanks to the Affordable Care Act’s Medicaid expansion. They also chose to sunset the ACA’s premium tax credits for Americans who who make more than $21,597 per year. That amount is 138% of the Federal Poverty Level (as of 2025), which is the cut-off for ACA-expanded Medicaid. Beyond that, Americans are eligible for the premium tax credits set to expire at the end of the year. I’ll let the Kaiser Family Foundation explain it:
Since 2014, the ACA has capped how much subsidized enrollees pay for their health insurance premiums at a certain percent of their income, on a sliding scale, with the federal government covering the remainder in the form of a tax credit. Enhanced tax credits work by further lowering the share of income ACA Marketplace enrollees pay for a plan. For example, with the enhanced tax credits in place, an individual making $28,000 will pay no more than around 1% ($325) of their annual income towards a benchmark plan.
That’s the “Obamacare subsidy” the Democrats and Rep. Marjorie Taylor Greene want to extend. Should they fail, the individual cited in KFF’s example would…
….pay nearly 6% of their income ($1,562 annually) towards a benchmark plan in 2026. In other words, if the enhanced tax credits expire, this individual would experience an increase of $1,238 in their annual premium payments net of the tax credit.
Keep in mind, that’s for a relatively low-income individual who likely still qualifies for a much smaller tax credit. The rest, though, will not. Many of them will be “hit by a ‘double whammy’ of losing their entire tax credit and being on the hook for rising premiums.”
Here’s how that works:
Enrollees with incomes above 400% of poverty will be subject to large increases in premium payments if enhanced premium tax credits expire. On average, a 60-year-old couple making $85,000 (or 402% FPL) would see yearly premium payments rise by over $22,600 in 2026, after accounting for an annual premium increase of 18%. This would bring the cost of a benchmark plan to about a quarter of this couple’s annual income, up from 8.5%.
By the way … an “annual premium increase of 18%”? Isn’t that exactly the kind of health insurance gouging that made Luigi Mangione a cult hero?
Well, that isn’t stopping the health insurance industry. As KFF notes…
Fueled by rising health care costs and the expiration of the enhanced premium tax credits, insurers are proposing the largest rate increases in 2026 since 2018, the last time uncertainty over federal policy changes contributed to sharp premium increases.
Hmmm … I wonder who was president in 2018? And who controlled Congress?
As for the “rising health care costs” … take a look at these comparisons complied by GoBankingRates for a piece on a “booming” medical tourism industry “that Fortune Business Insights projects to grow from $38.2 billion in 2025 to $162.8 billion by 2032”:
India
The Times of India recently reported on its home country’s booming medical tourism industry, which continues to draw Americans with the promise of world-class medical care at far below half the cost for many of the most common procedures:
Heart bypass surgery: $5,000 to $8,000 versus $70,000 to $150,000 in the U.S.
Knee replacement surgery: $4,000 to $6,000 versus $30,000 to $50,000 in the U.S.
Kidney transplant: $7,000 to $12,000 versus $200,000 to $300,000 in the U.S.
Annual individual health insurance premium: $120 to $300 versus more than $8,000 in the U.S.
Mexico
CMQ Hospital is a healthcare system and hospital network spanning several regions of Mexico, known for specialized services and comprehensive medical care. It also gathers and compiles data on global costs for treatments and procedures from the roughly 1 million mostly American and Canadian medical tourists who seek healthcare in Mexico every year, according to their website.
Here are a few of the many treatments it lists that cost less than half their Stateside price:
Angioplasty: $11,500 versus $28,200 in the U.S.
Lasik (both eyes): $1,900 versus $4,000 in the U.S.
Hysterectomy: $4,500 versus $15,400 in the U.S.
Singapore
Pacific Prime is an insurance firm that sells global medical insurance plans in Singapore, the U.S., Thailand, Hong Kong, Australia, Indonesia and a half-dozen other countries. Its data on pricing in Singapore’s highly rated healthcare system offers the following average cost comparisons.
Heart valve replacement: $12,500 versus $160,000 in the U.S.
