Oregon
Biden team’s tightrope: reining in rogue Obamacare agents without slowing enrollment • Oregon Capital Chronicle
President Joe Biden counts among his accomplishments the record-high number of people, more than 21 million, who enrolled in Obamacare plans this year. Behind the scenes, however, federal regulators are contending with a problem that affects people’s coverage: rogue brokers who have signed people up for Affordable Care Act plans, or switched them into new ones, without their permission.
Fighting the problem presents tension for the administration: how to thwart the bad actors without affecting ACA sign-ups.
Complaints about these unauthorized changes — which can cause affected policyholders to lose access to medical care, pay higher deductibles or even incur surprise tax bills — rose sharply in recent months, according to brokers who contacted KFF Health News and federal workers who asked not to be identified.
Ronnell Nolan, president and CEO of the trade association Health Agents for America, said her group has suggested to the Centers for Medicare & Medicaid Services that it add two-factor authentication to healthcare.gov or send text alerts to consumers if an agent tries to access their accounts. But the agency told her it doesn’t always have up-to-date contact information.
“We’ve given them a whole host of ideas,” she said. “They say, ‘Be careful what you wish for.’ But we don’t mind going an extra step if you can stop this fraud and abuse, because clients are being hurt.”
Some consumers are pursued when they respond to misleading social media marketing ads promising government subsidies, but most have no idea how they fell victim to plan-switching. Problems seem concentrated in the 32 states using the federal exchange.
Federal regulators have declined to say how many complaints about unauthorized sign-ups or plan switches they’ve received, or how many insurance agents they’ve sanctioned as a result. But the problem is big enough that CMS says it’s working on technological and regulatory solutions. Affected consumers and agents have filed a civil lawsuit in federal district court in Florida against private-sector firms allegedly involved in unauthorized switching schemes.
Biden has pushed hard to make permanent the enhanced subsidies first put in place during the covid pandemic that, along with other steps including increased federal funding for outreach, helped fuel the strong enrollment growth. Biden contrasts his support for the ACA with the stance of former President Donald Trump, who supported attempts to repeal most of the law and presided over funding cuts and declining enrollment.
Most proposed solutions to the rogue-agent problem involve making it more difficult for agents to access policyholder information or requiring wider use of identity questions tied to enrollees’ credit history. The latter could be stumbling blocks for low-income people or those with limited financial records, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.
“That is the knife edge the administration has to walk,” said Corlette, “protecting consumers from fraudulent behavior while at the same time making sure there aren’t too many barriers.”
Jeff Wu, acting director of the Center for Consumer Information & Insurance Oversight, said in a statement that the agency is evaluating options on such factors as how effective they would be, their impact on consumers’ ability to enroll, and how fast they could be implemented.
The agency is also working closely, he wrote, with insurance companies, state insurance departments, and law enforcement “so that agents violating CMS rules or committing fraud face consequences.” And it is reaching out to states that run their own ACA markets for ideas.
That’s because Washington, D.C., and the 18 states that run their own ACA marketplaces have reported far fewer complaints about unauthorized enrollment and plan-switching. Most include layers of security in addition to those the federal marketplace has in place — some use two-factor authentication — before agents can access policyholder information.
California, for example, allows consumers to designate an agent and to “log in and add or remove an agent at will,” said Robert Kingston, interim director of outreach and sales for Covered California, the state’s ACA marketplace. The state can also send consumers a one-time passcode to share with an agent of their choice. Consumers in Colorado and Pennsylvania can similarly designate specific agents to access their accounts.
By contrast, agents can more easily access policyholder information when using private-sector websites that link them to the federal ACA market — all they need is a person’s name, date of birth, and state of residence — to enroll them or switch their coverage.
CMS has approved dozens of such “enhanced direct enrollment” websites run by private companies, which are designed to make it easier and faster for agents certified to offer insurance through healthcare.gov.
Rules went into effect last June requiring agents to get written or recorded consent from clients before enrolling them or changing their coverage, but brokers say they’re rarely asked to produce the documentation. If CMS makes changes to healthcare.gov — such as adding passcodes, as California has — it would need to require all alternative-enrollment partners to do the same.
