Improper ACA and Medicaid enrollment cost $65 billion in 2024

A report from the Paragon Health Institute indicates that improper enrollment in the Affordable Care Act (ACA) exchanges and Medicaid expansion cost the U.S. government approximately $65 billion in 2024.

The analysis suggests that 14.3 million people enrolled in these programs in 2024 were ineligible. Improper exchange enrollment reportedly increased by more than 26% between 2024 and 2025, reaching an estimated 6.5 million enrollees. The report attributes these figures to program incentives that reward enrollment while providing insufficient motivation to verify eligibility.

Additionally, a June study by Paragon claimed that nearly 27% of ACA exchange sign-ups were improper in 2026, projecting that taxpayers could face $25 billion in improper subsidies this year. Separately, a KFF analysis suggests that ACA health insurance premiums are likely to see double-digit increases in 2027.