Insurance Fraud Accountability Act

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Bill ID: 119/s/976
Last Updated: March 17, 2026

Sponsored by

Sen. Wyden, Ron [D-OR]

ID: W000779

Follow the money

The bill

Insurance Fraud Accountability Act

S. 976, 119th Congress — read as touching Health Insurance.

The sponsor

Sen. Wyden, Ron [D-OR]

Every bill has someone who introduced it. That name is where the paper trail starts.

The money

$116,250 raised

30 itemised contributions to this sponsor, pulled from FEC filings.

The alignment

70% match to Project 2025

This bill's text tracks the "Department of Health and Human Services" section, p. 500-502 of the Mandate for Leadership.

Bill's Journey to Becoming a Law

Track this bill's progress through the legislative process

Latest Action

Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.

November 5, 2025

Introduced

Committee Review

📍 Current Status

Next: The bill moves to the floor for full chamber debate and voting.

🗳️

Floor Action

✅

Passed Senate

🏛️

House Review

🎉

Passed Congress

🖊️

Presidential Action

⚖️

Became Law

📚 How does a bill become a law?

1. Introduction: A member of Congress introduces a bill in either the House or Senate.

2. Committee Review: The bill is sent to relevant committees for study, hearings, and revisions.

3. Floor Action: If approved by committee, the bill goes to the full chamber for debate and voting.

4. Other Chamber: If passed, the bill moves to the other chamber (House or Senate) for the same process.

5. Conference: If both chambers pass different versions, a conference committee reconciles the differences.

6. Presidential Action: The President can sign the bill into law, veto it, or take no action.

7. Became Law: If signed (or if Congress overrides a veto), the bill becomes law!

Bill Summary

Another masterpiece of legislative theater, courtesy of the esteemed members of Congress. Let's dissect this farce, shall we?

**Main Purpose & Objectives:** The Insurance Fraud Accountability Act (S 976) claims to reduce fraudulent enrollments in qualified health plans under the Affordable Care Act (ACA). How noble. In reality, it's a thinly veiled attempt to placate insurance companies and their lobbyists while pretending to address a non-existent problem.

**Key Provisions & Changes to Existing Law:** The bill amends Section 1411(h)(1) of the ACA to impose civil penalties on agents and brokers who provide incorrect information or knowingly commit fraud. Oh, how draconian. The penalties range from $10,000 to $50,000 per individual affected, with a maximum fine of $200,000 for "knowing violations." Wow, that'll surely deter those nefarious insurance agents.

The bill also establishes a verification process for new enrollments and changes in coverage submitted by agents or brokers. Because, you know, the current system is just too lax.

**Affected Parties & Stakeholders:** Insurance companies, agents, and brokers will be thrilled to learn they might face slightly stiffer penalties for their egregious behavior. Meanwhile, consumers will continue to bear the brunt of rising premiums and reduced coverage options.

**Potential Impact & Implications:** This bill is a Band-Aid on a bullet wound. It does nothing to address the underlying issues driving up healthcare costs or improving access to quality care. Instead, it provides a convenient distraction from the real problems plaguing our healthcare system.

In reality, this legislation will likely lead to:

1. Increased administrative burdens and costs for insurance companies, which they'll inevitably pass on to consumers. 2. Reduced competition among agents and brokers, as smaller players are priced out by the increased regulatory compliance costs. 3. A continued lack of transparency and accountability in the healthcare industry, as the root causes of fraud and abuse remain unaddressed.

Congratulations, Congress! You've managed to create a bill that's equal parts toothless and tone-deaf. Now, let's get back to the real business of lining the pockets of your corporate donors.

Related Topics

Healthcare & Insurance Reform
Generated using Llama 3.1 70B (Dr. Haus personality)

💰 Campaign Finance Network

Sen. Wyden, Ron [D-OR]

Congress 119 • 2024 Election Cycle

Total Contributions
$116,250
27 donors
PACs
$0
Organizations
$9,550
Committees
$0
Individuals
$106,700

No PAC contributions found

1
SANTA YNEZ BAND OF MISSION INDIANS
2 transactions
$3,000
2
SHAKOPEE MDWEKANTON SIOUX COMMUNITY
2 transactions
$2,000
3
MOHEGAN TRIBE OF INDIANS OF CONNECTICUT
1 transaction
$1,000
4
SAN MANUEL BAND OF MISSIONS INDIANS
1 transaction
$1,000
5
MS BAND OF CHOCTAW INDIANS
1 transaction
$1,000
6
RENO-SPARKS INDIAN COLONY
2 transactions
$1,000
7
CHOCTAW NATION OF OKLAHOMA
1 transaction
$550