The largest is San Francisco-based HealthSherpa, which assisted 52% of active enrollments nationally for this year, said CEO George Kalogeropoulos.
The company has a 10-person fraud investigation team, he said, which has seen “a significant spike in concerns about unauthorized switching.” They report problems to state insurance departments, insurance carriers, and federal regulators “and refer consumers to advocates on our team to make sure their plans are corrected.”
Solutions must be “targeted,” he said. “The issue with some of the solutions proposed is it negatively impacts the ability of all consumers to get enrolled.”
Most people who sign up for ACA plans are aided by agents or platforms like HealthSherpa, rather than doing it themselves or seeking help from nonprofit organizations. Brokers don’t charge consumers; instead, they receive commissions from insurers participating in state and federal marketplaces for each person they enroll in a plan.
While California officials say their additional layers of authentication have not noticeably affected enrollment numbers, the state’s recent enrollment growth has been slower than in states served by healthcare.gov.
Still, Covered California’s Kingston pointed to a decreased number of uninsured people in the state. In 2014, when much of the ACA was implemented, 12.5% of Californians were uninsured, falling to 6.5% in 2022, according to data compiled by KFF. That year, the share of people uninsured nationwide was 8%.
Corlette said insurers have a role to play, as do states and CMS.
“Are there algorithms that can say, ‘This is a broker with outlier behavior’?” Insurance companies could then withhold commissions “until they can figure it out,” she said.
Kelley Schultz, vice president of commercial policy at AHIP, the trade association for large insurance companies, said sharing more information from the government marketplace about which policies are being switched could help insurers spot patterns.
CMS could also set limits on plan switches, as there is generally no legitimate need for multiple changes in a given month, Schultz said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Over the first few weeks of the college basketball season, not many Gonzaga fans were looking at a Dec. 21 matchup between the Bulldogs and Oregon as being one of the Zags’ toughest games on their nonconference schedule, considering the caliber of some of the other power conference teams scattered on the docket throughout November and December.
Nonetheless, Nate Bittle and the Ducks made sure to give general followers of the sport a fun matchup to watch going into the holiday break.
The Ducks (6-6) didn’t make things easy for the Zags (12-1), who managed to come away from the Moda Center on Sunday with their smallest margin of victory in nonleague play, a 91-82 win, thanks in large part to Braeden Smith’s masterful performance in the second half.
With Graham Ike bottled up for most of the night and Braden Huff dealing with foul trouble, Gonzaga’s backup point guard stepped up when it mattered most to steer the Zags toward their eighth win over a power conference team this season.
Smith, who played extra minutes due to an ill Mario Saint-Supéry, got under the Ducks’ skin just when it looked as if Gonzaga’s lead was in jeopardy of switching hands. The former Patriot League Player of the Year at Colgate finished with 21 points, 16 of which came after halftime, and dished out seven assists without committing a turnover in 27 minutes of action off the bench. He accounted for 13 consecutive points during a pivotal stretch in the second half that saw Gonzaga’s lead swell to 15 after Smith dished to Steele Venters for a crucial 3-pointer.
With the win, Gonzaga finished nonconference play with six wins combined over the SEC and Big Ten — five of which were considered Quad 1 or 2 games — and eight wins over top 100-rated KenPom teams (Oregon was No. 74, third-lowest ahead of No. 78 Arizona State and No. 100 Maryland). The Zags won all those games by double-digit margins, making Sunday’s victory over the Ducks their first of the season by fewer than 10 points.
Here’s what Mark Few had to say about Smith’s performance, and more, after the game.
On the pro-Gonzaga crowd in attendance
“We have a great following, and I really, really, really appreciate everybody that showed up today. I mean, that was the plan when Dana [Altman] and I set this thing up. I gotta be honest with you, I thought, we’d have more Zag nation than we had. We usually draw like crazy wherever we go, and especially in the Northwest.”
“So, little disappointed in that, but I was so happy for everybody that did show, and then the teams put on a great show. Quite frankly, those were two high level teams going at it.”
