Loss of ACA Coverage After Republicans Made ACA Expanded Subisidies Lapse: Numbers, Delayed Data Release, Misleading Fraud-Reduction Explanation, etc.

This post summarizes information that I have in some “notes” (in Substack terminology, a thing smaller than a “post”. You are currently reading a “post”.)

It covers the history of the rhetoric leading to non-expansion of the ACA expanded subsidies, then the data on the coverage loss from that (which is rolling in continuously and not complete), and then the propagandistic response.

(As will be indicated, there is already some data that CMS has not released that it has previously released, and there is a leaked report that CMS knows the coverage losses are bad, and is preparing a false response indicating the coverage loss is due mainly to the administration’s successful cracking down on ACA fraud.)

Order of Presentation:

I will go through the data on loss of coverage first, and the suppression and propagandistic, misleading response. (This starts beginning of 2026.)

I will then back up, and go through the rhetoric and “research” to justify the non-extension of the expanded subsidies. (Labelled “appendix”.) You will see the same agents involved there. Namely, Dr. Oz (head of CMS), and the Paragon Health Institute.

I also stuck on (after initial publication of this post) an “appendix 2”, which has a little more on the policy recommendations coming out of Dr. Brian Blase’s Paragon Health Institute, as I try to figure whether or not they are nothing more than a purely-propaganda organization.

I also stuck on 6/11/26 an “appendix 3”, with additional information about the current, and other, Paragon attacks on the ACA.

Baseline number:

Note about 25 million people enrolled in the ACA on-exchange plans in 2025. (Note that this is separate from ACA’s expanded Medicaid, and those people, about 20 million, are not included. The cuts to ACA expanded Medicaid were in OBBB, and have been timed not to happen until the start of 2027—after the midterms.)

However, the 25 million number for 2025 is people enrolling. Some will not have paid premium, or not paid it for very long. So, for 2025, you also see numbers like 24 million or 22 million covered, if people use slightly different definitions of what they’re looking at. (The general term for people who paid a premium, and that had some actual coverage, is “effectuated”.)

Initial Data in Early 2026: Open-Enrollment Reports and Data Files from CMS

The initial data, on open-enrollment, indicated only a 4.9% drop in enrollment, with the big defect in the data that people who wind not paying the premium are not counted as dropping coverage.

However, a problem with looking at that drop is that about 40% of people who were counted as enrolled in that data were auto-reenrolled from 2025. Many would likely have looked at the new bill, and, not being able to afford it, they would never pay. And, the ACA rules give them 3 months to pay the bill. So, people dropping via never paying the bill would still be counted as covered in this early data, which just goes to the end of the open-enrollment period in January. (You can confirm that 90 days to pay the premium in this New York Times story.)

Later Data Starts Trickling In, But not from the Federal Government / CMS

Now, if you read the Charles Gaba Substack, as I do, you will observe lots of data counting some of the non-payers has trickled in, from some of the state exchanges, from a consulting firm that has access to large amounts of insurer data, and from KFF surveys. Showing loss of coverage totaling more like 3 to 5 million of those 22 to 25 million.

A pretty comprehensive recent report on that stuff is this one from KFF, and, as well, from about two weeks earlier there is this very good New York Times article.

So, from either of these, you can see that, counting non-payers, we’re looking at 3 to 5 million losing coverage, or something like 12% to 16%.

(The losses are actually running around what the CBO predicted. Even a bit higher.

CBO wrote, here:

Without a permanent extension, CBO estimates, the number of uninsured people will rise by 2.2 million in 2026, by 3.7 million in 2027, and by 3.8 million, on average, in each year over the 2026-2034 period. )

A Bit of Data Usually Released By CMS in Not Released

Noted health policy data guy with a Substack Charles Gaba actually caught a significant case where the data, usually presented as part of a report on Medicare and Medicaid and CHIP, was omitted.

Charles reports on that here.

Quoting Charles:

Until now, the summary report also included a brief mention of total effectuated ACA marketplace enrollment in Qualified Health Plans (QHPs), rounded off to the nearest 100,000. As of December effectuated enrollment was ~21.8 million people.