No committee contributions found

1
WINTER, DAVID
1 transaction
$11,600
2
JAIN, TUSHAR
1 transaction
$6,600
3
ROSENTHAL, JOSHUA
1 transaction
$6,600
4
SAMANI, PYAHM
1 transaction
$6,600
5
SEIFF, KEN
1 transaction
$6,600
6
SMITH, BRIAN
1 transaction
$6,600
7
XETHALIS, GREGORY
1 transaction
$6,600
8
WOODS, ANDREW
1 transaction
$5,000
9
FISE, PETER
1 transaction
$5,000
10
PUTALA, CHRISTOPHER
1 transaction
$5,000
11
VANROEKEL, CAROLINE
1 transaction
$5,000
12
FOGG, ANGELA
1 transaction
$5,000
13
FOGG, PHILLIP JR.
1 transaction
$5,000
14
MAHFOUZ, SAMUEL
1 transaction
$5,000
15
CHASE, DAVID
1 transaction
$4,000
16
YOUNGMAN, ANDREW
1 transaction
$3,300
17
DIXON, CHRIS
1 transaction
$3,300
18
EMERSON, BILL
1 transaction
$3,300
19
ZACHARY, JENNIFER
1 transaction
$3,300
20
TURKISH, JASON
1 transaction
$3,300

Cosponsors & Their Campaign Finance

This bill has 10 cosponsors. Below are their top campaign contributors.

Sen. Duckworth, Tammy [D-IL]

ID: D000622

Top Contributors

10

1
AMERICAN EXPRESS
OrganizationNEWARK, NJ
$6,132
Feb 7, 2023
2
AMERICAN EXPRESS
OrganizationNEWARK, NJ
$605
Mar 3, 2023
3
CITIBUSINESS CARD
OrganizationCOLUMBUS, OH
$347
Jan 10, 2023
4
CITIBUSINESS CARD
OrganizationCOLUMBUS, OH
$254
Feb 7, 2023
5
AMERICAN EXPRESS
OrganizationNEWARK, NJ
$98
Jan 10, 2023
6
CITIBUSINESS CARD
OrganizationCOLUMBUS, OH
$74
Mar 3, 2023
7
KELLY, MICHAEL
WALKUP LAW FIRM • ATTORNEY
IndividualSAN FRANCISCO, CA
$3,300
Oct 7, 2024
8
LISTER, AMANDA
N/A • NOT EMPLOYED
IndividualNEW YORK, NY
$3,300
Oct 17, 2024
9
SUMEY, ROGER
IndividualELLICOTT CITY, MD
$3,300
Oct 11, 2023
10
CHEN, QIANHUI
RENAISSANCE TECHNOLOGIES LLC • ANALYST
IndividualSETAUKET, NY
$3,300
Mar 2, 2024

Sen. Hirono, Mazie K. [D-HI]

ID: H001042

Top Contributors

10

1
TUNICA-BILOXI TRIBE OF LA
OrganizationMARKSVILLE, LA
$3,300
Jun 15, 2023
2
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$2,500
Dec 30, 2023
3
THE CHICKASAW NATION
OrganizationADA, OK
$2,500
Nov 1, 2023
4
MS BAND OF CHOCTAW INDIANS
OrganizationCHOCTAW, MS
$2,000
Jul 7, 2023
5
TUNICA-BILOXI TRIBE OF LA
OrganizationMARKSVILLE, LA
$1,700
Jun 15, 2023
6
POARCH BAND OF CREEK INDIANS
OrganizationATMORE, AL
$1,000
May 23, 2024
7
THE CHICKASAW NATION
OrganizationADA, OK
$800
Nov 1, 2023
8
TONIO BURGOS & ASSOCIATES OF NEW JERSEY, LLC
OrganizationNEW YORK, NY
$500
May 18, 2023
9
CHUAN, JOHANNA
NOT EMPLOYED • NOT EMPLOYED
IndividualHONOLULU, HI
$3,400
Jun 9, 2024
10
MINATOISHI, LORRAINE REIKO
AEPAC • PRESIDENT AND FOUNDER
IndividualHONOLULU, HI
$3,300
Oct 21, 2024