On Braeden Smith and Mario Saint-Supéry
“Braeden was exceptional tonight. Mario’s had the flu — I don’t know what the heck’s going on, but he hasn’t been able to practice this whole week. And he even woke up feeling not as good as we thought he was going to be today. So we tried him a little bit, and God bless him, he couldn’t really function too well out there. So, we leaned on B Smith hard, and he responded big time. He saved us and was huge key to the game.”
On Gonzaga’s success in nonconference play
“I’ve been doing 27 years of this stuff, and we’ve always tried to schedule difficult. Especially this last — I don’t know, 10 years or 12 years; we’ve been trying to schedule to be a number one seed in a [nonconference play]. And I think — I’m sure somebody will dispute this with ‘analytics’ — but I think it’s the best run we’ve had in the nonconference.”
“I mean, literally, with who we’ve played, where we’ve played, how the games have stacked up; it just felt like that, and that’s not taking anything away — I mean, we’ve had teams go undefeated, as you know, to the very, very end of the season. But sometimes we weren’t able to play the type of schedule we played. The COVID year we certainly weren’t, and I can’t, off the top of my head, remember how we did in ’17 or ’19, but certainly not as good as we’ve done in the nonconference. Super proud of these guys.”
On Oregon center Nate Bittle
“We recruited Nate. He comes from a great family and he had a great high school career. It’s great to see him healthy. And then I think when you see him healthy, you can see how skilled he is. And I think when you play him, you forget how big he is.
“And listen, there are a lot of guys in college basketball that are [playing more than four seasons]. He’s not the only one, and they’ve taken advantage of it, and good for them. And until we can get some organization and some rules around this thing, I think we’ll continue to see that.”
On whether the Zags have room for growth
“There’s always [another level to reach]. We’re not even halfway through our season. The teams that continue to get better — I’ve said this every year, you got to continue to get better. Those are the ones that will win and advance in the NCAA Tournament. Teams that get stuck with how they’re playing in late December, it’s not going to happen. So, we have to stay on that growth plane.”
MORE GONZAGA NEWS & ANALYSIS
Ignore the scoreboard. Ignore the stat sheet. Ignore the litany of things that Dan Lanning, Tosh Lupoi, and Will Stein said after the game.
This was an ass-kicking by the Oregon Ducks, who beat the James Madison Dukes 51-34 on Saturday night in the first round of the College Football Playoff. Anyone who tuned in could see that. It doesn’t take advanced stats or high football IQ to see that the Ducks were the better, more talented team, and for the better part of 60 minutes, they did what they wanted to on the field.
Sure, giving up 34 points and over 500 yards of offense to a Group of Six team may not qualify as “championship-level” football to Lanning and his staff. However, if you’re going to mention what Oregon gave up, you have to also mention that those numbers were achieved by the Dukes late in the third and fourth quarter, when Oregon had literal fourth-string guys out there on the field.
Regardless, the standard is the standard in Eugene, and that wasn’t met for half of the game on Saturday. Ultimately, though, the Ducks won and will now move on to face the Texas Tech Red Raiders in the quarterfinals of the CFP. Before we preview that game, though, let’s further dive into this one and see what we can take away from the blowout.
A Pissed Off Dan Lanning
If you want to look at things in a positive manner — which Oregon fans often do not, for some reason — then the result on Saturday night is just about as perfect as you could ask for. The Ducks destroyed their first-round opponent with a zero-stress game from start to finish, knocked whatever rust there may have been off, and left with a pissed off head coach who will be demanding better from his players for the next 10 days leading up to the quarterfinal matchup vs. the Texas Tech Red Raiders.
Sounds pretty great when you put it that way, doesn’t it?
There were a lot of positives to take away from the day, but ultimately, it’s the way that Oregon finished that left Lanning calling this game “bigger sweet” after the game.
“The second half, as a team, we didn’t play the way we needed to be able to play,” Lanning said. “You’re going to find moments like that when you have a big lead to be able to choke somebody out. We didn’t do that.”
