At the center of the report is a dramatic increase in Affordable Care Act enrollment over the past several years. When Biden entered office, approximately 10 million Americans were enrolled through ACA exchanges. By 2024, that number had more than doubled to roughly 22 million participants.
Federal investigators now believe a substantial portion of that growth may not have represented legitimate enrollment.
“By our estimate, improper, phantom, and fraudulent enrollment peaked at 5.6 million people in 2025,” the report states.
The report further warns:
“We estimate 2.6 million improper and phantom enrollments remain, including over 1 million enrollments without a Social Security number.”
Administration officials say investigators uncovered multiple methods allegedly used to exploit the system. In some cases, applicants reportedly understated their income to receive larger taxpayer-funded subsidies than they were legally entitled to obtain. Other individuals allegedly received federal premium assistance despite not meeting eligibility requirements.
Perhaps the most troubling allegation involves what investigators describe as “phantom enrollments.” According to the report, some insurance brokers are accused of enrolling individuals into Obamacare plans without their knowledge or consent in order to collect federal commissions tied to enrollment numbers.
Officials argue that reduced verification requirements made such schemes significantly easier to execute and more difficult to detect.
The Trump administration says it has already taken several steps to tighten oversight and restore safeguards that were previously removed. Those actions reportedly include stricter income verification procedures, increased screening for duplicate Medicaid enrollments, the elimination of certain special enrollment periods, and expanded investigations into brokers suspected of fraudulent activity.
Federal officials have also moved to strengthen monitoring and accountability standards for agents and brokers operating within the federal marketplace.
As a result of those efforts, the administration says nearly three million improper or fraudulent enrollments have already been removed from Obamacare exchanges. Even after those removals, approximately 19.2 million Americans remain enrolled in ACA coverage.
Officials insist the goal is not to deny healthcare coverage to eligible Americans but to ensure taxpayer-funded benefits are reaching those who actually qualify under federal law.
“Preserving the fiscal and programmatic integrity of the ACA Exchanges is key to safeguarding taxpayer-funded resources for those that truly need them,” the report states.
“The federal government paying brokers to enroll individuals without their knowledge is not.”
The administration says additional enforcement actions are already underway and that investigations into suspected fraud continue across the federal marketplace.
“The Trump Administration continues to aggressively root out fraud, waste, abuse, and corruption by promulgating new regulations to improve program integrity, investigating suspected improper or fraudulent enrollment, and taking action against agents and brokers committing fraud.”
The report is expected to reignite a long-running political battle over Obamacare and whether stricter eligibility verification is necessary to protect taxpayers. Supporters of the administration argue the findings validate concerns that weakened safeguards can create opportunities for abuse and improper government spending.
For years, critics of relaxed enrollment rules warned that reducing verification requirements could lead to fraudulent applications and excessive taxpayer costs. Defenders of the Biden-era policies, however, maintained that the changes expanded healthcare access and made coverage easier for eligible Americans to obtain.
The debate is now likely to intensify as investigators continue reviewing an estimated 2.6 million additional enrollments that remain under scrutiny.
For President Trump and congressional Republicans, the findings may provide fresh ammunition in their long-running effort to overhaul or replace Obamacare. Trump has spent more than a decade criticizing the law and calling for major reforms. With federal investigators now alleging billions of dollars in questionable payments and millions of potentially improper enrollments, supporters of reform believe the report could add new urgency to efforts aimed at reshaping the nation’s healthcare system.
Whether the investigation ultimately leads to criminal prosecutions, additional enforcement actions, or broader legislative reforms remains to be seen. What is clear is that the administration is signaling that its review of Obamacare is far from over, and officials say more findings could emerge as the ongoing audits continue.
