Watchdog Flags 6.2 Million Obamacare Enrollees for Fraud
A prominent conservative healthcare policy organization is raising concerns that millions of Americans may be enrolled in subsidized Obamacare plans without meeting eligibility requirements, a situation it says could cost taxpayers up to $25 billion this year alone.
In a newly released study, the Paragon Health Institute, headed by former Trump economic adviser Brian Blase, estimates that approximately 6.2 million individuals who obtained coverage through Affordable Care Act exchanges in 2025 may not qualify for the subsidies they received.
According to the report, those potentially ineligible enrollees account for roughly 25 percent of all people currently covered through ACA marketplace plans.
The findings arrive as the Trump administration continues its campaign to identify waste, fraud, and abuse in federal programs. The report is likely to intensify scrutiny of Obamacare, a law President Donald Trump has repeatedly criticized.
Drawing on federal enrollment figures and Census Bureau data, Paragon argues that the number of Americans receiving subsidized marketplace coverage substantially exceeds the number who appear eligible based on income information.
“Obamacare enrollment over the last few years has been inflated by improper and phantom enrollees, and those enrollees are expensive to the taxpayer,” Blase told The Washington Post.
Blase said the issue appears especially pronounced in certain states, including Florida and Texas.
“The problem is more severe in states that did not expand Medicaid, because in those states there’s incentives to overestimate income and claim a subsidy,” Blase said.
Federal health officials have previously acknowledged concerns about enrollment accuracy within the ACA system.
A spokesman for the Centers for Medicare & Medicaid Services told The Washington Post that agency estimates indicated as many as 4.4 million enrollments during 2024 may have been improper.
The Government Accountability Office has also highlighted vulnerabilities in the program. In a report released in December, investigators said they were able to exploit weaknesses in the system.
“For example, we were able to get subsidized insurance for fake enrollees.”
Even experts who question some of Paragon’s conclusions have acknowledged that abuse of the enrollment process exists.
“There is clear evidence that, in 2024, rogue brokers improperly enrolled or switched the enrollment of a few hundred thousand people without their permission,” Jason Levitis of the Urban Institute testified before the Senate Finance Committee.
The Trump administration has already begun implementing measures intended to tighten eligibility standards and improve oversight of ACA enrollment.
During an April interview with Blase, CMS Administrator Mehmet Oz commended Paragon’s work investigating potential fraud and abuse within the healthcare program.
“I like using a scalpel, but there are some times you have to use a meat cleaver because the whole system is in such shock that you need to be able to fix it,” Oz said at the time.
Blase credited the administration with taking meaningful steps to address weaknesses in the system and remove questionable enrollments.
“The Trump administration has come in and is trying to clean up some of the obvious stuff,” Blase said.
As part of a broader effort to protect taxpayer funds, the White House’s fraud task force is also expected to review enrollment practices within the Affordable Care Act marketplace and examine whether additional safeguards are needed.
{Matzav.com}
