Recent data on Obamacare enrollment suggests that Ohio has seen the largest declines in the nation. But experts say the numbers may be skewed, and fraud may have had a significant impact as well.
Based on data from the U.S. Centers for Medicare and Medicaid Services, between February 2025 and February 2026, Affordable Care Act enrollment numbers in Ohio dropped from 497,443 to 336,058, a 32.4% decrease, as reported by Signal Ohio. That’s about three times the national average.
Soon after those numbers were released, the Paragon Institute released an analysis as well, which credited the decline, in part, to the removal of “phantom” enrollees.
In an interview with the Daily Signal, Paragon Institute President Brian Blase, who co-authored the study, described phantom enrollees as individuals who “had no medical claims” and “didn’t use their health plan a single time.” A chart included in the analysis shows that 35% of enrollees in Ohio in 2024 were “zero-claim.”
“[That makes Ohio] definitely one of the more problematic states,” he said.
Between 2022 and 2025, Blase explained, Ohio had “a huge increase in improper and phantom enrollees,” after which changes were made.
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“When the advanced subsidies went away and additional program integrity checks came in, a large number of those improper and phantom enrollees moved off the program,” he said.
Rush Sign-Ups Lead to Steep Drop-Offs
Another reason for the drop may relate to the rapid rise in enrollments in previous years.
“Ohio’s decline is large … but the increase in Ohio’s enrollment in the previous two years was like the highest in the country,” Blase said. “I think they probably had some really bad, unscrupulous brokers and enrollee intermediaries that enrolled a lot of people in the program that had no idea they were covered by the program.
“And now, as the enhanced subsidies went away, and there’s some additional eligibility checks, those people are appropriately coming off the program.”
Blase noted the time period is important too, as the Biden administration “pursued and implemented a lot of policies that enabled enrollment, regardless of proper eligibility reviews.”
CMS Numbers ‘Incomplete’
Edmund Haislmaier, a health care policy expert at The Heritage Foundation, said the Centers for Medicare and Medicaid Services numbers from 2025 to 2026 require more context.
“The data is somewhat inferior and incomplete because it doesn’t look at the whole market,” he told the Daily Signal.
Haislmaier said a better metric to use is insurance market data for the whole market “based on regulatory filings.” Every quarter, insurers in every state have to file, and that data gets aggregated by the National Association of Insurance Commissioners.
According to Haislmaier, at the end of the fourth quarter of 2025, there were 490,000 people on the books in Ohio. At the end of the first quarter of 2026, there were 425,000 people, a decline of only 13.2%.
The company that saw the largest decline in enrollments, Haislmaier said, is Centene Corporation, a Medicaid-managed care company. That company’s enrollments dropped 45%.
The Role of Fraud
Blase and Haislmaier both said the numbers may be skewed by various schemes involving brokers and agents who enroll people without their knowledge or consent.
One scheme, Blase explained, involves going to lower-income areas, obtaining people’s social security information, and signing them up for a plan without their knowledge. Another, conducted over social media, promised that individuals would get free cash or gift cards if people called a certain number and signed up to enroll in a health insurance plan.
“These people got enrolled, and the reason that the improper and phantom enrollment persisted is because the subsidies were made so large that people didn’t have any of their own premium payment,” Blase explained.
When asked if cracking down on fraud played a role in declines, Blase said that’s a “huge part of it.” His analysis shows “very tight correlations” between fraudulent enrollment and recent declines.
“States that had more improper and phantom enrollees had far greater loss of exchange enrollment than states that didn’t have as many,” he said.
Haislmaier spoke about people being enrolled in Affordable Care Act plans, or having their plans switched, without their knowledge.
“The person could be real, and they could be switching plans … and you don’t know it. And then when you use your insurance, they say, ‘Well, you’re not covered here anymore. You switched plans,’” he said.
And in plans that didn’t bill a monthly premium, many individual enrollees didn’t know they were signed up.
According to Haislmaier, Centene and Molina were two companies that offered plans with zero premiums in many of Ohio’s 17 rating areas across the state’s 88 counties.
“Because Centene and Molina were offering the lowest-cost silver plans, the second- or first-lowest-cost silver plans, in 15 out of 17 rating areas in Ohio, they were more exposed than other insurers to potential improper enrollment,” he said.
“Medicaid managed care [organizations] that are more likely to be exposed to low-income fraud are the ones who seem to be losing enrollments,” he added.
Subsidies Dried Up—or Did They?
Declining subsidies has been raised as an alternative theory for why fewer people are signing up for Obamacare. However, Blase countered that argument, saying current subsidies “are very generous” and the program continues to cap premiums people have to play.
“The vast majority of the premium increase over time has been borne by the federal government, so the affordability issue is really just for people four times above the poverty line,” he said.
“When they expanded the subsidies, they made the subsidies more generous for everybody. They also lifted the cap that existed at four times the poverty line, and so that meant when the enhanced subsidies went away, people just above four times the poverty line faced the biggest financial shock, and that was a very small number of overall Obamacare enrollees. So, it can’t be the reason for the enrollment declines.”
Where Are They Going?
One question raised by Ohio’s drop in Obamacare enrollees is where people are getting their health insurance now. Although it’s not clear where people go, “there’s a lot of possible explanations,” Haislmaier said.
Freelancers who formerly needed Obamacare may no longer need it if they become employees and gain benefits, Haislmaier offered as one example. Others might have had a change in income, and some Ohioans are going to fluctuate between Medicaid and the exchange based on income, he added.
Blase mentioned another option for how people are getting coverage: individuals may use insurance plans from others in their household, health sharing plans, or short-term limited duration plans.
“For the vast majority of legitimate Obamacare enrollees, they’re just going to go to another Obamacare plan,” Blase said.
As for the “phantoms” who had no claims and never once used their plans, Blase said “the phantoms are likely already enrolled in other types of coverage,” as they’re “duplicate enrollees” in Medicaid or an employer plan.
“They already have other sources of coverage, so you’re just reducing a duplicate form of coverage for them.”
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