Paragon Prognosis

The Massive Win of OBBB’s Medicaid Financing Reforms: HHS Economists Find Lower Health Care Prices on Top of Sizeable Taxpayer Savings

August 18, 2026

Obamacare Enrollment Abuse Update: $65 Billion Cos…

What The New York Times Gets Wrong About Obamacare

The Massive Win of OBBB’s Medicaid Financing Refor…

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Health Care Fraud Roundup: July 11–July 24, 2026

Mark Howell, Liam Sigaud and Brian Blase

Obamacare Enrollment Abuse Update: $65 Billion Cost in 2024

August 26, 2026

Affordable Care Act (ACA/Obamacare), fraud, improper enrollment, Medicaid Expansion, One Big Beautiful Bill (OBBB)

The Affordable Care Act (ACA) expanded health insurance in two main ways: 1) the creation of the government-sponsored exchanges that provide federal subsidies to purchase private health insurance plans and 2) the expansion of Medicaid to able-bodied, working-age adults with incomes up to 138 percent of the federal poverty level (FPL). The exchanges use federal premium tax credits (PTC) to subsidize plans, while the federal government pays at least 90 percent of the cost of Medicaid expansion enrollees.

What The New York Times Gets Wrong About Obamacare

August 19, 2026

Affordable Care Act (ACA/Obamacare), Covid Credits, Premium Tax Credit (PTC)

In an August 15 editorial, The New York Times offered a revisionist history of the Affordable Care Act (ACA) and badly mischaracterized recent actions by congressional Republicans and the Trump administration. Two telltale signs of a misleading ACA analysis are that it fails to explain just how heavily subsidized the individual market has become and that it ignores the widespread growth of improper and phantom enrollees in the ACA exchanges and Medicaid expansion. The Times editorial fails to mention either of these key facts—and contains a host of additional errors.

The Massive Win of OBBB’s Medicaid Financing Reforms: HHS Economists Find Lower Health Care Prices on Top of Sizeable Taxpayer Savings

August 18, 2026

Assistant Secretary for Planning and Evaluation (ASPE), average commercial rate (ACR), Intergovernmental transfer (IGT), One Big Beautiful Bill (OBBB), State Directed Payments (SDP)

The One Big Beautiful Bill (OBBB) contained significant Medicaid financing reforms to address state schemes that have shifted hundreds of billions of dollars in Medicaid costs to federal taxpayers. A new report from the Assistant Secretary for Planning and Evaluation (ASPE) at HHS shows that the benefits extend well beyond the substantial taxpayer savings. By reducing provider taxes and excessive state-directed payments (SDPs), the reforms are projected to lower prices and increase access to care for Americans outside Medicaid. ASPE estimates those benefits at between $502 billion and $875 billion from 2025 through 2034.

False Claims, fraud, Health Care Fraud Dashboard, HHS Office of Inspector General (OIG)

Health Care Fraud Roundup: July 11–July 24, 2026

July 31, 2026

Katherine Hall

Paragon’s Fraud Roundup continues to highlight widespread health care fraud across the country—including the FBI nabbing one of its “Most Wanted Fraudsters”; a group allegedly forcing unnecessary respiratory tests on elderly patients; and multiple cases of billing for lab tests, medical devices, and services that patients did not need or receive. It’s always important to stress that these are stories that came to light between July 11 and July 24—just two weeks of fraud in America.

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False Claims, fraud, Health Care Fraud Dashboard, HHS Office of Inspector General (OIG), kickbacks, program integrity

Health Care Fraud Roundup: June 27–July 10, 2026

July 17, 2026

Katherine Hall

Health care fraud continues to siphon hundreds of millions of dollars from taxpayers, according to the Paragon Health Care Fraud Dashboard. Between June 27 and July 10, the Department of Justice (DOJ) announced numerous charges, settlements, and sentences spanning laboratory testing, behavioral health, and medical transportation, and the Department of Health and Human Services Office of Inspector General (HHS-OIG) stripped funding from a state’s Medicaid fraud unit over insufficient fraud enforcement.

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Brian Blase and Mark Howell

Improper and Phantom Enrollment Predict Exchange Attrition

July 14, 2026

Affordable Care Act (ACA/Obamacare), phantom enrollees

States with the greatest amounts of improper and phantom enrollment consistently experienced the largest declines in effectuated enrollment after program integrity efforts intensified and zero-premium plans became less prevalent. That is what we would expect if much of the observed decline reflects the removal of duplicate, improper, and phantom enrollment rather than the loss of legitimate coverage.

Medicaid Medicare Private Health

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Health Care Fraud Roundup: June 13–26, 2026

July 7, 2026

Katherine Hall

Federal Employees Health Benefits (FEHB), fraud, Health Care Fraud Dashboard, Medi-Cal

As Paragon’s Health Care Fraud Dashboard continues to demonstrate, fraud drains billions of dollars every year from federal health programs, harming patients and taxpayers.

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New HHS Report Finds Decline in ACA Enrollment Results From Removal of Improper and Phantom Enrollees

June 30, 2026

Affordable Care Act (ACA/Obamacare), phantom enrollees

The assistant secretary for planning and evaluation (ASPE) at the Department of Health and Human Services (HHS) released an important report on Friday documenting widespread improper enrollment, phantom enrollees, broker misconduct, and weak eligibility verification in the Affordable Care Act (ACA) exchanges. The report reaches a striking conclusion: exchange enrollment declined by 2.9 million people between 2025 and 2026, and that entire net decline resulted from the removal of improper and phantom enrollees. Despite the decline, ACA enrollment remains far above pre-pandemic levels. February 2026 effectuated enrollment was 85 percent higher than in February 2019—an increase of 8.8 million enrollees.

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Liam Sigaud, Brian Blase and Mark Howell

Defending the Paragon ACA Improper Enrollment Analysis

June 29, 2026

Affordable Care Act (ACA/Obamacare), fraud, improper enrollment, obamacare

The analysis in The Persistent Obamacare Enrollment Fraud replicates and extends our prior work comparing open enrollment sign-up levels with estimates of the plausibly eligible population derived from the Census Bureau’s American Community Survey (ACS).

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Brian Blase and Liam Sigaud

Joan Alker’s Narrative on Child Medicaid Enrollment Is Built on Speculation, Not Evidence

June 1, 2026

Children's Health Insurance Program (CHIP), Medicaid Enrollment

Joan Alker, the Executive Director of the Georgetown Center for Children and Families, has theorized that falling Medicaid and CHIP enrollment among children is a troubling sign that the One Big Beautiful Bill (OBBB) is harming children. More recently, Maya Goldman, citing Alker, repeated a similar argument in Axios, suggesting that declining child enrollment reflects “spillover effects” from the law even before its major provisions have been broadly implemented. Both pieces rely on assumptions that are not demonstrated by the available evidence and overlook several alternative explanations that are at least as plausible—and in many cases more obvious—than the explanations they advance.