A new analysis from the Paragon Health Institute estimates that improper enrollment across Affordable Care Act (ACA) exchanges and Medicaid expansion reached 14.3 million people in 2024 and projected an associated federal cost of about $65 billion.
Paragon’s estimates and how it got to $65B
Paragon’s report combines its earlier estimates of improper exchange enrollment with improper Medicaid expansion enrollment to arrive at 14.3 million allegedly ineligible participants in 2024, which it says equals 34% of total ACA enrollees. The analysis projects that the combined federal cost of this improper enrollment was approximately $65 billion in 2024.
Quoting the report, Paragon writes: “The combined $65 billion cost shows that improper enrollment is not a trivial administrative error. 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.”
Paragon: “Improper” exchange sign-ups rose into 2025
According to Paragon, improper exchange enrollment increased by more than 26% from 2024 to 2025, reaching an estimated 6.5 million total exchange enrollees. A separate Paragon study released in June claimed that almost 27% of all ACA exchange sign-ups were improper in 2026 and projected taxpayers would pay up to $25 billion in improper subsidies “this year.”
Premiums and political reaction
Separately, a KFF analysis published in July found that Obamacare health insurance premiums are likely to rise by double digits again in 2027.
Some Republicans have criticized the ACA for driving up costs. In a Dec. 18, 2025 statement on X, House Speaker Mike Johnson referred to the ACA as “the Unaffordable Care Act,” adding: “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. It was a LIE. Now we know the truth: that Americans are worse off, and the Unaffordable Care Act has failed.”
What’s missing
The source material did not include responses from federal health agencies or ACA administrators to Paragon’s estimates.
