Key facts
- 760,000 people are being removed from the ACA marketplace over alleged fraud.
- The administration is investigating an additional 420,000 individuals for suspected fraud.
- A six-month moratorium on new agents and brokers selling ACA policies has been implemented.
- Officials claim the removal will save the federal government $2.2 billion.
- The administration used AI tools to identify enrollees based on broker enrollment, full tax credit payment, and lack of SSN or immigration documents.
- Insurers were asked to contact suspected enrollees, who had 30 days to respond.
The Trump administration is removing 760,000 individuals from the Affordable Care Act (ACA) marketplace, alleging fraud and aiming to save the federal government $2.2 billion. Officials stated that these individuals are either "phantoms" or "ghosts" or do not meet eligibility requirements. The administration is also investigating approximately 420,000 more people for suspected fraud and has imposed a six-month moratorium on new agents and brokers selling ACA policies.
Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services (CMS), claimed that expelling these individuals would save the government $2.2 billion, stating, "These are not real people." JD Vance, leading a federal taskforce on fraud, asserted that the actions ensure "people receiving Obamacare subsidies are actually entitled to receive them."
However, experts like Edwin Park from Georgetown University expressed concern about the lack of transparency, noting that "some number are being disenrolled inappropriately" and that the process "make it incredibly burdensome for individuals to enroll and stay enrolled." Cynthia Cox of KFF echoed these concerns, stating, "there is no way to know how many legitimately enrolled people had their plans canceled." The administration identified suspected enrollees using AI tools, flagging those enrolled by a broker, whose ACA premiums were fully covered by tax credits, and who had not provided social security numbers or immigration documents. Insurers were asked to contact these individuals, giving them 30 days to respond before their coverage was canceled.
Park noted that these actions follow recent efforts to reduce enrollment in Medicaid and Medicare, which he believes are intended to "sharply undercut the success of and the long-term viability of the ACA’s coverage expansions." He also pointed out that flawed analyses comparing administrative and census data have been used to claim millions of fraudulent enrollees. The disenrollments are occurring amidst significant cuts to the marketplace, with premiums doubling or tripling for some, and rising energy and food costs making coverage unaffordable for more people.