You might be shocked to learn that 14.3 million people were improperly enrolled in the ACA exchanges and Medicaid expansion in 2024. It’s a nationwide problem, but it shows up differently by state. In expansion states, it’s mostly Medicaid; in non-expansion states, it’s entirely the exchanges.
This was Obamacare under Joe Biden. Obama had no small part in this. Obamacare was meant to fail and force us into Stalincare.
The price tag: $65 billion in improper federal spending in 2024 — about 24% of all ACA Medicaid expansion and exchange subsidy spending.
California (~$13.2B) and Florida (~$10.5B) lead. California’s is almost entirely Medicaid expansion; Florida’s is entirely on the exchange side.
In 11 states, improper enrollment exceeds 50% of the entire 18–64 population below 150% of poverty.
Oregon is the standout. Paragon estimates that more people are improperly enrolled in Medicaid expansion than there are low-income adults in the state.
What policymakers should do to fix the problem:
- End the perverse 90% federal match that favors able-bodied expansion adults
- Verify income before granting subsidies — no more self-attestation
- End automatic re-enrollment and ex parte renewals
- Require a minimum premium to kill zero-cost phantom plans
- Hold brokers and insurers accountable for improper sign-ups
Until the incentives change, improper enrollment will persist.
And…Democrats want more of this until the system is completely destroyed. When they don’t like something, they destroy it. Then they replace it with something that doesn’t work. That is followed by them doubling down on whatever doesn’t work.
The price tag: $65 billion in improper federal spending in 2024 — about 24% of all ACA Medicaid expansion and exchange subsidy spending.
California (~$13.2B) and Florida (~$10.5B) lead. California’s is almost entirely Medicaid expansion; Florida’s is entirely on the exchange… pic.twitter.com/hqTbQbhtyx
— Paragon Health Institute (@Paragon_Inst) August 26, 2026