The Trump administration is removing 760,000 people enrolled in the Affordable Care Act (ACA) marketplace on allegations of fraud, officials said on Tuesday – adding to previous efforts to chip away at federally subsidized insurance programs and likely causing some of the lowest-income Americans to forego healthcare, experts said.
asserted
experts → remove → healthcare
The US government is also investigating about 420,000 people whom they suspect of fraud, and they are putting a six-month enrollment moratorium on new agents and brokers selling Obamacare policies, officials said at a press conference.
asserted
officials → investigate → conference
The removed enrollees are a mixture of “phantoms” and “ghosts” as well as people who don’t meet the eligibility requirements of Obamacare, said Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services (CMS).
asserted
Oz → remove → Medicare
“These are not real people,” he said, claiming that expelling them from the ACA marketplace would save the federal government $2.2bn.
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expelling → say → 2.2bn
JD Vance, who is leading a federal taskforce on fraud, claimed: “We’re actually making sure that the people receiving Obamacare subsidies are actually entitled to receive them.”
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people → lead → them
No details were provided about how many enrollees were fictional, enrolled by fraudulent brokers without their knowledge or expelled because of income restrictions.
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enrollees → provide → restrictions
“There’s no transparency about who these people are and why they’re being disenrolled, but I think it’s a reasonable concern that some number are being disenrolled inappropriately,” said Edwin Park, a research professor at the Center for Children and Families at Georgetown University’s McCourt School of Public Policy.
asserted
Park → ’ → Policy
“A common theme here is to make it incredibly burdensome for individuals to enroll and stay enrolled in their health coverage.
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individuals → make → coverage
Without more information, “there is no way to know how many legitimately enrolled people had their plans canceled”, said Cynthia Cox, senior vice-president and director of the Program on the ACA at KFF, an independent health policy organization.
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Cox → be → KFF
The move follows recent rules and legislation to reduce enrollment in Medicaid, Medicare and the ACA, said Park, who added: “A lot of these actions are intended to sharply undercut the success of and the long-term viability of the ACA’s coverage expansions, which have been an incredible success in terms of reducing the number of people without health insurance.”
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which → follow → insurance
About 19.2 million Americans are enrolled in the ACA marketplace, but nearly 3 million people lost their coverage between February 2025 and February 2026, according to the Center on Budget and Policy Priorities.
uncertain
people → enrol → Budget
The fraud taskforce has also withheld $2.2bn in Medicaid payments from California and Minnesota over alleged fraud – primarily in home health aide programs, which disability advocates say are a lifeline.
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advocates → withhold → programs
Officials followed an unusual path to verify ACA enrollment, experts said.
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experts → follow → enrollment
The administration sent to insurers a list of more than a million people suspected of being fraudulently enrolled in the ACA marketplace, also known as Obamacare.
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administration → send → Obamacare
Officials said on Tuesday that they used AI tools to identify the enrollees.
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they → say → enrollees
The people were identified by three factors: they’d been enrolled by a broker or agent, had all of their ACA premium paid by the tax credit, and they had not supplied social security numbers or immigration documents.
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they → identify → numbers
Insurers were asked to try to make contact with those enrollees; they were permitted to filter out people who had a previous claim or had communicated with the insurer.
uncertain
who → ask → insurer
The enrollees had 30 days to respond, or their coverage was canceled.
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coverage → have → days
“It is entirely possible that many of these people were enrolled without their knowledge or were so-called phantom enrollees,” Cox said.
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Cox → enrol → knowledge
“It is also entirely possible that many of these people were legitimately enrolled and simply did not respond in time.”
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many → enrol → time
People can appeal and be reinstated once they prove their identities – but this will likely function as an additional hurdle making it harder for people to stay enrolled, Park said.
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Park → appeal → hurdle
“We know that when you add a lot of red tape, increase the amount of complexity and the requirements for paperwork,” Park said, that “leads to eligible people being disenrolled.”
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people → know → paperwork
Vance spoke of two fraudulent brokers who were convicted of quietly enrolling people to collect commissions from insurance companies, acknowledging that “some of those people were probably legitimate”, but he did not speak of the steps necessary to reinstate them or to prevent future disenrollments.
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he → speak → disenrollments
Ending unscrupulous broker practices has been a bipartisan issue, and the Biden administration was the first to act, finalizing a rule to crack down on shady brokers.
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administration → end → brokers
Officials under Biden decertified about 200 such brokers – but Trump administration officials recertified them last year.
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officials → decertifie → them
About 35% of ACA enrollees have never used their health insurance, Oz said.
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Oz → use → insurance
“That’s just not possible,” he said, adding, “So we know there is fraud.”
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we → ’ → ?
But it’s not unusual for healthy people to be enrolled in insurance and not need to use it, Park noted: “You can expect in any insurance risk pool that there’s going to be a lot of people who don’t use much healthcare or use healthcare at all.”
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who → ’ → healthcare
By removing lower-risk enrollees, insurance premiums could increase or insurers could decide to leave markets entirely, he said.
uncertain
he → remove → markets
Some enrollees also appear to have been cut because they are low-income.
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they → appear → ?
The Affordable Care Act was intended to include a Medicaid expansion for those living under the poverty line, but a supreme court decision made the expansion optional.
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expansion → intend → line
In states that chose not to expand Medicaid, there is a group of low-income people who make too much money to qualify for Medicaid – earning between $16,000 and $22,000 per year – but don’t make enough to qualify for the ACA.
asserted
who → choose → ACA
“We’re going to make sure that they actually meet the income threshold requirements in order to receive these Obamacare benefits,” Vance said of this group.
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Vance → go → group
Oz called their disenrollment “a little bit painful”.
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Oz → call → disenrollment
Park said that there have been a series of “at best misleading” allegations arguing that a large share of current marketplace plan enrollees are fraudulently or inappropriately enrolled.
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share → say → enrollees
Reports from the Paragon Institute and the US Department of Health and Human Services (HHS) have indicated millions of fraudulent enrollees – but those analyses are “flawed”, Park said.
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Park → indicate → enrollees
These reports directly compare administrative data and unadjusted census data, but income and household sizes are calculated differently in these two measures.
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income → compare → measures
The census counts all individuals living in the household, while Medicaid and the ACA marketplace exclude non-dependent relatives.
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Medicaid → count → relatives
“That has a big effect on the number of people who appear to be in certain income ranges,” Park said.
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Park → have → ranges
“That has been used to say a huge percent of people don’t look like they have incomes in the right eligibility range.”
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they → use → range
…and 9 more, not listed.
The Aporia