Sen. Klobuchar, Amy [D-MN]

ID: K000367

Top Contributors

10

1
LEECH LAKE BAND OF OJIBWE
OrganizationCASS LAKE, MN
$3,300
Nov 5, 2024
2
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$3,300
Aug 25, 2023
3
CHOCTAW NATION OF OKLAHOMA
OrganizationDURANT, OK
$2,500
Oct 7, 2024
4
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$2,300
Jul 17, 2023
5
ARISTOTLE INTERNATIONAL
CONDUIT TOTAL LISTED IN AGG. FIELD
OrganizationWASHINGTON, DC
$500
Jul 19, 2024
6
SMITH, BRADFORD
MICROSOFT CORPORATION • ATTORNEY
IndividualBELLEVUE, WA
$6,600
Mar 30, 2023
7
SMITH, BRADFORD
IndividualBELLEVUE, WA
$6,600
Mar 30, 2023
8
BADEN, DREW
PROFESSOR • UNIVERSITY OF MARYLAND
IndividualBETHESDA, MD
$6,600
Feb 23, 2024
9
CAUCHY, CONSTANCE
NOT EMPLOYED • NOT EMPLOYED
IndividualMIDLAND, MI
$6,600
Jun 2, 2024
10
BADEN, DREW
IndividualBETHESDA, MD
$6,600
Mar 11, 2024

Sen. Murray, Patty [D-WA]

ID: M001111

Top Contributors

10

1
SAN PABLO LYTTON TRIBE
OrganizationSAN PABLO, CA
$3,300
Oct 26, 2023
2
SAN PABLO LYTTON TRIBE
OrganizationSAN PABLO, CA
$3,300
Oct 26, 2023
3
LOWER ELWHA KLALLAM TRIBE
OrganizationPORT ANGELES, WA
$3,300
Mar 30, 2023
4
LOWER ELWHA KLALLAM TRIBE
OrganizationPORT ANGELES, WA
$3,300
Mar 30, 2023
5
THE CHICKASAW NATION
OrganizationADA, OK
$3,300
Sep 22, 2023
6
AK-CHIN INDIAN COMMUNITY
OrganizationMARICOPA, AZ
$2,500
Nov 13, 2024
7
PUYALLUP TRIBE OF INDIANS
OrganizationTACOMA, WA
$2,500
Feb 22, 2024
8
PUYALLUP TRIBE OF INDIANS
OrganizationTACOMA, WA
$2,500
Sep 30, 2024
9
YAKAMA NATION
OrganizationSEATTLE, WA
$2,000
Oct 11, 2024
10
SISSETON-WAHPETON OYATE
OrganizationSISSETON, SD
$2,000
Jun 30, 2024

Sen. Schatz, Brian [D-HI]

ID: S001194

Top Contributors

10

1
CHEROKEE NATION
OrganizationTAHLEQUAH, OK
$3,300
Dec 30, 2024
2
CATAWBA INDIAN NATION
OrganizationROCK HILL, SC
$3,300
May 17, 2024
3
SENECA NATION OF INDIANS
OrganizationSALAMANCA, NY
$3,300
Apr 17, 2024
4
OTOE MISSOURIA TRIBE OF OKLAHOMA
OrganizationRED ROCK, OK
$3,300
Aug 12, 2023
5
PASCUA YAQUI TRIBE
OrganizationTUCSON, AZ
$3,300
Sep 29, 2023
6
OTOE MISSOURIA TRIBE OF OKLAHOMA
OrganizationRED ROCK, OK
$3,300
Aug 12, 2023
7
HABEMATOLEL POMO OF UPPER LAKE
OrganizationUPPER LAKE, CA
$3,300
Aug 12, 2023
8
HABEMATOLEL POMO OF UPPER LAKE
OrganizationUPPER LAKE, CA
$3,300
Aug 12, 2023
9
TURTLE MOUNTAIN BAND OF CHIPPEWA
OrganizationBELCOURT, ND
$3,300
Aug 12, 2023
10
TURTLE MOUNTAIN BAND OF CHIPPEWA
OrganizationBELCOURT, ND
$3,300
Aug 12, 2023

Sen. Shaheen, Jeanne [D-NH]

