90% of it goes to fund the government infrastructure along with paying for the salaries and lavish benefits of government employees attempting to manage the monstrosity.
90% of what’s left is fraud.
That leaves about 10 billion making into the hands of the people it was “intended” to serve.
The government programs actually have far less overhead and pay out a higher percentage to the end user (biller). Government has no incentive to deny payment ... just stamp them "approved."
It is that the things "covered" has grown to include a ton of sketchy items, and people smelling a gold mine exploit it. A pathetic amount of the "fraud" is just government as usual.