For weeks, opponents of Republicans’ One Big Beautiful Bill Act have portrayed it as a threat to health coverage for millions of Americans. Some critics have said that it would covertly repeal Obamacare.
If only. The bill is hardly a radical assault on health coverage. It would finally crack down on the waste, fraud, and abuse that has plagued Obamacare — and federal taxpayers — for years.
The bill’s most significant healthcare provisions are intended to bring a greater degree of stability, transparency, and integrity to Obamacare. This is certainly true of the proposed changes to its open enrollment period.
Right now, Americans looking to purchase health coverage on the federally run HealthCare.gov exchange are technically required to do so between Nov. 1 and either Dec. 15 or Jan. 15, depending on the health plan’s start date.
The idea behind this open enrollment period is to prevent people from waiting to purchase coverage until they become sick, as such behavior makes it impossible for insurers to manage risk effectively.
But that isn’t how the policy has worked in practice.
Thanks mostly to reforms implemented during the Biden administration, people can effectively purchase insurance whenever they want by declaring that they qualify for a “special enrollment period.”
People have long been able to qualify for special enrollment because of major life changes like getting married, having a baby, moving, or losing their existing health coverage. The Biden administration expanded special enrollment by allowing anyone with income between 100% and 150% of the federal poverty line — $32,150 to $48,225 for a family of four — to enroll in coverage at any point in the year.
And it did not require people to present evidence that they were eligible.
That defeats the purpose of the open enrollment period — and invites abuse of the system. People who follow the rules end up paying more for coverage, as their peers who wait until they get sick to sign up for coverage via special enrollment force insurers to hike premiums.
The One Big Beautiful Bill Act would address this abuse directly. It would limit open enrollment to the six-week period between Nov. 1 and Dec. 15. And while it wouldn’t abolish the special enrollment period, it would restore it to its original purpose: permitting people who experienced major life changes to sign up for coverage.
Republicans also propose to restore some integrity to the distribution of premium subsidies under Obamacare.
How much an enrollee earns each year has a significant effect on how big a federal subsidy the enrollee receives. Yet the federal government generally doesn’t confirm whether a consumer is reporting income honestly when signing up for a plan.
Such lax enforcement has made the exchanges a breeding ground for fraud. Research from the Paragon Health Institute suggests that nearly 6.4 million exchange customers are improperly enrolled in a marketplace plan this year — at a total estimated cost of $27 billion.
In response, the One Big Beautiful Bill Act establishes new procedures for verifying the income of exchange customers, rather than taking their word for it.
Here, too, the bill doesn’t seek to unravel or repeal a portion of Obamacare. It merely attempts to enforce rules that are already on the books.
Taken together, these provisions could help save taxpayers more than $106 billion.
This attempt to enforce the terms of Obamacare as written hasn’t stopped Democrats from misrepresenting Republicans’ bill as an instrument for depriving Americans of health insurance. Many point to a recent analysis from the Congressional Budget Office, which suggests that the number of Americans without health insurance would increase by 10.9 million in 2034 as a result of the One Big Beautiful Bill Act.
A sizable share of those who would lose coverage are right now benefiting from subsidies obtained either erroneously or fraudulently. They should enroll legitimately in plans available on the marketplaces.
Republicans are trying to minimize such wrongdoing — and secure massive savings for taxpayers in the process.
If Democrats wish to stand up for waste, fraud, and abuse, they are free to do so. But they should at least be honest about it.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is “The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It” (Encounter 2025). Follow her on X @sallypipes. Read Sally Pipes’ Reports — More Here.
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