Government Accounting Office (GAO) investigators reported Wednesday that only two of 24 fake recipients they inserted into the Obamacare program two years ago have been discovered by officials managing the federal health care system, even as 18 of the fakes are receiving as much as $10,000 per month in tax-funded services.

But that wasn’t the worst news made by the GAO report entitled in understated civil service language: “Patient Protection and Affordable Care Act: Preliminary Results from Ongoing Review Suggest Fraud Risks in the Advance Premium Tax Credit Persist.” The GAO is the investigative arm of Congress and is thus a part of the legislative branch of the federal government.

The Advance Premium Tax Credit (APTC) is paid by the government to health care insurance companies to lower the premiums of millions of Obamacare beneficiaries. Eligibility for the APTC was expanded greatly by President Joe Biden in 2021 during the COVID pandemic, then extended in 2022, with a December 31, 2025 expiration date.

President Donald Trump’s One Big Beautiful Bill (OBBBA) of 2025 affirmed the December 31 expiration date, as he and congressional Republicans argued that the APTC, which was intended to limit insurance premium increases, in fact passes along to big health care insurance firms multiple billions of tax dollars every year. The Republicans also argued that the fact that Obamacare requires hundreds of billions of tax dollars to keep premiums at reasonable levels is evidence of the program’s failure to live up to President Barack Obama’s promise that it would lower premiums.

But Democrats in the Senate, who demanded the APTC not be allowed to expire, refused to support an October 1 measure that would have kept the government open through November 21, thus providing Congress time to complete a 2026 budget. The resulting shutdown of the federal government lasted until November 13, making it at 43 days the longest-ever such cessation in official operations in the nation’s capital.

Congressional Democrats are major recipients of campaign contributions from the health care insurance companies that receive the bulk of the APTC funds. Those same companies also spent record amounts on lobbying Congress against the OBBBA in order to preserve the APTC.

The APTC’s future has yet to be determined, but the latest GAO report provides evidence of a federal health care program that is shot through with fraud and mismanagement.

Verification of eligibility for the APTC using applicants’ Social Security numbers (SSN) and tax filings is a huge problem with Obamacare, as GAO reported more than 29,000 cases in Plan Year 2023 and 68,000 in Plan Year 2024 in which the SSNs and tax filings could not be reconciled.

“GAO's preliminary analysis of data from tax year 2023 could not identify evidence of reconciliation for over $21 billion in APTC for enrollees who provided SSNs to the federal [Obamacare] Marketplace for Plan Year 2023. Unreconciled APTC may not necessarily represent overpayments, as enrollees who did not reconcile may have been eligible for the subsidy. However, it may include overpayments for enrollees who were not eligible for APTC,” the GAO report explained.

But GAO uncovered additional evidence that suggests a wider extent of the over-payments and the costs to taxpayers due to poor management by officials in the Centers for Medicare and Medicaid (CMS), which oversees the Obamacare program.

“GAO’s preliminary analyses also identified at least 30,000 applications in plan year 2023 and at least 160,000 applications in plan year 2024 that had likely unauthorized changes by agents or brokers. This can result in consumer harm, including loss of access to medications. In July 2024, CMS implemented a new control to prevent such changes, which GAO is reviewing in its ongoing work,” GAO reported.

The GAO report pointed to multiple weaknesses in the government’s anti-fraud enforcement measures.

“GAO preliminarily identified weaknesses in CMS’s APTC fraud risk management as compared to leading practices. Specifically, CMS has not updated its fraud risk assessment since 2018 despite changes in the program and its controls. Further, CMS’s 2018 assessment may not fully align with leading practices, like identifying inherent fraud risks. Finally, CMS did not use its 2018 assessment to develop an antifraud strategy. Together, these weaknesses appear to hinder CMS’s ability to effectively and proactively manage fraud risks in APTC,” GAO said.

The deal between congressional Republican and Democratic leaders that re-opened the government last month included a promised vote sometime in December on the future of the APTC. President Donald Trump has advocated replacing Obamacare with an expanded Health Savings Account (HSA) that would receive a significant amount of tax-paid pre-funding, and account holders would be able to purchase whatever health care coverage they choose.

But the Trump White House has yet to release any details of such a proposal, and there appears to be little movement in Congress to change the APTC’s expiration date. Democrats argue that health care premiums will explode if the APTC is allowed to expire at the end of this year.

Senator Rick Scott (R-Fla.), the former Republican Florida governor and health care industry executive, is leading a meeting of Senate and House GOPers set to convene Thursday to consider proposals similar to the Trump description.