ID: S001181

Top Contributors

10

1
TILT LANDSCAPE MAINTENANCE LLC
OrganizationPLYMOUTH, MI
$250
Feb 6, 2024
2
HAWASH, NOUR
BLINK TECH INC. • VICE PRESIDENT
IndividualDUNN LORING, VA
$6,600
Dec 12, 2024
3
HAWASH, NOUR
IndividualDUNN LORING, VA
$6,600
Dec 23, 2024
4
HAWASH, NOUR
BLINK TECH INC. • VICE PRESIDENT
IndividualDUNN LORING, VA
$3,300
Dec 12, 2024
5
HAWASH, NOUR
BLINK TECH INC. • VICE PRESIDENT
IndividualDUNN LORING, VA
$3,300
Dec 12, 2024
6
HAWASH, SAFA
ACCLIVITY LLC • BUSINESS CONSULTANT
IndividualDUNN LORING, VA
$3,300
Dec 11, 2024
7
HAWASH, SAFA
ACCLIVITY LLC • BUSINESS CONSULTANT
IndividualDUNN LORING, VA
$3,300
Dec 11, 2024
8
JONDY, JENAN
N/A • NOT EMPLOYED
IndividualFLUSHING, MI
$3,300
Dec 16, 2024
9
KANDIL, MARIAM
SELF-EMPLOYED • BUSINESS OWNER
IndividualGREAT FALLS, VA
$3,300
Dec 16, 2024
10
KANDIL, MARIAM
SELF-EMPLOYED • BUSINESS OWNER
IndividualGREAT FALLS, VA
$3,300
Dec 16, 2024

Sen. Smith, Tina [D-MN]

ID: S001203

Top Contributors

10

1
OTOE MISSOURIA TRIBE OF OKLAHOMA
OrganizationRED ROCK, OK
$3,300
Jan 23, 2024
2
OTOE MISSOURIA TRIBE OF OKLAHOMA
OrganizationRED ROCK, OK
$3,300
Jan 23, 2024
3
MUSCOGEE CREEK NATION
OrganizationOKMULGEE, OK
$2,000
Dec 28, 2023
4
MIAMI TRIBE OF OKLAHOMA
OrganizationMIAMI, OK
$2,000
Mar 18, 2024
5
MUSCOGEE CREEK NATION
OrganizationOKMULGEE, OK
$2,000
Jul 31, 2024
6
MILLE LACS BAND OF OJIBWE INDIANS
OrganizationONAMIA, MN
$1,300
Jun 27, 2023
7
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,300
Jun 27, 2023
8
MUSCOGEE CREEK NATION
OrganizationOKMULGEE, OK
$1,300
Jul 31, 2024
9
MILLE LACS BAND OF OJIBWE INDIANS
OrganizationONAMIA, MN
$1,200
Jun 27, 2023
10
FOND DU LAC BAND
OrganizationCLOQUET, MN
$1,000
Jun 27, 2023

Sen. Welch, Peter [D-VT]

ID: W000800

Top Contributors

10

1
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 8, 2023
2
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
May 3, 2024
3
FIELD, MARSHALL
THE OLD MOUNTAIN COMPANY, INC. • EXECUTIVE
IndividualCHICAGO, IL
$3,300
May 18, 2023
4
RECHNITZ, JOAN
IndividualRED BANK, NJ
$3,300
Apr 22, 2024
5
RECHNITZ, JOAN
IndividualRED BANK, NJ
$3,300
Apr 22, 2024
6
GORDON, PATRICIA
SELF • MD
IndividualLOS ANGELES, CA
$3,300
May 22, 2024
7
STILLER, ROBERT
NOT EMPLOYED • NOT EMPLOYED
IndividualPALM BEACH, FL
$3,300
Sep 22, 2024
8
STILLER, ROBERT
NOT EMPLOYED • NOT EMPLOYED
IndividualPALM BEACH, FL
$3,300
Sep 22, 2024
9
KALKUT, CRAIG
WEST FRONT STRATEGIES • GOVERNMENT AFFAIRS
IndividualWASHINGTON, DC
$2,500
May 3, 2023
10
SCHWARTZ, MARTIN
MINILEC SERVICE • CONSUMER ELECTRONICS
IndividualCARMEL, CA
$2,000
May 18, 2023

Sen. Van Hollen, Chris [D-MD]

