The Trump administration has reinstated some people it removed from Affordable Care Act coverage in what the administration called an anti-fraud sweep of about 760,000 people, KFF Health News reported on Oct. 15, citing insurance industry sources. Not all of those cut were fraudulently enrolled, KFF Health News reports. How many people have been restored is not known: the Centers for Medicare & Medicaid Services (CMS) has not given a figure, and insurance industry sources characterized it as a small number.
What the insurers say
Insurance industry sources told KFF Health News that CMS has reinstated a small number of people whose coverage should not have been canceled. More could follow in the coming weeks if enrollees discover they are uninsured when they go to use their coverage.
David Merritt, senior vice president of external affairs at the Blue Cross Blue Shield Association, confirmed that some Blue Cross Blue Shield members are among those who have been reinstated. He also said CMS has an expedited review process for people who discover they were improperly removed from coverage.
The administration is providing few details about the cancellations, such as how robust the outreach was, how long it takes people to get reinstated after discovering their coverage was wrongly canceled, and how many cancellations have been reversed.
How the sweep worked
The cancellations affect only states that use HealthCare.gov, the federal marketplace. The 21 states that fully run their own marketplaces generally have more robust fraud prevention programs and have reported few or none of the kinds of unauthorized sign-ups plaguing the federal marketplace. Many of the people removed are likely in red states such as Texas, Florida, Louisiana and Mississippi, which saw rapid ACA enrollment growth from 2020 to 2025.
According to information CMS gave KFF Health News, the agency selected nearly 1.2 million enrollments for further review in June. Each had all four of what CMS deemed warning signs for fraud:
- The application included no Social Security number or immigration document number.
- A broker was involved in the sign-up process.
- The plan had no monthly premium payment.
- The enrollee had had no contact with their insurer and no claims filed.
CMS sent lists of those accounts to specific insurers and told them to use at least two methods of contact, such as a phone call and a letter. Policyholders had 30 days to respond to the insurers’ outreach and provide the missing information. CMS removed from coverage those who did not respond.
The figures count different things. Nearly 1.2 million enrollments were reviewed; about 760,000 people were cut. In NPR’s September report on the original announcement, the administration put the cancellations at about 315,000 enrollments covering about 760,000 people, and said a further 419,000 sign-ups would get additional verification.
Timeline
- June: CMS selected nearly 1.2 million enrollments for review, according to information it gave KFF Health News.
- Aug. 31: the cancellations took effect, according to CMS as summarized in later coverage.
- Sept. 22: the cuts were announced by Vice President JD Vance and CMS Administrator Mehmet Oz, according to NPR’s September report.
- Oct. 14: Health and Human Services Secretary Robert F. Kennedy Jr. and Oz held a press conference touting the removal this year of subsidies for about 189,000 enrollees with duplicate coverage.
- Oct. 15: KFF Health News reported the reinstatements.
- Mid-to-late November: insurers must tell CMS how many second-phase enrollees do not respond to outreach, according to Merritt.
What CMS has not provided
CMS did not respond to requests for data on the reasons it canceled enrollments. KFF Health News asked what percentage of enrollees were deemed ineligible because of incorrect income reporting or other health coverage, such as through a job, and how many because their applications lacked immigration documents or Social Security numbers. “Currently, there is no additional data to share,” the agency’s press office said.
CMS would not provide a list of the insurers it contacted, but publicly available documents show that Oscar Health was one. In an August earnings call, CEO Mark Bertolini said the company was reviewing the files and that “there are a number of cases where we’ve actually had contact” with people on the list. He did not specify how many. In a filing with the Securities and Exchange Commission, Oscar estimated that 250,000 to 300,000 of its members might be removed from coverage because of the CMS effort. The company had about 3 million members in the second quarter and declined to comment for the article, citing a quiet period before an earnings report.
The administration’s case and the dispute
The administration announced the cuts in September as the removal of fraudulent or improper enrollments, and NPR’s September report cited $2.2 billion in projected savings. Supporters say the sweep was long overdue.
