New Bill Mandates Annual Fraud Risk Report on ACA Subsidies Starting December 2025

The newly introduced Fraud Risk Assessment of Obamacare Subsidies Accountability Act isn’t changing who gets healthcare subsidies, but it is changing how the government watches the money. The core of this bill is simple: It requires the Secretary of Health and Human Services (HHS), working with the Treasury Department, to conduct and submit an annual fraud risk assessment specifically focused on the advance premium tax credits (APTCs), which are the subsidies used to help pay for health insurance premiums under the Affordable Care Act (ACA).

The Annual Report Card on Subsidy Risk

Starting December 31, 2025, and every year after, HHS must send a detailed report to key Congressional committees and the HHS Inspector General. This isn't just a general assessment; it has to follow the specific framework for managing fraud risks laid out by the Comptroller General back in 2015. For anyone receiving subsidies—which is millions of people—this means the government is stepping up its efforts to ensure those payments are going to the right people. The assessment must include a complete list of controls HHS currently uses to prevent fraudulent claims for the advance tax credits. Think of it as a mandatory annual audit focused purely on the risk of people misrepresenting their income or eligibility to get a bigger subsidy than they deserve.

What This Means for Everyday People

If you’re one of the millions who rely on the ACA marketplace and the APTCs to make insurance affordable, this bill primarily affects the behind-the-scenes mechanics. The good news is that greater oversight can help ensure the program remains financially sustainable, meaning the subsidies you rely on aren't being drained by bad actors. However, increased scrutiny often means increased administrative workload for the agencies involved (HHS and Treasury). For beneficiaries, this could eventually translate into slightly more rigorous verification processes or requests for documentation when you sign up or renew your plan, as the agencies try to tighten up any weak spots the annual risk assessment identifies. For the busy contractor or small business owner who already dreads tax season, any new layer of verification could add a little friction to the process, but the trade-off is a more secure system.

Oversight and Accountability

By requiring this annual, standardized report, the bill hands a powerful tool to Congressional oversight committees (like Ways and Means, Finance, and Energy and Commerce). They will get a yearly, structured deep dive into where the program is vulnerable to fraud and exactly what HHS is doing about it. This moves accountability from occasional internal reviews to a mandatory, annual public-facing requirement. While the bill doesn't change the subsidy amounts or who is eligible, it ensures that the plumbing of the ACA subsidy system gets a thorough, yearly inspection, forcing the agencies to constantly update their defenses against fraud and misuse of taxpayer dollars.