ID: V000128

Top Contributors

10

1
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Jun 3, 2023
2
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
OrganizationPRIOR LAKE, MN
$1,000
Apr 25, 2024
3
BROE, PATRICK
FOUNDER • BROE GROUP
IndividualDENVER, CO
$5,000
Sep 17, 2024
4
BROE, PAULA
NOT EMPLOYED • NOT EMPLOYED
IndividualDENVER, CO
$5,000
Sep 17, 2024
5
FUSTOK, OMAR
SELF EMPLOYED • HEALTHCARE
IndividualHOUSTON, TX
$3,300
Dec 6, 2024
6
HUSAIN, NOMAAN K.
HUSAIN LAW • ATTORNEY
IndividualHOUSTON, TX
$3,300
Dec 5, 2024
7
HUSAIN, NOMAAN K.
HUSAIN LAW • ATTORNEY
IndividualHOUSTON, TX
$3,300
Dec 5, 2024
8
JAVED, MOHAMMAD SHAHID
TRUE INSURANCE SOLUTIONS • REAL ESTATE
IndividualBEAUMONT, TX
$3,300
Dec 4, 2024
9
JAVED, MOHAMMAD SHAHID
TRUE INSURANCE SOLUTIONS • REAL ESTATE
IndividualBEAUMONT, TX
$3,300
Dec 4, 2024
10
JAVED, MUHAMMAD TAHIR
RICELAND HEALTHCARE • CEO
IndividualBEAUMONT, TX
$3,300
Dec 4, 2024

Sen. Blumenthal, Richard [D-CT]

ID: B001277

Top Contributors

10

1
OLSON, LYNDON
NOT EMPLOYED • NOT EMPLOYED
IndividualWACO, TX
$3,300
Dec 20, 2024
2
ALIX, JAY
ALIX PARTNERS • FOUNDER
IndividualBIRMINGHAM, MI
$3,300
Oct 2, 2023
3
KIM, CHRISTINE M.
BBB LLC • ATTORNEY
IndividualNEW YORK, NY
$3,300
Oct 31, 2023
4
ALIX, JAY
ALIX PARTNERS • FOUNDER
IndividualBIRMINGHAM, MI
$3,300
Apr 15, 2024
5
ROURE, RITA
PAGNY - LINCOLN HOSPITAL • PHYSICIAN
IndividualGREENWICH, CT
$3,300
Apr 10, 2024
6
ROURE, RITA
PAGNY - LINCOLN HOSPITAL • PHYSICIAN
IndividualGREENWICH, CT
$3,300
Apr 10, 2024
7
CHAVEZ, TOM
KRUX INC. • CEO
IndividualSAN FRANCISCO, CA
$3,300
Jul 13, 2024
8
CHAVEZ, TOM
KRUX INC. • CEO
IndividualSAN FRANCISCO, CA
$3,300
Jul 13, 2024
9
JONES, JERRY C.
LIVERAMP INC. • EXECUTIVE
IndividualLITTLE ROCK, AR
$3,300
Sep 19, 2024
10
NESSEL, ARIEL
NESSEL DEVELOPMENT • OWNER
IndividualROSS, CA
$3,300
Jul 12, 2024

Donor Network - Sen. Wyden, Ron [D-OR]

PACs
Organizations
Individuals
Politicians

Hub layout: Politicians in center, donors arranged by type in rings around them.

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Showing 89 nodes and 45 connections (78 secondary connections hidden)

Total contributions: $160,534

Top Donors - Sen. Wyden, Ron [D-OR]

Showing top 25 donors by contribution amount

7 Orgs20 Individuals

Industry Impact

Which industries are materially affected by specific provisions in this bill. 1 helped, 1 harmed.

  • −Health Insuranceconfidence 0.90

    Section 2(a) imposes civil and criminal penalties on agents and brokers who provide false or fraudulent information in health plan enrollments, increasing regulatory burden and potential costs for health insurance industry participants involved in enrollment processes.

  • Section 2(b)(1)(C) requires the enrollment verification process to prioritize continuity of coverage and care, including not disenrolling individuals without consent, which supports stable patient coverage and reduces churn for hospitals and health systems.

Who funds the sponsor on these industries

For each industry this bill affects, here's what the sponsor (Sen. Wyden, Ron [D-OR])received from donors associated with that industry during the 2022–present cycles. Donations are not proof of intent — they are a record of who funds the people writing the law.