Brian Blase, whose Paragon Health Institute has supplied many of the sometimes controversial findings cited by those who allege widespread enrollment fraud in the ACA, supports it. “This was clearly phantom enrollees,” he said. He thinks more than 99% of the cancellations are of zero-premium coverage, meaning plans with no monthly premium payment, that people were signed up for by rogue call centers without their knowledge, or for people who do not exist at all. Blase said the carriers had a big incentive to reach the enrollees because they would lose the subsidy payments they were receiving if the plans were canceled.
Other policy experts question how many legitimate consumers were caught, perhaps because they failed to open a letter from their insurer or answer a phone call. Katie Keith, a director of the Center for Health Policy and the Law at Georgetown Law, said: “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.”
Matthew Fiedler, a senior fellow at the Brookings Institution, said: “There will be legitimate people who don’t have a claim or don’t respond to an inquiry from an insurer. 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.” Ronnell Nolan, president and CEO of Health Agents for America, a trade group for health insurance agents, said: “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.”
Brokers and policy analysts note that some of the factors used to question enrollments, such as a plan’s having no claims filed in a year, are not that unusual. Many people do not visit a doctor or hospital in a given year. Policy experts also note that a missing Social Security number on an application could indicate a fake enrollee, but it might also be an oversight, or the number might not be required, as for a child when the person applying is an adult not seeking coverage for the child.
The second phase
An additional 419,000 sign-ups are being scrutinized. Merritt said insurers must let CMS know how many of those enrollees do not respond to outreach efforts by “around mid-to-late November, after the midterm elections.”
Johnny Wallin, chief operating officer of Texas-based Marketplace Insurance Exchange, which helps clients in about 35 states enroll in coverage, said insurers asked his organization for help contacting people on the CMS lists, prompting “an all-hands-on-deck” effort by agents. Some of the clients on the lists were vacationing overseas. He said his agents could not reach about 60 of them, and that insurers have also asked his team to help contact people in the second phase.
A separate announcement on Oct. 14
At the Oct. 14 press conference, Kennedy and Oz touted the removal this year of subsidies for about 189,000 ACA enrollees with duplicate Medicare, Medicaid or Children’s Health Insurance Program coverage. By KFF Health News’ account, they cited not fraud but a failure to look for concurrent enrollments or continued coverage for dead people, and credited an effort begun last year by the Trump administration to restore more frequent data-matching checks than were done under the prior administration. That is the administration’s own account.
KFF Health News does not say whether the 189,000 overlap with the 760,000, and its wording is “removal of subsidies,” so it is not clear whether those enrollees lost coverage or only their subsidies.
What reinstatement requires, according to officials
Blase and Trump administration officials say people who were unfairly caught up need only call the marketplace and provide their Social Security number or other missing information to be reinstated. The outreach window that preceded the cancellations was 30 days.
Blase offered his own view of the timing: “Everyone has the political incentive for that process to be that easy,” Blase said. “We’re a month before the election.”
KFF Health News adds that, as prior reporting has shown, it is not always a quick process to get an ACA plan canceled or reinstated after an unauthorized sign-up or switch, even when a consumer discovers the problem and contacts the marketplace. Not everyone answers phone calls from unknown numbers or opens their mail or email, even with the outreach CMS required.
The politics
The enrollment cut is part of a larger Republican strategy to focus on fraud in government programs, including Medicaid and hospice care, which polls show resonates with GOP voters. How the move will play out politically is uncertain; healthcare costs are tied with gas prices as a top concern for voters. Adrianna McIntyre, an assistant professor of health policy and politics at the Harvard T.H. Chan School of Public Health, said: “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.”
What is not known
It is not known how many people have been reinstated, how long reinstatement takes, or how many of the 760,000 cancellations were for each of the reasons, since CMS has not provided that breakdown. The coverage does not explain how nearly 1.2 million enrollments reviewed became about 315,000 canceled enrollments, or how those relate to the 419,000 in the second phase. How many of the 419,000 will be found improperly enrolled will not be known until the insurers’ non-response report, due after the election.