How Florida—Yes, Florida—Complicates Trump’s Obamacare Attacks

THE TRUMP ADMINISTRATION last week announced convictions in a major fraud case against two men accused of enrolling people in the Affordable Care Act under false pretenses and then collecting the commissions.

The men targeted the homeless and people suffering from substance abuse, sometimes coaching them on how to qualify for coverage, according to evidence federal prosecutors presented to a jury in West Palm Beach, Florida. The pair collected millions in fees, while triggering about $180 million worth of federal payments to insurers, before the feds caught on to them.

The conviction was a tribute to the skills of federal investigators and prosecutors. But Trump administration officials highlighted the announcement for another reason, one that should sound familiar to you. They used it to strengthen their case against the Affordable Care Act—a.k.a. Obamacare.

For months, administration officials and their allies have been pointing to stories of fraudulent enrollment as proof the law is a hopeless, wasteful boondoggle. They did so in the spring and summer, to justify some of the Affordable Care Act cuts that were in the Republicans’ One Big Beautiful Bill. And they’re doing so now, as part of the debate over whether to extend the Affordable Care Act’s enhanced subsidies that are set to expire at year’s end.

“They ripped all of us off $180 million—that’s what they took before being stopped,” Mehmet Oz, the Trump administration official who oversees the Affordable Care Act, said in a video accompanying the Justice Department’s announcement on Thursday. “These rackets are real, and we need to fix the Obamacare subsidies that allow it to happen so frequently.”

The argument might sound persuasive, in part because enrollment scams really have been an issue in the Affordable Care Act marketplaces. But there is good reason to think that Oz and other critics of the program are both overstating and mischaracterizing the fraud. There is even more reason to think “fixing” the Affordable Care Act subsidies in the way many Republicans envision is not just wholly unnecessary but likely to be harmful.

Partly that’s because fraud is not an Obamacare problem. It’s an American health care problem, endemic to a system with such high costs and so many confusing paths to coverage. Scams happen all time, including a particular kind that is especially punishing to people with serious medical conditions—and that could actually become more common if Trump and the Republicans get their way on Affordable Care Act subsidies.

To see why, let me tell you about a different story, one that hasn’t become a GOP talking point but is every bit as relevant to the debate now taking place...