Improper enrollment across Affordable Care Act exchanges cost American taxpayers billions of dollars in 2024, according to a Paragon Health Institute analysis released Wednesday.
Combining Paragon’s previous estimates of improper exchange enrollment and Medicaid expansion enrollment suggests that 14.3 million individuals enrolled in these programs in 2024, or 34% of total ACA enrollees, were actually ineligible, according to the report. The analysis also projects that improper enrollment across the two ACA programs cost the federal government approximately $65 billion in 2024.
Moreover, improper exchange enrollment rose by over 26% from 2024 to 2025, up to an estimated 6.5 million total enrollees, according to Paragon.
🔥New from Paragon: We estimate 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, entirely the… pic.twitter.com/9NWgj2P0uC
— Paragon Health Institute (@Paragon_Inst) August 26, 2026
“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.”
A separate Paragon study released in June claimed that almost 27% of all ACA exchange sign-ups were improper in 2026. It also projects taxpayers will pay up to $25 billion in improper subsidies this year, nearly a quarter of total projected ACA subsidy spending for the year. (Read more: The Daily Caller, 8/26/2026) (Archive)