Trump Adds Some Back After Cutting 760K From ACA Plans
The Trump administration has reinstated a small number of people it wrongly removed from Affordable Care Act health plans, after cutting roughly 760,000 enrollees in a sweeping anti-fraud crackdown, according to NPR. Insurance industry sources told KFF Health News that the Centers for Medicare & Medicaid Services (CMS) has restored coverage for an undisclosed number of people whose plans should not have been canceled, and more reinstatements could follow as enrollees discover they are uninsured when they try to use their coverage.
The Crackdown
Late last month, CMS announced it had canceled approximately 315,000 unauthorized enrollments covering more than 760,000 individuals in states using HealthCare.gov, the federal marketplace, while touting billions in potential taxpayer savings, according to the agency’s press release. The agency said the move was expected to return roughly $2.2 billion in taxpayer-funded subsidies. Vice President JD Vance and CMS Administrator Mehmet Oz announced the removals, which applied only to federal marketplace states, not the 21 states that run their own exchanges.
The campaign was part of a broader Republican strategy to target fraud in government programs, including Medicaid and hospice care — an issue that polls show resonates with GOP voters ahead of the November midterm elections. At an Oct. 14 press conference, Health and Human Services Secretary Robert F. Kennedy Jr. and Oz also touted the removal of subsidies for about 189,000 ACA enrollees with duplicate Medicare, Medicaid, or Children’s Health Insurance Program coverage.
How Enrollees Were Flagged
CMS selected nearly 1.2 million enrollments for review in June, each bearing what the agency deemed four warning signs for fraud: no Social Security or immigration document number, a broker involved in the sign-up, zero monthly premium, and no contact with the insurer or claims filed. The agency sent lists of those accounts to specific insurers, instructing carriers to use at least two methods of contact — such as a phone call and a letter — and giving enrollees 30 days to respond. CMS disenrolled those who did not.
Supporters argue the sweep was overdue. Brian Blase, president of the Paragon Health Institute, which has supplied much of the research behind the fraud claims, said the cancellations were justified. “This was clearly phantom enrollees,” he told NPR, estimating that more than 99% of the cancellations involved zero-premium coverage signed up by rogue call centers without people’s knowledge, or for people who don’t exist. He added that for anyone unfairly caught up, reinstatement simply requires calling the marketplace and providing the missing information.
A Reversal Under Pressure
Not all of those removed were fraudulently enrolled, KFF Health News reported. David Merritt, senior vice president of external affairs at the Blue Cross Blue Shield Association, confirmed that some BCBS members are among those who have been reinstated and that CMS has an expedited review process for people improperly disenrolled.
Policy experts question how many legitimate consumers were caught in the dragnet, perhaps because they failed to open a letter from their insurer or answer a call from an unfamiliar number. “It may be true that some of those enrollments were not authorized, but it can be equally true that people got lost in the shuffle and have a valid enrollment. Without more information, it’s almost impossible to tell,” said Katie Keith, director of the Center for Health Policy and the Law at Georgetown Law. “That they are not being very transparent is telling too.”
Johnny Wallin, chief operating officer of Texas-based Marketplace Insurance Exchange, described an “all-hands-on-deck” effort by agents to reach clients — some of them vacationing overseas. “Getting them to answer the phone isn’t easy,” he said, noting his team could not reach about 60 of them.
The administration is providing few details about the cancellations, including how robust the outreach was, how long reinstatement takes, and how many cancellations have been reversed. CMS declined to provide data on its reasons for canceling enrollments, saying only, “Currently, there is no additional data to share.”
The Bigger Picture
Recent reporting has shown that getting an ACA plan canceled or reinstated after an unauthorized sign-up is not always quick, even when consumers discover the problem themselves. Brokers and analysts note that some factors used to question enrollments — such as a plan with no claims filed in a year — are not unusual. Insurers “want those healthy people in the insurance pool to help bring down the rates,” said Ronnell Nolan, president and CEO of Health Agents for America. “We’re against fraud, and CMS has allowed a lot of fraud to happen. But we don’t want people who just didn’t go to the doctor to be canceled.”
Unauthorized sign-ups by rogue agents seeking commissions have been a documented concern for several years, with much debate over the magnitude of the problem. CMS has suspended some brokers and barred new brokers from enrolling clients on the federal exchange during the upcoming open enrollment period.
“There will be legitimate people who don’t have a claim or don’t respond to an inquiry from an insurer,” said Matthew Fiedler, a senior fellow at the Brookings Institution. “If the goal is to target fraudulent enrollment, what CMS did is better than tossing people at random, but is likely to miss the mark.”
Separately, ACA enrollment has fallen sharply — by nearly 3 million this year to about 19.2 million — due largely to the expiration at the end of 2025 of enhanced subsidies. CBS News reported that enrollees now pay an average of $178 a month in premiums, a 58% increase from 2025, while deductibles have climbed 37% to nearly $3,800 a year. The administration has taken some credit for the decline, attributing it to the fraud crackdown, a claim many analysts dispute.
“To the extent there is a reaction depends on whether the government got it wrong, whether people try to get care and then find out their coverage is no longer active,” said Adrianna McIntyre, assistant professor of health policy and politics at the Harvard T. H. Chan School of Public Health.
What’s Next
A second phase of the anti-fraud effort is already underway, scrutinizing an additional 419,000 sign-ups. Insurers must report non-responders to CMS by “around mid-to-late November, after the midterm elections,” Merritt said — meaning the ultimate scope of the removals remains unknown.
With healthcare costs ranking as a top voter concern, the political stakes are high. Many of those removed are likely in red states such as Texas, Florida, Louisiana, and Mississippi, which saw rapid ACA enrollment growth from 2020 to 2025. But how the episode plays out at the ballot box — and how many more people will learn they lost coverage — is not yet clear. What is clear, critics say, is that the burden of proving eligibility has fallen on ordinary Americans who may never have known their coverage was in question.