While the government shutdown continues and health-care reform remains gridlocked, Obamacare (the Affordable Care Act) burdens taxpayers with out-of-control costs. For more than a decade, Obamacare has been riddled with systemic fraud that has been denied by Democratic Party bureaucrats, ignored by much of the media, and paid for by weary taxpayers.
Built on lies including “if you like your doctor, you can keep your doctor,” Catholics continue to bitterly recall the duplicitous role that Sr. Carol Keehan, CEO of the Catholic Healthcare Association, played in passing Obamacare—despite the pushback by the Catholic bishops because of its inclusion of abortion funding and the contraception mandate. Sr. Keehan’s mendacious shepherding of the health-care program was rewarded with a silver signing pen from President Obama.
Intensifying the pressure today on an already overburdened health-care system, the influx of several million undocumented immigrants has pushed government-funded health care to a breaking point. According to an October 2024 CBO report to Rep. Jodey Arrington, federal and state governments spent $27 billion on Emergency Medicaid for noncitizens ineligible for full Medicaid coverage between 2017 and 2023. In 2023, the estimated cost of health care for undocumented immigrants in the United States was approximately $3.8 billion, specifically for Emergency Medicaid services.
Hospitals are bound by law to provide emergency services to undocumented patients under the Emergency Medical Treatment and Labor Act (EMTALA), enacted in 1986. This is a federal law that requires hospitals to provide emergency medical care to all individuals, regardless of immigration status or ability to pay. Under EMTALA, any hospital that receives Medicare funding must conduct a medical screening exam for anyone who arrives at the emergency department and must provide stabilizing treatment for emergency medical conditions, including active labor. This mandate applies to undocumented immigrants as well as uninsured citizens and legal residents—and most of us strongly support the provision of this care to all on an emergency basis.
Unfortunately, such care is costly. According to the Trump administration, the estimated cost of emergency health care in 2024—including labor and delivery and postnatal care of the mothers and newborn babies—of undocumented immigrants in the United States rose 142 percent from the year before to an astonishing 9.1 billion dollars of taxpayer funds to pay for the emergency health care of those in the country illegally. Between 2020 to 2024, Medicaid taxpayer health-care dollars provided to illegal immigrants tripled.
Though critics argue that the Trump administration’s numbers are inflated, few challenge the fact that the nation’s hospitals are facing a fiscal crisis. In January 2024, Dr. Donna Lynne, CEO of Denver Health, publicly voiced concern over the financial strain caused by uncompensated care for undocumented individuals. Speaking at a finance and governance committee meeting, she stated, “Where do you think the migrants are getting care? They are getting care at Denver Health…It’s going to break Denver Health in a way that we didn’t even anticipate.” Her remarks highlighted the hospital system’s mounting fiscal challenges, noting that Denver Health treated over 8,000 undocumented immigrants in 2023, accounting for approximately 20,000 visits. Uncompensated care costs surged from $60 million in 2020 to $136 million in 2023.
These expenses will continue to grow even though, according to the enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193), eligibility for Medicaid was intended to be limited to “qualified aliens.” That includes lawful permanent residents (also known as green-card holders), asylum seekers, refugees, and people who are paroled into the United States for one year or more. By designating millions of undocumented illegal immigrants as “paroled into the United States,” the Biden administration effectively redefined the legal status of undocumented immigrants, making them eligible for enrollment in the government-sponsored, taxpayer-funded Affordable Care Act. Illegal immigrants with parole status can choose to enroll in ACA Marketplace plans and can receive premium tax credits and cost-sharing reductions if they meet income requirements—all at the taxpayers’ expense.
This latest “illegal” immigrant health-care scam to gain access to taxpayer-funded ACA Marketplace plans follows one that was exposed by Bloomberg in June 2025, which revealed yet another under-reported Obamacare frontier in health-care fraud. This fraud encouraged deceptive ACA enrollments driven by AI-generated deepfakes of celebrities like Taylor Swift, Joe Rogan, and Andrew Tate. The way the scam worked was to use social media to draw on celebrity deepfakes to promote cash giveaways and ACA-related offers on social media simply for “signing up” for Obamacare. Viewers of the ads were invited to call telemarketing centers where commissions were paid on a per-lead model. The centers then redirected callers to insurance brokers who enrolled them in ACA plans, replete with premium tax credits and taxpayer-subsidized health care well beyond emergency room care—often without their consent or understanding.
Enhance Health was one of the largest brokers enrolling consumers in ACA Marketplace plans, reportedly registering over one million individuals in 2023. Many of the callers to Enhance and other such brokers were enrolled in fully subsidized ACA plans without even realizing they were signing up for health care. According to Georgetown University’s “litigation tracker, Turner et al v. Enhance, LLC et al. was a class action complaint alleging that certain fraudulent and misleading practices by insurance call centers to enroll people into Marketplace plans or switch their coverage constituted violations of the Racketeer Influenced and Corrupt Organizations Act (RICO). The fact that many of these “registered” insured individuals did not even exist has recently come to light. A report called “Unpacking the Great Obamacare Enrollment Fraud,” by the Paragon Health Institute, revealed that four to five million fraudulent enrollments occurred in 2024 alone, costing taxpayers $15–26 billion.
As the government shutdown continues, Senate Democrats are using the Working Families Tax Credit and broader Affordable Care Act (ACA) subsidies as leverage in negotiations. Rejecting stopgap funding bills, the Democrats want a guarantee that the corrupt-ridden ACA health insurance subsidies will be extended—and continue to support the health-care needs of the undocumented immigrants who have been illegally paroled into the country. In contrast, Republicans view the Democrats’ demands as a form of political hostage-taking—holding up government funding in order to push through what they believe are expensive, partisan priorities. For the Republicans, the recalcitrant Democrats are prioritizing health-care handouts that will deepen the deficit and reward those who refuse to work.
It is clear that the Affordable Care Act is riddled with subsidies, political spin, and outright fraud, but even Republicans acknowledge that the system is cracking. Whether Democrats call it compassion or Republicans call it corruption, the reckoning is here, and reform is no longer a choice—it’s a necessity.
This article was originally published on Crisis Magazine.