However, starting this month, this data point is missing...and that’s not by accident; it includes this footnote:

As of the January 2026 data, Marketplace enrollment data are no longer included in this report but will be available separately soon.

A Leak from Inside CMS indicates CMS knows of the big coverage drops, and is preparing a response falsely indicating the coverage drops are due mainly to the administration’s successful crackdown on fraud.

That report is from former Washington Post Health System Reporter Paige Winfield Cunningham, here, in a NOTUS story.

Quoting that:

More than one in five people who enrolled in health insurance through http://healthcare.gov/ during open enrollment and in the weeks immediately following were dropped from coverage for failing to pay their first month’s premium, according to internal Centers for Medicare and Medicaid Services, or CMS, documents obtained by NOTUS that haven’t been made public.

The roughly 21% decline in enrollment in the 30 states using the federal marketplace is significantly higher than the rate of last year, when 12% of enrollees dropped off over the same time frame.

The numbers support widespread fears that the end of extra, pandemic-era subsidies, which congressional Republicans declined to extend in December, would leave Affordable Care Act plans unaffordable for some Americans.

Faced with such a stark drop in enrollment, leadership at CMS, which is led by Administrator Mehmet Oz, is seeking to attribute a majority of the enrollment declines to rooting out fraud rather than people not paying their premiums, according to three CMS sources. The sources said it’s unlikely fraud is behind most of the cancellations.

(Insertion: Finally, 6/26/26 some data and explanations from the CMS. Caught by Charles Gaba, and rapidly conveyed to the Substack wonkiverse, here. I tried to summarize it quickly in my own note here . what CMS released 6/6/26. Further, after reading it, CMS is doing exactly what the the Cunningham NOTUS report said it would do: attribute a majority of the enrollment declines to rooting out fraud rather than people not paying their premiums. I have explored this a bit in my own preliminary note: brief examination of CMS report, where so far, on several counts, the CMS claim looks fishy to me.

Note: with the insertion into this original (pre-6/26/26) post (that you are now reading) of the CMS 6/26/26 report with the data and the “coverage losses are due to fraud reduction” claim, I’ve jumped you ahead. The rest of the stuff through the appendices jumps back in time to 5/13/26, where the evidence of the coming 6/26/26 data release and due-to-fraud claims is taking shape. Notably, what will come on 6/5/26 via a Washington Post Editorial is a Paragon Health Institute report making claims about widespread ACA fraud. Since I’ve taken everyone to the 6/26/26 “culmination” of the buildup to the “coverage losses are due to fraud reduction” assertion from CMS, you might reasonably decide you have less interest in everything before the appendices, and skip over to the appendices, or just skim until you get to the appendices.—End 6/26/26 insertion.)

I catch an obscure New York Times Story about ACA fraud, mentioning both Dr. Oz, and the Paragon Health Institute.

(This one on 5/13/26/) Familiar with both entities, I say, Aha, this must be the start of the propagandistic false response!

And here it is. Pointed to in a very recent Washington Post editorial.

This editorial

Extracting key text and links from that:

A new report estimates that 6 million people are improperly enrolled in health coverage through the Affordable Care Act, costing taxpayers $25 billion annually. The scale of the fraud might seem implausible, but the evidence supporting it is compelling.

...

The Paragon Health Institute is a conservative think tank founded by Brian Blase, who served as a White House health care adviser during President Donald Trump’s first term. Paragon's report on improper ACA enrollment, co-written by Blase and four others, is neither anti-immigrant fearmongering nor partisan rage bait. In fact, it paints red states in the worst light.

The five states with the highest estimates of improper enrollees (Florida, Texas, Georgia, South Carolina and North Carolina) all voted for Trump in 2024. The report says the incentives are strongest for enrollment fraud in states that did not expand Medicaid under the ACA, which tend to be red states.

...

Here’s how the fraud works: The federal government provides subsidies up to the full premium for health coverage bought on the ACA exchanges for people with incomes between 100 to 150 percent of the federal poverty line. Unscrupulous intermediaries, such as brokers and agents, lie about the income or existence of applicants, who are then improperly approved for subsidies that go directly from the federal government to insurers. Those intermediaries receive commissions for signing up these phantom “customers.”Paragon researchers used Census Bureau data on the number of adults making between 100 to 150 percent of the federal poverty line in each state, minus the number of people covered by Medicare or Medicaid, to estimate the maximum number who could be eligible for the largest ACA subsidies. They found that the number of people who signed up for ACA coverage in the 2026 open enrollment window exceeded the maximum eligible population in 28 states, totaling 6.2 million improper enrollees nationwide.