While the Ducks didn’t choke JMU out, and instead gave up a 99-yard touchdown drive late in the 4th quarter that allowed the Dukes to cover the 21.5-point spread, it was still a convincing enough win to give Oregon hope for the remainder of the CFP. When the starters were on the field, and the Ducks were clicking, they looked as good as any team we’ve seen in the nation this year, and one that can give a great game to the Texas Tech Red Raiders in the Orange Bowl.
Couple that with a pissed off Dan Lanning who wants more, and you might have a perfect storm brewing in Eugene.
No Rust to be Found
Coming into this game, there was a question about how the Ducks would deal with the rust that likely built up during the three weeks since their last game in the end of November. A year ago, during Oregon’s 25 days off between the Big Ten Championship and the Rose Bowl, we saw Oregon lose a step, which proved fatal against the Ohio State Buckeyes.
If there was any rust that accumulated this year, it was not noticeable against James Madison.
The Ducks’ offense was a freight train early in this game, scoring on average a touchdown every four plays, and displaying an efficiency that we haven’t seen since the Chip Kelly era of Oregon football. At one point late in the second quarter, the Ducks had 34 points on 21 plays, with an average of 16.6 yards per play, 15.0 yards per carry, and 19.9 yards per completion. A few plays later in the third quarter, they took it up another level.
I thought we might see a drive or two stall out in the first quarter of this game because of the rust, but that wasn’t the case. Instead, Oregon became the first team in CFP history to have five different players score five touchdowns on the first five drives of the game.
Rust wasn’t a factor here, to say the least. It will be interesting to see if Texas Tech can say the same thing 10 days from now.
Oregon’s WR Duo
Oregon’s WR health has been in question all year long, but on Saturday night, they finally got good news on that front. Both Dakorien Moore and Gary Bryant Jr. — Oregon’s two leading WRs who have been out since the beginning of November with injuries — suited up and got into the game for the Ducks. Of course, neither had a massive impact — Moore had one catch for five yards, while Bryant didn’t record any stats — but it was a great opportunity for both to knock some rust off and get back into the game before the stretch run of the playoffs.
There’s been an idea that, if Oregon could get healthy at the right time this year, they might be dangerous. Well, they appear to be healthy, with Evan Stewart potentially returning next week as well, and it’s coming when they need it the most.
Benson and McClellan Make Statements
Despite Moore and Bryant Jr. returning to the field on Saturday, it was still clear that Malik Benson and Jeremiah McClellan have their roles in this offense, and they aren’t about to give them up any time soon. For starters, Benson was incredible in this game, hauling in five catches for 119 yards and two touchdowns. The chemistry that he has developed with Dante Moore has been impressive to see, and his ability to use speed to get over the top of the defense is unmatched. He truly has turned into a game-breaking weapon for the Ducks over the past two months.
Similarly, McClellan has really blossomed and become one of the Ducks’ best possession receivers on the roster. His ability to make tough, contested catches dazzles each and every game, and it showed up once again on Saturday night, as he finished with six catches for 83 yards and a touchdown.
Oregon’s offense might be getting Dakorien, Gary, and Evan back in the near future. However, that’s not going to detract from what Malik and Jeremiah can do on the field. Ultimately, it’s only going to make them harder to stop.
Look Out for Dante Moore Draft Buzz
One of the biggest narratives for Oregon this year has been about what QB Dante Moore plans to do after this season: stay in Eugene for another year or head to the 2026 NFL draft.
If he continues to perform like he did on Saturday, then a draft declaration feels like a foregone conclusion.
Moore was magnificent, particularly early on, going without an incompletion until late in the second quarter while spreading the ball around and making big-time plays. In the end, he finished with 313 yards and four touchdowns on 19-of-27 completions, while also adding a rushing TD as well. He also had a pair of interceptions that he would want back, but ultimately, it was an impressive performance.
Now, it will be interesting to see how his NFL stock rises because of it. In the first round of the CFP, there wasn’t particularly much great QB play to speak of, with the likes of Carson Beck, Ty Simpson, Trinidad Chambliss, John Mateer, and Marcel Reed all being the biggest names. Moore was far more impressive than that group.
