John R. Graham

Health and social policy analyst. Visiting Fellow @Paragon_Inst. Former @WaysandMeansGOP, @SenateAging, @HHS_ASPE, and @HHSRegion10

[Wall Street Journal Opinion @WSJopinion]

An ObamaCare fraud update: A new study finds some 6.2 million people are improperly enrolled.
https://t.co/CN08CFKkcj

[John R. Graham @johnrgraham]

@MattAFiedler @DrOzCMS The argument is accurate. 35% percent of 2024 enrollees had zero claims - up from 20 percent in 2021. Only 15% of enrollees in job-based benefits have zero claims in one year. If churn make the difference, that argues against Obamacare as a funtional market.

[Brian Blase @brian_blase]

Yet, there was a massive shift from silver to bronze plans among the lowest-income enrollees. Not in states with minimal fraud, i.e., those with state-based exchanges (SBE). But, massive switching in https://t.co/iX3w5vDN0V states and legacy https://t.co/iX3w5vDN0V states. 4/5

[Brian Blase @brian_blase]

This year, the large fraud scheme involves switching phantoms from $0 premium silver plans to $0 premium bronze plans. This table demonstrates why silver plans offer the lowest-income ACA enrollees the best deal. 3/5

[Brian Blase @brian_blase]

Improper enrollment & fraud soared under Biden's enrollment-at-any-cost strategy.

And the perverse automatic reenrollment system locked much of this in place.

Millions in $0 premium plans were simply rolled into another year of coverage—even many who filed no claims. 2/5

[Brian Blase @brian_blase]

Why did Obamacare fraud & improper and phantom enrollement explode?

Because everyone involved benefited.

Enrollee - free coverage.

Broker - commission.

Insurer - a taxpayer-funded subsidy to cover the entire premium.

The result? More than 25% of enrollees are improper. 1/5

[John R. Graham @johnrgraham]

@HHS_ASPE research indicates the Medicaid work & community engagement requirements in the One Big Beautiful Bill will lift 1.6-2.9 million people out of poverty: https://t.co/o0ApwoH4Mu.

[Brian Blase @brian_blase]

Before the Medicaid managed care plan lobbying organization in the fall of 2024, I debated Chris Jennings.

I said that I’ve seen no evidence that managed care in Medicaid improved quality or lowered costs. I asked for examples…and I’ve still not received anything!

[Paragon Health Institute @Paragon_Inst]

🚨The Persistent Obamacare Enrollment Fraud🚨

We estimate 6.2 million improper ACA exchange sign-ups in 2026—27% of total sign-ups, an unchanged % from 2025.

Taxpayers will fund up to $25B in improper subsidies—nearly 1/4 of all projected ACA spending.

https://t.co/ow4ZdugHUL

[Paragon Health Institute @Paragon_Inst]

These findings suggest that a substantial portion of ACA exchange enrollment since 2021 did not reflect increases in legitimate and eligible individuals.

Instead, excessive subsidies, weak verification controls, misaligned intermediary incentives, and permissive enrollment systems created conditions that enabled large-scale improper enrollment and phantom coverage to persist.

[Rapid Response 47 @RapidResponse47]

.@DrOzCMS on the disaster known as Obamacare: "We believe that 35%, roughly, of the people that are using Obamacare exchanges... may not be legit. And that actual number may translate to 5-6 million people we could be paying premiums for."

[Brian Blase @brian_blase]

In other words, the percentage of all children (0-18) on Medicaid or CHIP has increased by about 1.5 percent between February 2020 and February 2026.

[Paragon Health Institute @Paragon_Inst]

For over three years, states couldn’t remove ineligible people from Medicaid due to the continuous coverage mandate.

By 2023, ~18 million were on the rolls who no longer qualified. Enrollment is still elevated vs. pre-pandemic levels.

[Paragon Health Institute @Paragon_Inst]

Debunking the myth that "chilling effects" from the OBBB are causing child Medicaid enrollment to drop.

The evidence points elsewhere: pandemic distortions, duplicate enrollment, demographics, and program cleanup far better explain the trend. 🧵⬇️

https://t.co/eTNNWaXKmJ

[Paragon Health Institute @Paragon_Inst]

Statement from the Paragon Health Institute on CMS Interim Final Rule
Regarding Medicaid Work Requirements 🚨⬇️

[Scott Jennings Show @JenningsShow]

REFORMING THE SYSTEM: WORK, NOT WELFARE.

@brian_blase joins the @JenningsShow to break down his latest article on healthcare reform from the Big, Beautiful Bill. The BIG issue of topic is the major structural changes made to Medicaid—including the implementation of commonsense work requirements.

[Paragon Health Institute @Paragon_Inst]

The Trump Admin has made health price transparency a priority—providing patients and employers with information they can actually use.

Paired with greater consumer control, these efforts are driving a more efficient health sector.

READ MORE⬇️
https://t.co/05OM8rzqV5

[Brian Blase @brian_blase]

New op-ed with @johnrgraham

"The hospital lobby is powerful, and change will require overcoming their lobbying efforts to protect the status quo. ... [H]ealthcare will remain unaffordable until the cronyism comes to a halt."

Read the full piece here: https://t.co/gT4mw0qN49

[Brian Blase @brian_blase]

🔥Incentives matter.

The incentives push toward enrollment in govt health programs, even when it is improper.
1) Insurers make more $
2) Brokers make more $
3) Hospitals receive more $
4) People get enrolled

So, eligibility verification is crucial.

https://t.co/DTKdVRJDdM

[Paragon Health Institute @Paragon_Inst]

🚨NEW🚨The American Hospital Association Responds to Paragon: Our Reply

The industry is turning to the same lobbying tactics that have enriched it for decades and led to increasing costs and market consolidation. We address all four of AHA’s criticisms⬇️
https://t.co/I7ztYgfMhA