Industries this bill HELPS

Project 2025 Policy Matches

This bill shows semantic similarity to the following sections of the Project 2025 policy document.AI-enhanced analysis provides detailed alignment ratings.

Department of Health and Human Services

Moderate
Vector: 63%
Pages: 500-502AI Enhanced

AI Analysis:

"The bill focuses on reducing fraud in ACA health insurance exchanges through enhanced penalties and verification processes, which aligns with Project 2025's emphasis on strengthening program integrity and reducing waste, fraud, and abuse in healthcare programs. However, the bill targets ACA exchange enrollments rather than Medicaid specifically, limiting direct overlap."

Key themes:program integrityfraud preventionaccountabilityeligibility verificationconsumer protections

— 467 — Department of Health and Human Services l Direct dollars to beneficiaries more effectively and responsibly. The current funding structure for the Medicaid program rewards expansions, lacks transparency, and promotes financing gimmicks. CMS should: 1. End state financing loopholes. 2. Reform payments to hospitals for uncompensated care. 3. Replace the enhanced match rate with a fairer and more rational match rate. 4. Restructure basic financing and put the program on a more fiscally predictable budget (which should include reform of Disproportionate Share Hospital payments to hospitals).31 l Strengthen program integrity. Make program integrity a top priority and the responsibility of the states. To protect the taxpayers’ investment: 1. Incentivize states. An enhanced contingency fee should be paid to states that successfully increase their efforts to decrease waste, fraud, and abuse. The current system’s IT development 90/10 matching rate should be allowed for improvements in states’ current fraud and abuse and eligibility systems. Innovative programs that show a positive return on investment for both the state and federal governments should be allowed without the onerous waiver process. 2. Improve Medicaid eligibility standards to protect those in need. As Medicaid enrollment continues to climb, it is imperative that there are appropriate and accurate eligibility standards to ensure that the program remains focused on serving those who are in need. To this end, CMS should: a. Hold states accountable for improper eligibility determinations. b. Require more robust eligibility determinations. c. Strengthen asset test determinations within Medicaid.32 3. Conduct oversight and reform of managed care.33 l Incentivize personal responsibility. CMS should allow states to ensure that Medicaid recipients have a stake in their personal health care and a say in decisions related to the Medicaid program. Personal responsibility

Department of Health and Human Services

Weak
Vector: 64%
Pages: 497-499AI Enhanced

AI Analysis:

"The bill focuses on reducing fraud in ACA health insurance exchanges through penalties and verification processes, while Project 2025's HHS section centers on Medicare Advantage, Medicare and Medicaid reform, and rolling back specific Biden-era policies. Both share a concern for program integrity and reducing waste/fraud, but the substantive policies and target programs differ significantly."

Key themes:fraud preventionprogram integrityconsumer protectionsaccountabilityHHS oversight