Florida, where the scam seems to have been scaled most lucratively, had more than 3 million exchange enrollments in 2026 despite an estimated eligible population of 636,000. Thirteen states had enrollments in excess of 200 percent of the estimated eligible population.

The exact nature of the fraud can take many forms. Sometimes intermediaries sign up real people without their knowledge. Sometimes individuals misrepresent their income to qualify for subsidies, which the federal government did too little to punish for too long. Sometimes intermediaries enroll people already receiving coverage through Medicaid in duplicate coverage through the ACA. Sometimes they fabricate applications entirely.

Fabricated applications and applications submitted without a person’s knowledge are best for insurers, since fake people or people who don’t know they have coverage never file claims. The insurers, which deny any wrongdoing, get all the government subsidies with none of the costs. Paragon's Prior Research has found that 40 percent of individual market patients had zero claims in 2024, far higher than the 15 to 25 percent norm in ACA exchanges before the expanded subsidies.

After Reading the New Paragon Report from the WP article:

So, I’ve gone through the Paragon Health Institute report, and I am able to point us to the exact text of the propagandistic response, which I will do shortly.

Firstly, undoubtedly, there is some real fraud apparently indicated, on the part of insurance brokers hooking up people with ACA policies. No doubt about that.

Paragon describes that the fraud problem is worse in states which did not expand Medicaid. This is from people with no option at all for affordable health coverage because of the states’ decision to not expand (which is despite 90% of the costs being borne by the Federal government.)

Well, of course! You give people with an income below 100% of the Federal Poverty Level no legal option to be health insured unless they drop themselves to dirt poor in both income and assets to qualify for traditional Medicaid, and, duh, some will try cheating, and put their income over 100% of FPL to be health insured! They want to have health insurance, like they would have in every other damned developed country. They are rightfully outraged at the incompetence and cruelty of their government! (That is precisely what Medicaid non-expansion does. Again, duh!)

How Paragon and Republicans can not recommend that all states that have not expanded Medicaid do so, to repair both the incredibly inequity and rightful rage, and the incentive to fraud, is hard to fathom.

So, that number of people who really should have coverage, but the Republican legislators in those states put into a situation of no health coverage—something any of us would dread, seems to be about 1.4 million. (From here.) Really, they should cheat!

Another case: in Paragon recommending, and in fact allowing to happen, the lapse of the ACA expanded subsidies, without proposing a correction over the returned 400% FPL subsidy cliff, you have some people having to pay incredibly unaffordable amounts of money for premium if their income nudges them above the cliff.

The the non-extension of the expanded subsidies, as it was done, produces a gross inequity, which will produce rightful outrage. And, what has happened: as here; https://normspier828307.substack.com/p/aca-2026-enrollment-after-expanded-1df

we see, caught by both Charles Gaba and me, about 280,000 people unexpectedly with incomes just a bit below the 400% of FPL subsidy cliff.

So, of course, many of them will have cheated to get there. This is what we expect in response to a rightful outrage at an incompetent policy hurting them so badly!

So, we have 200,000 or 300,000 who also should cheat!

(This forces me to chime in with an observation. I have observed that a Ph.D. is not any kind of guarantee of an ability to reason competently. Even in quantitative fields. This is from my experience. So far, my experience has left the possibility that a Ph.D. in physics or pure math might be such a guarantee, subject to refutation by counterexample. But not any other Ph.D.!)

So, I guess Paragon has the 6 million number, which they sometimes classify as “improper” situations. I don’t know what that “improper” is about. (And the calculations they did do are not open to public inspection, with, say, the computer programs and data sets available for public access, so people can rerun, and check the software and apparent definitions.)

They may have a point about people who are in manageable ACA premium conditions (say in the 138% to 400% FPL zone), who have understated income a bit on the exchange, and don’t wind up paying the slightly lower premiums due to the understated income back. (I think they have now actually changed the law, and people are required to pay the excess back. At least in some cases.)

