Obamacare failed to make health care more affordable. Every day the government shutdown lumbers on, more Americans are looking more closely at health care costs and learning just how damaging the impact of Obamacare has been.
The latest evidence comes from the Obamacare exchanges which have seen a spike in “zero-claim enrollees.” Because of irresponsible Biden-era policies, federal subsidies were increased during Covid. Health insurers received payments on behalf of 35 percent of enrollees—and 40 percent of fully subsidized enrollees—who did not use a single service for the time period they were covered. Zero-claim enrollment, which is more than double the rate in a typical health insurance market, is consistent with evidence of widespread fraud.
Some people have claimed that the improper enrollment claim is exaggerated. Even if that were the case (and I find the evidence of mass improper and fraudulent enrollment overwhelming), it would show that Obamacare is failing on another one of its key promises—having people access regular and preventive health services. The new data also shows that Obamacare coverage increasingly does not equal care.
The premise behind Obamacare’s preventive services mandate was straightforward and optimistic: By eliminating cost‐sharing for evidence-rated preventive services (those graded “A” or “B” by the U.S. Preventive Services Task Force), patients would seek timely screenings, counselling, and “wellness” visits. This in turn would reduce emergency care, lower hospitalizations, and improve health. Under Obamacare’s mandate, the services covered without copays include annual check-ups (well visits), mammography, pap smears, colorectal cancer screening (including colonoscopy), and immunizations.
Research generally concludes that Obamacare’s mandate slightly increased preventive care. However, research generally does not distinguish Obamacare exchange enrollees from the commercially insured population (which also incurred the mandate).
But despite mandates for preventive services with zero cost-sharing, a large and growing share of ACA exchange enrollees never submit a claim, meaning they apparently use none of the services their policies cover—preventive or otherwise.
Since Obamacare eliminated potential financial cost barriers to preventive services, why would so many covered individuals never obtain any services at all—not even a well-visit or screening?
When someone has coverage with “first-dollar” preventive services but makes no use of the system, some possible explanations arise. They may be healthy and have no need for care in that year. Or they may lack access (such as provider network issues) or awareness that preventive services are free. Finally, we have to consider whether they are improperly enrolled, or a phantom enrollee.
In either of the latter two cases, Obamacare’s assumption—that coverage leads to preventive care uptake, better health, and lower costs—is significantly undermined.
Personally, I have been enrolled in an Obamacare plan, bought using an individual coverage health reimbursement arrangement for four years now. My insurer aggressively advertises the free preventive services and wellness visits. I receive letters, emails, and text messages for an annual physical and the flu shot. Obamacare insurers have probably ramped up these efforts in recent years out of concern around a low medical loss ratio (that would force higher payments to providers or rebates) as well as their internal concern about a growing number of zero-claim enrollees and the public perception problem of useless coverage that creates.
The main explanation for the rise in zero-claim enrollees is the tremendous amount of fraud and abuse endemic to Obamacare. The data does not lie. In 2025, there are more than 6.4 million ineligible people enrolled in a fully subsidized Obamacare plan—and in 15 states there are more than twice as many people enrolled in fully subsidized plans than are eligible. And the examples of the fraud are overwhelming, as a huge money-making apparatus from lead generators to unscrupulous agents and brokers to insurers made massive profits from the fraud. Millions have been enrolled without their consent or knowledge, falling victim to fraud schemes.
Obamacare supporters and the health insurance industry cannot have it both ways. Those who downplay the fraud simply show that Obamacare is broken in other ways as the coverage does not translate into any care—not a single visit to the doctor, prescription filled, or lab test ordered. The reality is that both explanations indict the law. If millions of enrollees are fraudulent, taxpayers are being robbed. If such a large number of enrollees are real but not using any care, Obamacare’s central theory collapses—that generous subsidies and “free” preventive services would drive better health and savings. Either way, the system is failing on its own terms.
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