— 465 — Department of Health and Human Services 1. Make Medicare Advantage the default enrollment option. 2. Give beneficiaries direct control of how they spend Medicare dollars. 3. Remove burdensome policies that micromanage MA plans. 4. Replace the complex formula-based payment model with a competitive bidding model. 5. Reconfigure the current risk adjustment model. 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. l Replace the bureaucrat-driven fee-for-service system with value- based payments to empower patients to find the care that best serves their needs. l Codify price transparency regulations. l Restructure 340B drug subsidies27 toward beneficiaries rather than hospitals. l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. These government price controls will limit access to medications and reduce patient access to new medication. This “negotiation” program should be repealed, and reforms in Part D that will have meaningful impact for seniors should be pursued. Other reforms should include eliminating the coverage gap in Part D, reducing the government share in — 466 — Mandate for Leadership: The Conservative Promise the catastrophic tier, and requiring manufacturers to bear a larger share. Until the IRA is repealed, an Administration that is required to implement it must do so in a way that is prudent with its authority, minimizing the harmful effects of the law’s policies and avoiding even worse unintended consequences.30 Medicaid. Over the past 45 years, Medicaid and the health safety net have evolved into a cumbersome, complicated, and unaffordable burden on nearly every state. The program is failing some of the most vulnerable patients; is a prime target for waste, fraud, and abuse; and is consuming more of state and federal budgets. The dramatic increase in Medicaid expenditures is due in large part to the ACA (Obamacare), which mandates that states must expand their Medicaid eligibility standards to include all individuals at or below 138 percent of the federal poverty level (FPL), and the public health emergency, which has prohibited states from performing basic eligibility reviews. The overlap of available benefits among the various health agencies has led to a complex, confusing system that is nearly impossible to navigate—even for recipients. Recipients are often faced with a “welfare cliff” of benefit losses as they earn above a certain amount, which is contrary to the fundamental purpose of empowering individuals to achieve economic independence. Benefits increasingly involve nonmedical services such as air conditioning and housing, many of which are already handled by departments other than HHS. Improper payments within Medicaid are higher than those of any other federal program. These payments are evidence of the inappropriateness of Medicaid’s expansion, which, stemming largely from public health emergency maintenance of effort (MOE) requirements and the Affordable Care Act, has crowded out the primary targets of these programs: those who are most in need. True health care reform cannot be accomplished in a bureaucratic silo or only through Medicaid and health safety net programs. Reform of the tax code is also essential to genuine, effective reform of our health care system. All components of the health care system should be part of the reform efforts, and it is imperative that the system be modified to assist states with their current programs. Therefore, the next Administration should: l Reform financing. Allow states to have a more flexible, accountable, predictable, transparent, and efficient financing mechanism to deliver medical services. This system should include a more balanced or blended match rate, block grants, aggregate caps, or per capita caps. Any financial system should be designed to encourage and incentivize innovation and the efficient delivery of health care services. Federal and state financial participation in the Medicaid program should be rational, predictable, and reasonable. It should also incentivize states to save money and improve the quality of health care.

Department of Health and Human Services

Weak
Vector: 62%
Pages: 497-499AI Enhanced

AI Analysis:

"The bill targets fraud prevention in ACA exchange enrollments, while Project 2025's HHS section focuses on Medicare Advantage reforms, site neutrality, conscience protection, and physician-owned hospital restrictions; they share only broad themes of HHS oversight and program integrity."

Key themes:HHS oversightconsumer protectionprogram integrityfraud prevention

— 464 — Mandate for Leadership: The Conservative Promise l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. Additionally, regulations should advance site neutrality by eliminating the inpa- tient-only list and expanding the ambulatory surgical center covered procedures list. Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. Whether a medical ser- vice is delivered in a physician’s office, a clinic, or a hospital setting, the Medicare payment for that service should be the same. CMS should expand the application of site-neutral payment options to more settings. Such a policy would level the playing field among providers and remove the financial disabilities for medical professionals who would compete with hospital systems.23 Finally, HHS needs to restore and enhance conscience protection regulations that allow medical practitioners to participate in federal health care programs without being compelled to provide sex changes or similar services. LEGISLATIVE PROPOSALS l Remove restrictions on physician-owned hospitals. The Affordable Care Act (ACA)24 imposed restrictions prohibiting Medicare from reimbursing physician-owned and specialty hospitals. The current restrictions do little more than serve the special interests of large hospital systems and undercut consumer choice of high-quality, specialty care. These restrictions should be removed so that physician-owned hospitals can compete with other hospitals in serving Medicare patients.25 l Encourage more direct competition between Medicare Advantage and private plans. Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically: — 465 — Department of Health and Human Services 1. Make Medicare Advantage the default enrollment option. 2. Give beneficiaries direct control of how they spend Medicare dollars. 3. Remove burdensome policies that micromanage MA plans. 4. Replace the complex formula-based payment model with a competitive bidding model. 5. Reconfigure the current risk adjustment model. 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. l Replace the bureaucrat-driven fee-for-service system with value- based payments to empower patients to find the care that best serves their needs. l Codify price transparency regulations. l Restructure 340B drug subsidies27 toward beneficiaries rather than hospitals. l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. These government price controls will limit access to medications and reduce patient access to new medication. This “negotiation” program should be repealed, and reforms in Part D that will have meaningful impact for seniors should be pursued. Other reforms should include eliminating the coverage gap in Part D, reducing the government share in

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About These Correlations

Policy matches are calculated using a hybrid approach: initial candidates are found using semantic similarity between bill summaries and Project 2025 policy text, then an AI model (Llama 3.1 70B) provides detailed alignment ratings and analysis. Ratings range from 1 (minimal alignment) to 5 (very strong alignment). This analysis does not imply direct causation or intent.

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