The Trump administration has removed nearly three million people from the Affordable Care Act enrollment rolls after a Department of Health and Human Services report found that fraudulent, improper, and phantom sign-ups ballooned to 5.6 million at their peak, costing taxpayers an estimated $10 billion between 2021 and 2024.

The HHS report, obtained exclusively by Fox News Digital, lays out a striking picture of how the ACA exchanges became a magnet for fraud after the Biden administration relaxed eligibility checks, loosened income verification requirements, and opened the door to more year-round enrollment. The result, according to the administration, was a system where brokers could enroll people without their knowledge, applicants could misstate their income to collect subsidies they didn't qualify for, and over a million enrollments lacked even a Social Security number.

Another 2.6 million improper and phantom enrollments remain on the rolls, the report states, and the administration says it intends to remove those as well.

How ACA enrollment doubled, and who was really signing up

The numbers tell a stark story. When the Biden administration took office, roughly 10 million Americans were enrolled in ACA coverage. By 2024, that figure had surged to 22 million. The Biden White House touted the growth as proof that Obamacare was working better than ever.

But the HHS report now attributes a significant share of that growth to fraud. The report estimates that improper, phantom, and fraudulent enrollments peaked at 5.6 million people in 2025, meaning that at the high-water mark, more than one in four enrollees may not have belonged on the rolls at all.

A Trump administration official told Fox News Digital that approximately $10 billion was swindled from taxpayers during the 2021, 2024 period as a direct consequence.

The mechanism was not complicated. The Biden administration's decision to relax income verification meant applicants could misstate earnings to qualify for subsidies. Expanded special enrollment periods meant people could sign up outside the normal windows with fewer checks. And brokers, paid by the federal government for each enrollment, allegedly gamed the system by signing people up without their consent.

Phantom enrollments and the broker problem

The report reserves some of its sharpest language for what it calls "phantom enrollments", cases where insurance brokers enrolled individuals in ACA plans without their knowledge. The practice allegedly allowed brokers to collect enrollment-based payments from the federal government for people who never requested coverage and may not have known they had it.

The report put it bluntly:

"The federal government paying brokers to enroll individuals without their knowledge is not [preserving fiscal and programmatic integrity]."

The administration says it has begun taking action against agents and brokers committing this kind of fraud, though the report does not name specific individuals or firms targeted. The concern about broker misconduct is not new. As far back as mid-2024, House Republican committee chairs demanded federal audits after the Paragon Health Institute found that up to five million Americans may have been incorrectly receiving ACA subsidies. Paragon's president, Brian Blase, a former Trump White House health policy official, said at the time that it was "stunning how little has been done to date looking at these issues."

Those congressional Republicans described the scope of the problem as suggesting "malicious intent," and called on the GAO and HHS Inspector General to conduct systemic reviews. Even some Democrats raised concerns about enforcement failures, though the Biden administration did not act on the warnings before leaving office.

The Trump administration's appointment of Dr. Mehmet Oz as Medicare and Medicaid Services administrator in January 2025 signaled an early focus on rooting out waste in federal health programs. Oz was sworn in at the Oval Office on January 22, 2025, with President Trump and HHS Secretary Robert F. Kennedy Jr. present.

What the administration has done so far

The report outlines a series of steps the Trump administration has taken to restore integrity to the ACA exchanges. Officials restored income verification requirements that the Biden administration had loosened. They ended certain special enrollment periods that had allowed year-round sign-ups with minimal scrutiny. They cross-checked ACA rolls against Medicaid enrollment to catch duplicates. And they launched investigations into phantom enrollments tied to broker fraud.

The result so far: nearly three million enrollees removed from the rolls. Current ACA enrollment stands at approximately 19.2 million, still well above the 10 million figure from the start of the Biden era, but significantly below the 22 million peak.

The report frames the remaining work clearly:

"We estimate 2.6 million improper and phantom enrollments remain, including over 1 million enrollments without a social security number."

That last detail, over a million enrollments lacking a Social Security number, raises its own set of questions. The report does not specify whether those enrollees are illegal immigrants, identity fraud cases, or some other category. But the sheer volume suggests the verification failures under the prior administration were not marginal. They were systemic.

A pattern of looking the other way

The Biden administration's approach to ACA enrollment fits a broader pattern that conservatives have flagged across multiple agencies. The same administration that loosened ACA safeguards also diverted whistleblower complaints and resisted oversight in other areas of federal governance.

The political incentive was straightforward. Higher ACA enrollment numbers let the Biden White House claim a policy success. Every new enrollee was a talking point. Whether those enrollees were real, eligible, or even aware they had been signed up was, apparently, a secondary concern.

The HHS report frames the contrast in institutional terms:

"Preserving the fiscal and programmatic integrity of the ACA Exchanges is key to safeguarding taxpayer-funded resources for those that truly need them."

That language, "those that truly need them", is a polite way of saying that fraud doesn't just waste money. It crowds out the people the program was designed to help. Every dollar spent on a phantom enrollee is a dollar unavailable for a working family that actually qualifies for coverage.

The broader question of accountability within Obama-era policy frameworks continues to surface across multiple fronts, from health care to foreign policy to executive overreach.

Open questions remain

The HHS report raises as many questions as it answers. The methodology behind the 5.6 million fraud estimate is not detailed in the portions made public. The $10 billion figure comes from an unnamed administration official, and the calculation behind it has not been independently verified. Whether any of the nearly three million people already removed from the rolls were legitimate enrollees caught up in the cleanup is not addressed.

Nor does the report specify what legal consequences, if any, await the brokers who allegedly ran phantom enrollment schemes. The administration says it is "taking action against agents and brokers committing fraud," but no names, indictments, or civil penalties have been disclosed.

Those details matter. A fraud crackdown that removes millions from health coverage rolls carries real consequences for real people. If the administration's estimates are accurate, the cleanup is overdue and necessary. But the public deserves to see the receipts, the full methodology, the enforcement actions, and the safeguards ensuring legitimate enrollees aren't swept up in the process.

The Paragon Health Institute's earlier estimate that the fraud could cost taxpayers $20 billion in 2024 alone suggests the $10 billion figure cited by the administration may even be conservative. Either way, the scale is enormous.

Meanwhile, the legacy of the Obama-era health care law continues to generate controversy well beyond enrollment numbers, touching everything from fiscal accountability to the fundamental question of whether the federal government can run a program this large without inviting massive abuse.

The bottom line

The Trump administration's report describes a system that was deliberately weakened, predictably exploited, and quietly ignored for four years. The Biden administration traded program integrity for headline enrollment numbers. Brokers cashed in. Taxpayers footed the bill. And millions of Americans who play by the rules were left sharing a system with people who had no business being on it.

The administration says it will continue removing improper enrollees and pursuing the brokers who gamed the system. The report's closing line captures the posture:

"The Trump Administration continues to aggressively root out fraud, waste, abuse, and corruption by promulgating new regulations to improve program integrity, investigating suspected improper or fraudulent enrollment, and taking action against agents and brokers committing fraud."

Whether that promise holds will depend on follow-through, on named enforcement actions, transparent methodology, and a willingness to show the public exactly how deep the rot goes.

When the government makes it easier to cheat than to verify, cheating is exactly what it gets. The only question is how long it takes someone to care enough to count.