Otherwise, the business about fraud when people have both a Medicaid and an ACA plan is not as bad as it might sound to some. We don’t want that—it causes some extra administrative spending, and we especially don’t like all of those Florida insurance agents grabbing a commission for secretly giving a person who already had Medicaid an ACA plan.

But, it’s not like the cost of the duplicated coverage is as if each duplicate costs the government an extra amount being the average $15,000 a person for healthcare in the U.S. Unless there is fraud on the part of providers, there won’t be duplicate billing. (Yes, insurers pull in up to 20% of whatever is billed to an ACA plan instead of Medicaid for a person who has both, since ACA has an 80% payout-rate minimum. So there is that loss.)

In a sense, the duplication is like, when a couple has insurance from two jobs, they often have two plans covering them. But only one of the insurances actually pays each bill that rolls in.

Anyway, I’m pretty sure Paragon (and the Washington Post / Jeff Bezos editorial board) is trying to keep that fraud and improper enrollment number high, at 6 million, to justify weakening and possibly eventually killing the ACA off, directed at people not aware of the details. It looks like propaganda to me, directed at a public, much of which is, Walter Lippmann indicated, far less than omnicompetent. (This feeling is substantially from observing the carrying forward of Paragon propagandistic terminology, like “phantom enrollees”, to Republican politicians’ inflammatory, anti-ACA speeches. And a few other prior Paragon behaviors. See the Appendix!)

—

Trying to isolate the essence of the false propaganda: From the data in the report, Paragon really had difficulty, but they did the best they can, so I quote:

Because of the expiration of the COVID-era subsidy boosts and the buildup of substantial improper and phantom enrollment, enrollment attrition will likely return closer to pre-COVID patterns. Assuming an 18 percent decline from this year’s open enrollment in 2026 would result in average monthly effectuated enrollment of about 19 million people in 2026—an amount still 90 percent higher than the pre-COVID average.

So, while citing “the buildup of substantial and improper phantom enrollment”, they are also pointing out they expect a loss in eventual 2026 effectuated enrollment (“effectuated” means people who actually paid premiums) to 19 million, which is maybe 4 million down from the same number in 2025.

(This large drop numbers is what the CBO said would happen, and has also been reported by Charles Gaba, KFF, and the New York Times, using various non CMS sources, because CMS has not yet released that data. I guess Paragon is preparing us for that huge drop, and will let the president and the other Republicans figure out exactly they want to distort it or lie about it.)

So, whatever words Paragon put to try to soften the fact, the 4 million drop is fully consistent with numerous people facing higher premiums, many living paycheck to paycheck in the very-low 100%-150% FPL income zone, and people in other income zones, dropping coverage.

Still, despite that, Paragon put in:

Allowing the enhanced COVID-era ACA subsidy boosts to expire was a prudent policy change. The exchanges remain heavily subsidized, particularly for lower-income enrollees, and the underlying ACA subsidy structure continues to provide substantial premium assistance. In HealthCare.gov states, taxpayers still cover roughly 94 percent of premiums for the median subsidized enrollee, while nearly 70 percent of enrollees face monthly premiums below $100. The evidence presented in this report suggests that the exchange market remains saturated with subsidies, particularly for individuals claiming income between 100 and 150 percent FPL.

I would say the two quoted paragraphs above (the first of them not immediately above) are what we have so far, which is short of of the full expected propagandistic response indicated in the report from CMS insiders reported on by Paige Winfield Cunningham in NOTUS.

So, the data showing the large drops has not been released by the Federal Government and at least one normally-done release has been delayed. Paragon indicates it predicts the same large drops that are trickling in from non-federal-government sources. And Paragon has done no more than beg the question¹ to assert that the expanded subsidies should not be extended. In a video of a discussion between key players in the expected propagandistic response, Dr. Oz, and Dr. Brian Blase of the Paragon Health Institute, here, besides talking up themselves, talk up all the fraud on the ACA exchanges, and how Dr. Oz has been working on cutting fraud, but don’t claim the fraud reduction is the cause of the large coverage drops Paragon has predicted. (As below, this may be because they only find a fraud reduction of 250,000 with the Paragon projected coverage reduction of several million.)