So how will he compare against the likes of Fernando Mendoza, Julian Sayin, and Gunner Stockton? That’s going to be something to monitor. If he looks anything like he did in Round 1, though, the Ducks have a long CFP run ahead of them, and Moore might be off to the NFL in April.
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The No. 5 Oregon Ducks defeated the No. 12 James Madison Dukes 51-34 in their first-round College Football Playoff matchup on Saturday night at Autzen Stadium. With the win, the Ducks secured their first playoff victory since 2014 and are one of the eight remaining teams with a shot at the national championship. Oregon is looking to secure its first in school history and give generations of Ducks fans a memory that will last a lifetime.
Following the first-round win over James Madison, the Ducks’ national championship odds remained the same. Entering Saturday night’s playoff matchup, Oregon had the fourth-best odds to win the national championship at +800, according to FanDuel Sportsbook.
With the win over James Madison, Oregon still ranks No. 4 in national championship odds at +800. No. 2 Ohio State (+180), No. 1 Indiana (+320), and No. 3 Georgia (+500) are the three teams ahead of the Ducks in odds to win the national championship. The Ducks are tied with their quarterfinal opponent, the No. 4 Texas Tech Red Raiders, at +800.
Oregon’s Dominating Offensive Performance vs. James Madison
Oregon’s offense was red-hot from its opening drive as the Ducks became the first team in CFP history to score a touchdown on its first five offensive possessions. The Ducks had a 34-6 lead heading into halftime with quarterback Dante Moore throwing for 211 yards and recording four total touchdowns, and one interception on 11-of-14 passing in the first half. Moore finished the game throwing for 313 yards, four touchdown passes, and two interceptions on 19-of-27 passing.
Three different Oregon receivers collected touchdowns in the win over James Madison, including Malik Benson, Jeremiah McClellan, and Jamari Johnson. Benson led the Ducks in receiving in the win with five receptions, 119 yards, and two touchdowns.
Oregon running back Jordon Davison led the Ducks in rushing with 10 carries for 90 yards. Dierre Hill Jr. also collected a rushing touchdown, along with six carries for 76 yards in the win. In his first game back from injury, running back Jayden Limar returned a blocked punt for a touchdown.
Concerns On Defense For Oregon?
James Madison’s offense found success in certain moments of the game against Oregon. The Dukes’ first two offensive possessions of the game challenged Oregon’s defense. Two holding penalties led to a blocked field goal on a promising drive for the Dukes, which stalled their offensive momentum in the first half.
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The Dukes scored four touchdowns in the second half, with wide receivers Nick DeGennaro and George Pettaway recording touchdown receptions. Tight end Lacota Dippre and quarterback Alonza Barnett III both recorded rushing touchdowns. James Madison had 509 total yards of offense against Oregon’s defense, compared to the Ducks’ 514.
Despite the win and the Ducks taking out most of their defensive starters in the second half, some fans may walk away disappointed with how Oregon performed defensively during multiple drives in the game. A poor defensive performance won’t cut it if Oregon hopes to make a run at the national championship.
Early Orange Bowl Preview vs. Texas Tech
With the win, Oregon advances to the CFP Quarterfinal, where they’ll face off against the No. 4 Texas Tech Red Raiders in the Orange Bowl on Jan. 1. The kickoff from Hard Rock Stadium in Miami is scheduled for 9 a.m. PT on ESPN
The Orange Bowl matchup between the Ducks and the Red Raiders will be the fourth all-time meeting and the first since Oregon defeated Texas Tech 38-30 in Lubbock in 2023. Oregon leads the all-time series 3-0 against Texas Tech.
Defense will be a massive key in the Orange Bowl, as the Ducks and Red Raiders have two of the best defenses in college football. Whoever makes the most game-changing plays on defense will likely advance to the CFP Semifinal at the Peach Bowl in Atlanta, Georgia, on Jan. 9.
- Game odds refresh periodically and are subject to change.
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