Many Americans consider Barack Obama the worst President ever.
A bombshell new discovery bolstered that belief.
And that’s because Barack Obama stuck Americans with this awful $65,000,000 bill.
The Numbers Are Worse Than Anyone Admitted
A new Paragon Health Institute report unearthed a staggering figure that puts the full scope of Obamacare’s enrollment fraud problem on full display.
Combining Paragon’s estimates of improper exchange and Medicaid expansion enrollment indicates that 14.3 million people enrolled in those programs in 2024 — or 34 percent of all ACA enrollees — were not eligible. The Paragon Health Institute estimates improper enrollment in the two ACA programs cost the federal government approximately $65 billion in 2024.
That’s not a rounding error. That’s roughly one out of every three people in these programs collecting taxpayer-funded subsidies they had no business receiving.
The price tag works out to $65 billion in improper federal spending in 2024 — about 24 percent of all ACA Medicaid expansion and exchange subsidy spending. California (approximately $13.2 billion) and Florida (approximately $10.5 billion) led all states.
“The combined $65 billion cost shows that improper enrollment is not a trivial administrative error,” Paragon’s report states. “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.”
That quote deserves a second read. The problem isn’t a glitch. The incentives themselves are broken, and the people who built this system either knew that or didn’t care enough to find out.
How the Fraud Machine Actually Works
Insurers benefited from a business model in which taxpayers covered the lion’s share of the premium cost. Fraud rings formed to maximize the commissions insurers paid to brokers and enrollment entities.
Everyone at the table got a cut. The enrollee got free coverage. The broker collected a commission. The insurer pocketed a taxpayer-funded subsidy covering the entire premium. The only party left holding the bill was the working American who had nothing to do with any of it.
The prevalence of fully subsidized coverage led to roughly 4 million phantom enrollees — fictitious applicants created to benefit insurers and brokers, along with those enrolled without their knowledge or who already had other coverage.
One indicator of phantom enrollment is that by 2024, half of exchange sign-ups lacked basic information on race or ethnicity — a sharp increase from the pre-Biden era.
These enrollments involve individuals claiming income between 100 and 150 percent of the federal poverty level to qualify for the largest subsidies, far exceeding the number of potentially eligible people in that income bracket.
In other words, the data shows more people claiming poverty-level incomes to grab maximum subsidies than the Census Bureau says actually exist at that income level. The math doesn’t add up because the applications were never honest to begin with.
Centers for Medicare and Medicaid Services Administrator Mehmet Oz addressed the issue during a White House press briefing. “We believe that 35%, roughly, of the people that are using Obamacare exchanges . . . may not be legit,” Oz said. “And that actual number may translate to 5-6 million people we could be paying premiums for.”
Improper exchange enrollment increased by more than 26 percent from 2024 to 2025 — up to an estimated 6.5 million enrollees. The problem wasn’t shrinking under the Biden administration. It was accelerating.
The Biden Administration Built This and Walked Away
“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,” Paragon Health Institute President Brian Blase said in a statement.
The Biden administration didn’t accidentally stumble into this. It actively dismantled the guardrails. It boosted subsidies through COVID-era emergency measures and then kept those boosts running long past any emergency. It weakened eligibility verification. It allowed automatic re-enrollment without checking whether people still qualified. And when whistleblowers and researchers started raising alarms, Washington shrugged.
The Government Accountability Office testified at a House Judiciary Committee hearing that the exchanges approved 96 percent of fictitious applications for subsidized coverage. GAO also found that $21 billion that taxpayers sent to health insurers as subsidy payments in 2023 has not been properly accounted for and that 68,000 Social Security numbers were enrolled in plans for more than 366 days in 2024.
Ninety-six percent of fake applications got approved. That’s not a failure of oversight. That’s a system with no functioning oversight at all.
In August 2025, the Centers for Medicare and Medicaid Services released data showing a surge in exchange enrollees who never used their health plan — 35 percent of all enrollees in 2024 and 40 percent of fully subsidized enrollees — a percentage double the amount before the Biden COVID bonus subsidies. Insurers received $35 billion in 2024 for exchange enrollees who never used their plan.
Thirty-five billion dollars paid out to insurers for people who never saw a doctor, never filled a prescription, and in many cases may not exist. That’s not healthcare. That’s a money transfer from American workers to insurance companies and the broker networks that game the enrollment system.
House Speaker Mike Johnson has been vocal about the law’s failures. Johnson notably referred to the ACA as “the Unaffordable Care Act” in a statement posted to 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 said.
None of those promises held. Costs went up. Fraud went up. And the people who were supposed to be served by the program found themselves competing for coverage with phantom enrollees and fraud rings.
What the Trump Administration Is Doing About It
Congress and the Trump administration have taken steps to restore program integrity in the exchanges and Medicaid expansion. The most important is that Congress allowed the COVID-era subsidy boosts that drove much of the improper exchange enrollment to expire after 2025. For the administration, enforcement has proved more effective so far than regulatory reforms: CMS ended subsidies for nearly 1.5 million people found ineligible for financial assistance or enrolled without authorization, while its 2025 Marketplace Integrity and Affordability rule was largely undone when a federal court vacated eight of its provisions in June 2026.
A federal court stepping in to block cleanup efforts is exactly the kind of institutional resistance that lets fraud persist. The administration moves to fix the problem. A judge strikes down the fix. The fraud continues. And the taxpayer keeps paying.
The One Big Beautiful Bill also added important Medicaid guardrails. Those reforms represent real progress, but the Paragon numbers make clear that the damage already done runs into the tens of billions.
Additional integrity reforms enacted administratively and legislatively should further reduce improper enrollment over the next two years. The ACA exchanges can only function effectively if taxpayer-funded subsidies are directed to eligible individuals and if enrollment systems are not vulnerable to fraud and abuse. The goal of health policy should not be to maximize enrollment regardless of eligibility or cost. The goal should be to ensure that public resources are directed to the people they are intended to serve.
That last line sounds obvious. But it was apparently not the operating principle of the people who ran these programs for years.
The broader lesson here isn’t complicated. Government-run healthcare programs with weak verification, automatic enrollment, and subsidy structures that reward participation over eligibility will always attract fraud. Always. The incentives guarantee it. And when the people administering those programs are more interested in enrollment numbers than in whether the enrollees are real, the fraud scales to whatever the system will allow.
Sixty-five billion dollars in one year. That’s the bill the Biden administration handed American workers before walking out the door. And the same party that built this system is now positioning itself as the defender of Obamacare against any attempt to clean it up.
A KFF analysis published in July found that Obamacare health insurance premiums are likely to rise by double digits again in 2027. The people who actually pay their own premiums keep getting squeezed while the fraud machine keeps running.
The Trump administration is doing the hard work of pulling ineligible enrollees out of a system that was designed to let them in. But until Congress finishes the job of fixing the underlying incentive structure, Paragon’s researchers will keep publishing reports, and the numbers will keep being staggering.
Sources: Paragon Health Institute, “Obamacare Enrollment Abuse Update: $65 Billion Cost in 2024”; Paragon Health Institute, “The Persistent Obamacare Enrollment Fraud”; The Daily Caller, August 26, 2026; KFF, July 2026