Is the full claim that fraud is causing the drop yet to come? The astute reader will note that one key player, the president, has not yet appeared to address the issue. He is apparently busy with Iran/Israel/The Strait and occasionally the Knicks. Certainly, we should be looking out for the claim that the whole drop is from fraud reduction, and/or getting undocumented people off the ACA roles, or something as false, but more bizarre. With the president using his trademark (and usually highly-effective) confident assertions of complete falsehoods, as say, here or more recently here .

I might as well also toss in, that looking at the early 2026 data, they didn’t find much drop in fraud due to the administration’s anti-fraud activities. Quoting: While the number of improper enrollees declined by about 250,000 from the 2025 open enrollment period, improper enrollment as a percentage of total enrollment held steady at about 27 percent of all enrollees.

Bonus Content: I have a Youtube of Dr. Brian Blase, who heads up Paragon, of Dr. Oz and a few others, here.

(I’ve watched most of it, and I find it helpful, because I’m trying to figure out how well Dr. Blase has a grip on the analytical issues, and, as well, how much he’s just being a propagandist.

In the interchange with Dr. Oz, I caught two cases where Dr. Blase chose very propagandistic misleading framings, so he clearly does some propaganda.

I will attempt to point the particular cases out later, when I have some time. 6/9/26: I’ve done that, in this note. )

6/14/26: I was delighted to catch, this morning, a Substack post by Jonathan Cohn (author of The Ten Year War , written back when the war on Obamacare had only been running ten years), who also has a popular Substack (within Bulwark) on healthcare.

The post, here (note behind the Bulwark Substack paywall) was on the exact issue I have covered: the coverage losses and fraud claims coming from Paragon and elsewhere.

It’s a pretty comprehensive post, with some references and aspects that I did not catch in my post here (and also with many I did catch, I’m proud to say!). If you’re really interested in scooping up all the details, I might suggest clicking on each and every hyperlink in the Cohn post, and also examining the footnotes. (Also, note I am mentioned in one of the footnotes, and in fact this post is hyperlinked to in that footnote. As well, if you’re a fan of Andrew “xpostfactoid” Sprung, and/or Charles “wunderkind” Gaba, as many people with an interest in the ACA are, they are also mentioned and hyperlinked to in the Cohn post. )

APPENDIX: Prior History (Leading Up to Non-Renewal of Expanded Subsidies)

1)At the end of 2025, the Democrats shut down the government in order to try to prevent the expiration of the ACA expanded subsidies, as well as to try to prevent the coming OBBB cuts (scheduled for 2027).

The Republicans, both in the administration and outside, indicated that the Democrats had shut down the government in order to provide healthcare to undocumented immigrants.

(This was quite demonstrable false, with, if you figure the amount of money involved, only 1%-2% of the money involved had anything to do with undocumented immigrants—being over the reimbursement rate for emergency ER care for undocumented immigrants legally required by the Reagan-era EMTALA law, and another 7% was for “legally present” people (refugee status), who the Republicans prefer to think of as “illegal”. The other 90%+ was for U.S. citizens, and maybe some people with green cards.)

We have V.P. Vance, here, at a “press conference”, asked by a “reporter” about “two key Democrat lies”.

(If you look at the transcript, which I have on this old Substack post , you can see that in artful propaganda, Vance only talked about the two issues above.)

Similarly, Mike Johnson said here

it is a fact, that no one can dispute, that they [the Democrats] shut the government down over restoring free healthcare to illegal aliens as part of their $1.5 trillion wild partisan wish list.

(Same artful propaganda explanation for the same exact reason. Incidentally, if you check that last referenced Substack post of mine, you will find a factcheck, and other links, to confirm the actual truth is what I said it is.)²

2)Paragon Health Institute Claims of Widespread ACA Fraud were circulating mid-2025.

I looked into them with some curiosity here and here . Anyway, if you check the second of those two posts, you can see that some large organizations with large research staffs challenged the validity of Paragon’s (and its head, Dr. Blase’s) thinking, As well as some conservative policy people are quoted with the same challenges of that thinking.

