President Trump is moving mountains to reduce healthcare costs.

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 dollars. And he championed direct-to-consumer pharmaceutical sales that cut out price-gouging middlemen.

Despite Trump’s efforts, the executive branch can only fix some of what’s wrong with our healthcare system. The power and responsibility to make transformative and permanent changes largely rest with Congress. With healthcare 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 healthcare system. The health insurance industry should bear 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 stimulus bills — the ironically named American Rescue Plan and Inflation Reduction Act — which used COVID-19 as a pretense to 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 more than $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 the wealthiest 1 percent. Yet Democrats want to make these “temporary” enhanced subsidies permanent. That would mean pouring more public dollars — $350 billion by 2035 — into an insurance system plagued by fraud, waste and abuse. For a party that dreams of a single-payer, socialist healthcare 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. 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, according to one recent estimate.

As bad as the fraud, waste and abuse are within the 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.

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.

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 abuses, Medicare Advantage spends upward 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 healthcare agenda, 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, restore integrity to federal programs, and fulfill a Republican campaign promise to reduce the federal deficit.

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.

Robert Romano is the president of Americans for Limited Government. He wrote this for InsideSources.com.

President Donald Trump (AP Photo/Alex Brandon)