After a series of scary headlines, prompted in no small part by fearmongering on the left, Obamacare’s open enrollment period is finally upon us. For those individuals about to explore their options on the Exchange, or those who just want to learn more about the issues behind the government shutdown, here are some fast facts about open enrollment and the enhanced Exchange subsidies currently scheduled to expire on Dec. 31.
1. Nearly half of all Exchange enrollees currently qualify for “free” premiums.
Under the original, circa 2010 version of Obamacare, all households had to pay at least 2 percent of their income toward a “benchmark” silver-level insurance plan. In theory, some households could qualify for a “skinnier” bronze-level insurance plan with no out-of-pocket premium (and a higher deductible as a result), but most households paid something for their coverage.
However, the Covid-era enhanced subsidies passed by the Biden administration allowed households with incomes below 150 percent of poverty to qualify for zero-dollar (i.e., “free”) premiums. Perhaps unsurprisingly, households reporting income below this threshold have risen to nearly half (45 percent) of all Exchange enrollees. While the left views this policy outcome as a feature, most taxpayers would likely consider it a bug, for the obvious reason below.
2. CBO and others have found millions of fraudulent enrollees, costing tens of billions of dollars annually.
The Congressional Budget Office found 2.3 million enrollees “improperly claimed [subsidies] via intentional overstatement of income” in 2025, falsely claiming income just above the poverty level to qualify for subsidies. Applying the average Exchange subsidy to this population results in estimated fraudulent spending of $13.9 billion per year.
A separate study from the Paragon Health Institute took a broader look at fraud, examining areas where enrollees have incentives to understate and overstate their income to qualify for the richest subsidies. (Disclosure: While I have done work for Paragon, I had no involvement with this particular report and am writing this article on my own behalf.) This broader examination of Exchange program integrity found 6.4 million potentially fraudulent enrollees in 2025, for which the federal government is paying $27.1 billion this year alone.
3. If the enhanced subsidies expire, the federal government will still pay 75-80 percent of enrollees’ premiums on average.
No, that’s not a typo. A graphic from the leftist think tank KFF (formerly the Kaiser Family Foundation) admits as much.
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