Brand new reports have revealed that improper enrollment across the Affordable Care Act exchange ultimately cost taxpayers billions of dollars in 2024, according to data from a Paragon Health Institute analysis. When Medicaid expansion enrollment and Paragon’s previous estimates of improper exchange enrollment are factored together, a total of 14.3 million people enrolled in the programs in 2024 were actually ineligible.
This improper enrollment across both programs cost the government $65 billion in 2024. Improper exchange enrollment increased by over 26% from 2024 to 2025, hitting 6.5 million total enrollees. “The combined $65 billion cost shows that improper enrollment is not a trivial administrative error,” Paragon’s report says.
“It is the predictable result of programs that reward enrollment while weakening incentives to verify eligibility. Until policymakers change those incentives, improper enrollment will persist in both the ACA exchanges and Medicaid expansion.” A different study published by Paragon released in June 2026 says that almost 27% of all ACA exchange sign-ups were improper this year.
The study also projects that American taxpayers are going to be forking over $25 billion in improper subsidies this year, which is close to a quarter of the total projected ACA subsidy spending for the year. A KFF analysis that was published in July discovered that Obama health insurance premiums are likely to spike by double digits in 2027.
According to a report from The Daily Caller, this data lends major credibility to the claim by Republican lawmakers that Obamacare would lead to a massive increase in healthcare costs across the United States. House Speaker Mike Johnson (R-LA) referred to the program as “the Unaffordable Care Act” back on December 18, 2025 in a statement shared on X.
“Fifteen years ago, Democrats promised the American people that Obamacare, aka the Unaffordable Care Act, would lower costs, improve care, and let patients keep their doctors,” Johnson wrote. “It was a LIE. Now we know the truth: that Americans are worse off, and the Unaffordable Care Act has failed.” The Paragon study also discussed the impact that the COVID-19 pandemic had on improper enrollment.
The report stated that during this time, the Biden administration placed a higher emphasis on getting people enrolled in the program than they did on program integrity, which includes expanding self-attestation of income, weak pre-enrollment verification, and encouraging automatic re-enrollment, among others.
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“Despite the expiration of COVID-era subsidy boosts and Trump administration efforts to reverse negligent Biden-era policies, excessive subsidies, zero premium plans, weak verification systems, automatic re-enrollment, and misaligned incentives for enrollment intermediaries have created a perfect storm for improper and phantom enrollments that drain tens of billions from taxpayers while undermining program integrity,” Brian Blase, Ph.D., president of Paragon Health Institute went on to say.
“The findings also suggest that a significant share of the enrollment declines expected over the next two years will reflect the removal of duplicate, improper, and phantom enrollment rather than losses of legitimate coverage,” Blase continued.
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