I’ll just drop down one case here:

It is therefore imperative that policymakers understand that Paragon developed these allegations using inaccurate data, dubious assumptions, and an apparent lack of understanding of how health insurance actually works.

(From the American Hospital Association. Link to verify the quote is in that 2nd post.)

3)Paragon Health Institute Produced a Graph That I’m Pretty Sure is Wildly Erroneous, which was used as the justification for not extending the ACA expanded subsidies at the end of 2025.

It was used by both Senate Majority Leader John Thune (in this video, from the day the Senate voted against extending the expanded subsidies) and House Majority Leader Mike Johnson (in this tweet)

to justify not extending the ACA expanded subsidies

The graph is labelled, and purports to show, “Obamacare Plan Premiums Have Increased Nearly 2x Faster than Employer-Based Premiums Since 2014”, and is to be found (with Paragon’s explanatory text) here: https://paragoninstitute.org/paragon-pic/obamacare-plan-premiums-have-increased-nearly-2x-faster-than-employer-based-premiums-since-2014/ and is:

Now, the thing is, I’m pretty sure that graph is completely erroneous, due to mainly an omission of a certain cost, and a shifting of one of the graphs. When I tried to adjust for the errors, I got that the ACA plan cost tracked in the graph rose either slightly more, or slightly less, than employer-based plan.

(I’ll spare the details here. But I have them, and my alternative correction attempt here: https://normspier828307.substack.com/p/senate-republican-leader-john-thune , if interested.

Actually, since it’s a kind of fun, slight, readily-visible puzzle for the quantitative folks, especially if they know the history of the ACA and the Republican battle against it, I’ll put the main explanation in a footnote.³)

4) On Dr. Oz. Note this propagandstic-setup collaboration with Fox from late 2025, here, indicating fraud that needed to be stopped, as part of the propaganda battle against the ACA.

It’s obvious propaganda, aimed at riling up the angry voter, which all readers of this post can tell from the wording and framing.

However, in terms of any factual content, note that here is a general playing on many of the voters not having a sense of numerical quantities.

The total federal spending on healthcare is $1.9 trillion ($1900 billion) a year, and, incidentally, the OBBB Medicaid and ACA expanded subsidy cuts that the shutdown of late last year was trying to reverse are $150 billion a year.

So, the numerically-skilled mind sees federal share of healthcare spending in California is about $190 billion a year (since CA has almost exactly 10% of the U.S. population), and the $1.3 billion withheld according to the Times story, let’s say it really is because of fraud, is about 1/150 of the spending.

Ditto if you take the Dr. Oz / Fox fraud by “Criminal Illegal Immigrants”. $1 billion, compared to $1900 billion a year in total federal medical expenditures, or even the $150 billion a year the Republicans have cut (combined OBBB and lapsed ACA expanded subsidies.)

5) Dr. Oz, again. More technical, but there is a case where Dr. Oz seems to indicate that something that the Republicans are trying to do makes ACA coverage cheaper when it actually does the EXACT OPPOSITE. (That’s within here: https://normspier828307.substack.com/p/cost-sharing-reductions-silver-loading , though I warn you, it is quite technical around “cost-sharing-reductions” and “silver loading”.)

—

Incidentally, on the whole fraud thing, hopefully the reader will catch that fraud, besides being something that arouses anger, is commonly used in manipulation of publics selectively.

Thus, the fraud issue is focused on on the ACA exchanges, or Medicaid, in much of the Republican public-manipulation here. (You’ll even catch it if you bother to listing to Dr. Oz as he speaks with Dr. Brian Blase on that Youtube video.)

The thing is, there is also much tax-cheating fraud that the IRS could be checking for. And we note that the administration has reduced the staff for checking for tax cheats. (Here.)

Appendix 2: Additional Paragon Health Institute Stuff

I caught this Paragon post, and this is a case of clear propaganda as well. More accurately it’s a trick:

https://paragoninstitute.org/paragon-pic/biden-era-medicaid-cost-surge/

So, it says:

The first change is that the Affordable Care Act (ACA) significantly expanded Medicaid by granting eligibility to able-bodied, working-age adults and favoring them over traditional Medicaid enrollees (children, pregnant women, seniors, and the disabled) through significantly higher federal reimbursement rates for state spending on them. Paragon has produced a comprehensive reform that would end the ACA’s federal discrimination against traditional Medicaid enrollees and move nearly half of Medicaid expansion enrollees into the exchanges with a large premium tax credit. This is a long overdue policy reform that Congress should consider.

