You could be a Learing Center and not even know it
Vice President JD Vance’s fraud task force is removing about 760,000 people from Affordable Care Act exchange coverage, according to the Wall Street Journal. Just for reference, the entire population of our great neighbor, North Dakota is around 790,000. Many (likely most) of these do not know they are even signed up.
CMS says that is roughly 315,000 enrollments, with another 419,000 sent for extra checks on income and legal residence. Administrator Mehmet Oz says some of these “enrollees” never existed; others were signed up without knowing it. The White House estimates $2.2 billion in improper subsidies stopped. Brokers face suspensions and a six-month freeze on new agents. Vance cited one ring of 40 agents that funneled 50,000 names into the system.
Brokers are paid to recruit and sign up Obamacare enrollees based on incentives written into the sweeping Affordable Care Act (ACA/Obamacare) when it was implemented. When insurance agents complained that the intent of Obamacare was clearly to dive private health insurance out of business and them with it, they were offered finder’s fees to sign up or upgrade policies for Obamacare.
This is only part of a much larger problem of our public health programs (Medicaid, Medicare and Obamacare) paying tax dollars too enroll people who are dead, make too much money or are on multiple programs without knowing it.
American Experiment’s Peter Nelson’s 2024 report, What the Medicaid Undercount Reveals About the Medicaid ‘Unwinding’ showed what happens when Washington pays first and verifies later. Continuous enrollment during COVID did not just protect people who needed Medicaid. It left millions on the rolls after they got a job, aged into Medicare, or bought other coverage—often without them knowing. American Experiment’s review of Census data found that growth in the Medicaid undercount—largely people who did not know they had Medicaid—accounted for about 70 percent of total Medicaid enrollment growth from 2019 to 2022. Managed-care underwriting gains jumped to $9.1 billion in 2021 and again in 2022 after averaging about $1.5 billion before the pandemic. In February 2024 Nelson also warned that Biden-era rules threatened states with new reporting mandates and penalties while they tried to unwind that mess—changing the bargain after states had already accepted extra federal match for continuous coverage.
Now American Experiment is looking deeper into the improper payment and fraud that is crippling our health care system and one thing is crystal clear, fraud is being fed by improper enrollment of ineligible enrollees.
In August 2025 CMS data, showed nearly 12 million individual-market enrollees generated zero medical claims—triple the pre-boost figure—so taxpayers sent tens of billions to insurers and middlemen coverage nobody used. Stack those phantom ACA plans next to phantom Medicaid enrollees and you are not looking at a rounding error. You are looking at an irresistible fortune.
Minnesota lives this twice. Medicaid spending here nearly doubled from $12.3 billion in FY 2019 to a projected $24 billion in FY 2026; cost per enrollee rose from about $11,280 to $20,280. We have estimated as many as one in five Minnesota Medicaid “recipients” were phantoms—dead, out of state, on another program, or unaware.
Vance should consider an automatic appeal process that will reduce the risk of eligible enrollees being kicked off the program due to paperwork snafus. If not, opponents will seize on these rare instances to discredit the entire process; needed to shut off the fraud spigot.
Critics will also call Vance’s purge a coverage cut. Removing a name that was never a patient is not a cut. It is an audit. Verify first. Pay second. That is the only way a safety net stays a safety net.
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