President Trump is moving mountains to reduce health care costs for the American people. In recent months, he struck agreements with several pharmaceutical giants to offer medicines at lower prices. He issued an executive order forcing hospitals to disclose their prices to patients so Americans who need non-emergency procedures can compare costs and save their hard-earned dollars. And he championed direct-to-consumer pharmaceutical sales that cut out price-gouging middlemen.
But despite President Trump’s tireless efforts, the executive branch can only fix some of what’s wrong with our health care system. The power, and the responsibility, to make transformative and permanent changes largely rests with Congress. With health care affordability at the top of voters’ list of concerns, it’s critically important for congressional Republicans to spend 2026 tackling the rampant fraud, waste, and abuse within our health care system. The health insurance industry should draw the brunt of Congress’s efforts.
Consider the recent debate over the Obamacare “temporary” enhanced subsidies, which nominally funnel taxpayer dollars to individuals, but in reality send the payments straight to insurance companies. This extra spending was part of the Biden-era stimulus bills—the ironically-named American Rescue Plan and Inflation Reduction Act—which used Covid-19 as a pretense to massively increase federal spending.
Democrats are committed to maintaining the truisms that no federal spending program is ever temporary, and subsidies rarely benefit their intended recipients. As Johns Hopkins professor Ge Bai has noted, a West Virginia couple earning over $500,000 could receive subsidized coverage thanks to this taxpayer largess. So could an Arizona family of four making $600,000.
It is absurd that a government $37 trillion in debt is sending money it doesn’t have to wealthiest one percent. Yet Democrats want to make these “temporary” enhanced subsidies permanent. That would mean pouring more public dollars—about $350 billion by 2035—into an insurance system plagued by fraud, waste, and abuse. But for a party that dreams of a single-payer, socialist health care system where taxpayers fund every expense, this is perhaps unsurprising.
Last year, insurers pocketed Obamacare subsidies for nearly 12 million exchange enrollees who were not using their coverage at all. Many of these individuals were “phantom” enrollees—people who didn’t even know they had been signed up for plans, and in some cases were simultaneously enrolled in entirely different plans.
This improper enrollment across the Obamacare marketplaces cost taxpayers $27 billion in 2025 alone, according to one recent estimate.
But as bad as the fraud, waste, and abuse are within the Obamacare exchanges, it’s arguably even worse in other corners of the insurance market.
Consider Medicare Advantage plans, which enroll more than half of Medicare beneficiaries. The program was originally designed to save taxpayers money while offering seniors additional options by harnessing the power of competition and forcing insurers to compete for seniors’ business.
But here too, insurers have found a way to game the system.
In one scheme, insurers try to attract seniors—especially healthy ones with lower costs—to higher-cost plans with unnecessary benefits like ski passes, pet food, and golf clubs.
But even as they attract healthier patients, insurers make them look sicker. They “upcode” patients, making diagnoses appear more severe in order to assign them higher risk scores. On average, Medicare Advantage enrollees’ risk scores are almost 20 percent higher than traditional Medicare enrollees. That allows insurers to extract more money from the younger workers who pay for the program.
Because of these kinds of abuses, Medicare Advantage spends upwards of 20 percent more on its enrollees than traditional Medicare does. One report estimates that spending amounted to about $83 billion in extra taxpayer funds.
As Republicans shape their health care agenda in the new year, they would be wise to put these problems, and the insurance industry masterminds behind them, front and center. Combating insurers’ fraud, waste, and abuse is the most straightforward way to lower costs for families, restore integrity to federal programs, and fulfill Republican campaign promise to reduce the federal deficit.
President Trump has demonstrated the courage required to demand better for the American people and to deliver on his promises. The time is now for congressional Republicans to follow his lead.