Paragon estimates that improper enrollment across the programs cost federal taxpayers roughly $65 billion during 2024. The findings are likely to intensify the long-running political fight over Obamacare, particularly as lawmakers debate federal healthcare spending and the cost of insurance subsidies.
The organization argues that the problem goes beyond isolated paperwork mistakes or individual cases of incorrect enrollment.
“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.”
The report also points to a troubling trend in ACA exchange enrollment.
According to Paragon, the number of people estimated to be improperly enrolled in the exchanges increased by more than 26% between 2024 and 2025. The organization puts the estimated number of improper exchange enrollees at approximately 6.5 million in 2025.
Those numbers come as the federal government continues to spend heavily on ACA subsidies intended to make health coverage more affordable for millions of Americans.
Paragon had already raised similar concerns in a separate study released in June. That analysis estimated that nearly 27% of ACA exchange enrollments were improper in 2026.
The organization further projected that taxpayers could spend as much as $25 billion this year on subsidies connected to improper enrollment. If that estimate holds, the questionable payments would represent close to one-quarter of all projected ACA subsidy spending for 2026.
The findings arrive amid broader concerns about the future cost of Obamacare coverage.
A July analysis from KFF projected that health insurance premiums under the ACA could again increase by double digits in 2027. Rising premiums have become a major political issue as Americans continue to confront higher healthcare expenses.
Republicans have repeatedly argued that the Affordable Care Act has failed to deliver on its promises of making healthcare more affordable and accessible. Conservatives have also pointed to the cost of federal subsidies and the growing role of government in the insurance market as evidence that the law has fallen short.
House Speaker Mike Johnson has been among the prominent Republican critics.
In a Dec. 18, 2025 statement posted to X, Johnson referred to Obamacare as “the Unaffordable Care Act.”
“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. “It was a LIE. Now we know the truth: that Americans are worse off, and the Unaffordable Care Act has failed.”
The Paragon findings are likely to add another layer to that debate, particularly as lawmakers consider whether current eligibility safeguards are sufficient to protect taxpayer dollars.
At the heart of the issue is a basic question: How much federal money is being distributed to people who do not meet the requirements for the programs receiving those funds?
If Paragon’s estimates are accurate, the amount is substantial. Its combined 2024 estimate places improper enrollment at more than 14 million people and the associated federal cost at approximately $65 billion.
Critics of the ACA are likely to use the findings as further evidence that the system needs stronger eligibility checks and tighter oversight. Supporters of the law, meanwhile, may challenge the methodology and conclusions behind the estimates.
Either way, the numbers underscore the enormous financial stakes surrounding Obamacare.
With premiums expected to remain a major concern and federal subsidy spending continuing at a significant level, questions over eligibility and program integrity are unlikely to disappear.
For taxpayers, the debate is about more than political labels. It is about whether billions of federal dollars are reaching Americans who qualify for assistance — and whether government programs have adequate safeguards to ensure that money is spent as intended.