What this is about is that ACA expanded Medicaid has a 90% reimbursement rate to states from the federal government, whereas old-fashioned traditional Medicaid, which still exists, and covers some people (indeed, many children, pregnant women, seniors, and the disabled) is reimbursed 50%-70% by the federal government.

The reason the higher reimbursement was done for expanded Medicaid when the ACA was passed in 2010 was to make it financially not too difficult for states to expand Medicaid, thereby covering a good chunk of their people who would not otherwise have any affordable coverage.

And, you want to keep the higher reimbursement, not reduce it (which is what Paragon proposes). Because, you want states not to have an incentive to not expand Medicaid (as 10 Republican ones still have not), or to undo the expansion of Medicaid for that states that have done it. (Thus, states that are really crappy to their citizens would save an especial amount of money, and, as well, sometimes wind up freeloading on other states that are not crappy to their citizens when citizens move to another state to have health coverage. This is, actually, the exact same argument for not having completely open U.S. borders with automatic U.S. citizenship for anyone as soon as they get here.)

I’ve also seen this little trick before, in a purported policy document from the Manhattan Institute, which, actually and God bless him, former Biden White House chief economist Jared Bernstein posted on his Substack once, as a useful document to get a grip on solutions to the U.S. debt problem, which is a concern of his.

I found this significant enough to do a Substack post on it: ( here .)

(If interested, you can find the relevant links in that post of mine, or, let me give them: Manhattan Institute report

And, the Substack post where Mr. Bernstein referenced the report is this.)

Jared indicated when he referenced the document that he did not agree with everything in it. (And, of course, I don’t expect him to have read the whole thing carefully, and pass the long document on to 20 different policy experts in 20 different areas to find all of the tricks the Republicans had buried in it, before posting it. So it’s OK, JB!)

Still, I was kind of stunned to see the trick embedded in the document on policy to try and subvert the ACA covertly.

—

As well, I know Health Policy specialist Jonathan Cohn, who has a Substack within Bulwark (paywalled, though) did at least three posts last year mentioning Paragon and Dr. Brian Blase (who we learn from them served in the Trump administration in the first Trump term).

For those interested, who have access beyond the Bulwark paywall, they are: this, this, and this.

—

Paragon claims to be “Nonpartisan”?: Right here, on the archived version of their main page. (They seem to have removed that claim in the current version.)

Non-partisan is certainly quite a stretch. It reminds me of Bill "No Spin" O'Reilly and Truth Social. As though emboldened propagandists, having developed the feeling they can fool just about everyone without being caught, have inserted an inside joke for themselves for their additional jollies, by mocking those who have been so easily duped⁴.

Appendix 3: Related counters to Paragon stuff from other sources:

I’ve noticed Charles Gaba seems to now be posting, with his summary statistics on 2027 proposed rate changes in the states, the statistics on both ACA plan, and small group plan rate changes. For example, for D.C. (So far, he’s done about 3 of the 51 states plus D.C.) This allows us to compare ACA to some of the employer plans, helping us with some data on the comparative cost-rise issue that the Paragon graph that I cited, used to not extend the expanded subsidies, claims to show. (At this point, small employers and ACA are coming out about the same on rises, though both are much higher than the economy can sustain if those trends continue indefinitely.)

I also caught Andrew Sprung, of the xpostfactoid blog, with addressing the new Paragon report on fraud (here), indicating additional posts on the matter from him on xpostfactoid are to come.

1. I am using the term “beg the question” not in the way it is commonly used nowadays, even on PBS, but as certain purists might insist it be used (claiming the common use is an incorrect usage that has seeped into the language from those not understanding the actual meaning). I use it as when an argument assumes the very thing it's trying to prove (often with fluffy words inserted to try and hide the begging of the question from the reader or the writer or both). See Merriam-Webster on the issue , if interested.