Hip replacement: $12,000 versus $43,000 in the U.S.
Spinal fusion: $9,000 versus $62,000 in the U.S.
Somehow, the almost comical discrepancy between procedures in the US and dozens of other countries didn’t attract the same attention from lawmakers as “young, able-bodied men” who, the GOP would have us believe, are living the Life of Riley by defrauding Medicaid.
To the contrary, every assessment I’ve seen found most of the waste, fraud and abuse is committed by providers and insurers, not patients.
Just today The Wall Street Journal exposed the “booming” rehab industry’s “multimillion-dollar problem” with fraud:
The rehabs are often in locations that people might be tempted to travel to, such as beachside cities in Florida. It’s become especially prevalent in California, where operators have discovered a steady stream of revenue by luring people with addiction from across the country and billing their private insurance. Lawsuits and federal cases allege that rehabs can charge insurance hundreds of thousands of dollars for a few months’ stay, but offer little in the way of treatment.
The patients are rounded-up by professional wranglers…
Patients often come through recruiters—widely known as body brokers in the industry—who are paid to target people addicted to drugs with promises of recovery in glamorous California seaside rehabs. Many sign patients up for private insurance plans that offer high reimbursement rates and few restrictions, according to insurance experts. They focus on rural areas with high rates of drug use and few options for rehab, so they can argue to insurers that travel is necessary.
Patients themselves rarely pay premiums. Instead, brokers help them purchase plans under the Affordable Care Act, where federal subsidies can mean no out-of-pocket costs for people below a certain income. They also broker patients who are on their parents’ insurance.
Federal and state law prohibits paying for patient referrals. But the insurance money is so good that it makes it worthwhile for rehab centers to pay to recruit patients—often referred to as clients—and fly them across the country.
In a real sense, addicts are cash cows these facilities milk until the money runs dry. Then they are put out to pasture…
When the money runs out, they kick the patients out without support or referrals, regardless of whether or not they’ve recovered—a practice known as “patient dumping” or “curbing.”
These dumped patients, financially bereft and often still addicted, end up joining “the swelling ranks of the homeless.”
“They’re just churned like cattle until they’re dead or homeless on the streets,” said Dan Kreitman, who ran the special investigations unit at insurer Centene, and oversees the Healthcare Fraud Prevention Partnership, a partnership between government officials and stakeholders in the healthcare system.
Of course, we didn’t hear a word about this during the hard-sell on “waste, fraud and abuse.” We also didn’t hear any plan to do something about the skyrocketing cost of healthcare. Instead, they scapegoated “able-bodied” Medicaid recipients who are the same working poor who went without healthcare before the ACA covered them with health insurance. But under the banner of eliminating “waste, fraud and abuse” they are about to be kicked off a supposed “gravy train” that leads to treatment for diabetes. And cancer. And any ailment or injury that will now go untreated until they are forced to run up a bill in an emergency room… a bill that will be likely be defrayed by raising the cost of an aspirin in a little white paper cup to $25.
That, in turn, will continue to drive Americans abroad as medical tourists while, at the same time, this wasteful, abusive system entices the rehab industry to drive Americans like cattle to the abattoir. - jp
Hospital Crisis Watch: 500 Health Care Providers Closing or at Risk as the Nation Continues Reeling From the GOP Health Care Crisis
https://www.protectourcare.org/hospital-crisis-watch-500-health-care-providers-closing-or-at-risk-as-the-nation-continues-reeling-from-the-gop-health-care-crisis/
States are cutting Medicaid provider payments long before Trump cuts hit
https://www.npr.org/2025/10/05/nx-s1-5558321/states-are-cutting-medicaid-provider-payments-long-before-trump-cuts-hit
Providers face $32.1B in lost 2026 revenue if enhanced ACA subsidies expire
https://www.fiercehealthcare.com/providers/providers-face-321b-lost-2026-revenue-if-aca-enhanced-premiums-expire
Brace for the Single Largest Spike in Health Insurance Premiums—Ever
https://www.motherjones.com/politics/2025/10/aca-obamacare-premium-shutdown-tax-credit-increase/