Obamacare Ghosts: 40% of Enrollees Had No Medical Claims

PAUL PRESTONxd
4 days ago
3 min read

AENN

Chriss W. Street

Mountain TopTimesJan 13, 2026

2025 enrollment data reveals that 40 percent of Obamacare fully subsidized enrollees had zeromedical claims last year.

Huge insurance companies are thrilled to push the Affordable Healthcare Act (ACA) coverage because the percentage of Obamacare zero-claim enrollees is double the rate for their traditional individual and small group health plan coverage.

As a result, insurers pocketed at least $35 billionin premiums from Obamacare government subsidized customers that never went to a hospital, saw a doctor, or had a prescription last year.

The Centers for Medicare & Medicaid Services (CMS) reported that Obamacare marketplace membership despite very hefty price increases, has more than doubled from 11.6 million members in 2021, to 23.6 million members in 2025. Last year, 3.2 million new consumers signed up for Obamacare coverage, and 20.4 million were re-enrolled.

The key to Obamacare growth has been fully-subsidized “ghost” members that initially enrolled as low-income members, and then never had to prove the next year that they were still eligible for subsidies. The ACA marketplace simply auto-re-enrolled these fully-subsidized ghosts.

President Trump’s One Big Beautiful Bill that passed last summer will require Obamacare exchanges to annually re-verify applicants’ eligibility for subsidies each year before re-enrolling them. But that requirement does not kick-in until 2028.

The auto-re-enrollment has transformed the ACA exchanges from a consumer opt-in insurance market, into a passive entitlement system that has treated inaction as proof of eligibility and permits improper and even fictitious enrollees to remain in the system year after year.

Approximately 45 percent of 2025 enrollees were administratively reenrolled without any action by the ghost enrollees. This has prevented requiring fully-subsidized members from having to confirm their income, residency, or immigration status.

For partially-subsidized Obamacare members with higher income, more than 10 percent of consumers who selected bronze and silver plans during the annual open enrollment period, failed to “effectuate coverage.” That means they did not even pay their first month coverage premium.

In the early days of Obamacare coverage that started in 2014, the effectuated coverage rate was low because there were very few zeropremium options available.

But the Biden administration during Covid-19 pandemic turned-off the income verification system. As a result, over 97% of enrollees receiving subsidies from zero-premium plans did not effectuate coverage.

The Biden folks also dropped the requirement that enrollees receiving subsidies be required to file annual tax return information.

The Government Accountability Office recently estimated that over one-third of enrollees on federal exchanges failed to reconcile $20 billion of subsidies in 2024, and $27 billion of subsidies in 2025.

All this explains why Congressional Democrats are again threatening to shut down the government again on January 31, 2026, unless Trump extends Obamacare subsidies to the ghosts for the next three years.

Since the record is not good for folks who think they can coerce Trump to “bend the knee,” you might want to make some popcorn to watch a titanic political battle at the end of this month.

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