2. Imagine a blind person walks into a small grocery store, asks the storekeeper for help finding a loaf of bread to buy. The owner/clerk hands hands the blind person a bag of mouldy bread that that the storekeeper is eager to get rid off, and accepts payment.

I really am having a hard time distinguishing VP Vance and Mike Johnson making the statements they did make, ethically, from my example with the storekeeper. Yes, I see the state of having little or no critical-thinking skills is a more common situation than blindness, and, I also see that the former does not have formal socially-recognized status as a disability and the latter does. But, still, I can’t really make out the fundamental difference.

3. The ACA has cost-sharing-reductions (CSRs), which are lower copays, that people with incomes up to 250% of FPL (Federal Poverty Level) which they get only if they choose a silver plan. From the ACA outset in 2014, to 2017, the cost of these was funded by direct-to-insurer payments made by the federal government, which were not part of the explicit premium for a plan listed on the exchanges.

The Republicans launched a lawsuit to prevent those direct-to-insurer payments by the federal government, on the rationale that the ACA law did not explicitly allocate funds for the direct-to-insurer payments. And, in 2017, the Republicans won the lawsuit.

The cost of the cost-sharing-reductions was then transferred to explicit premium listed on the exchange in mid 2017. Further, due to a practice called “silver loading” gradually done by almost all insurers in almost all states, the silver plans wind up (gradually from 2018 onwards) containing overwhelmingly only people getting the cost sharing reductions, making their price become especially high. (Thus, the silver-plan on-exchange listed premiums go from including none of the cost of the cost sharing reductions in 2014, to bearing the full cost of the cost-sharing-reductions, for a population that is almost entirely getting those cost-sharing-reductions, in 2026.)

Quantitative people familiar with the CSR issue will pick up this likely explanation immediately on seeing the graph, with that sudden cost rise there between 2016 and 2018 on the tracked ACA silver plan in the Paragon graph. (I have traced the data sources, and confirmed that Paragon is using the premium from the KFF premium calculators for the various years, which I can’t imagine would add in the federal direct-to-insurer payments, as the KFF premium calculators are designed for consumers.)

I have refrained from saying with absolute certainty that the Paragon graph excludes the CSR payments only because I am a nice guy, trying to be exceedingly responsible. (It would be an easy matter for KFF, which produced the calculators, to confirm the direct-to-insurer payments are excluded. As well, the graph having been used as the primary justification by the Republicans for not extending the expanded subsidies, if the democracy we have actually functioned at any kind of a respectable level, Paragon would be directed to answer the question about that.)

(As it is, the text on the Paragon site around the graph calls attention to the sharp rise from the transfer of the cost from a hidden one, to explicit premium. As if they had intentionally prepared a graph to be used deceptively, but then could claim, they were a competent research organization, rather than a pure propaganda organization.)

The other thing about the graph is that the data source for the employer plans, the KFF annual employer surveys, would not have been available in 2025, when the graph was prepared. (As far as I can tell.) So Paragon must have shifted employer plans up by a year. Which is relevant, because 2025 to 2026 is expected to be a high-jump year for all health insurance, due to things like GLP-1’s and other factors.

4. The mockery goes beyond this. Quoting Walter Lippmann about the public in many circumstances (from here):

We must assume that a public is inexpert in its curiosity, intermittent, that it discerns only gross distinctions, is slow to be aroused and quickly diverted; that, since it acts by aligning itself, it personalizes whatever it considers, and is interested only when events have been melodramatized as a conflict.

The public being “interested only when events have been melodramatized as a conflict” really speaks to me at times. And thus, let me repost a link to the video of Senate Republican leader John Thune, where he used (an in all likelihood wildly-erroneous—as above—graph) to justify not extending the ACA expanded subsidies.

Note Forbes, which posted the video, has labelled it John Thune Shreds Obamacare Ahead Of Senate Vote On Expiring ACA Tax Credits, which is, of course, indicative of a need to melodramatize events as a conflict to draw the voters in. (The word shreds.)

However, in this case, it’s also a mockery of the voters beyond the mockeries prior discussed. The voters are made to cheer for their own deception! Not just this case. Repeatedly. It’s all over the place!