The Trump administration announced the removal of 760,000 individuals from the federally subsidized Affordable Care Act marketplace on allegations of fraudulent enrollment, officials said. Additionally, the administration is investigating approximately 420,000 other enrollees suspected of fraud and has implemented a six-month moratorium on new agents and brokers selling ACA policies. Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services, characterized the removed enrollees as “phantoms” and “ghosts” along with those failing to meet eligibility requirements, asserting the action would save the federal government $2.2 billion.
Health policy experts expressed concerns about the transparency and methodology of the disenrollments. Edwin Park of Georgetown University’s Center for Children and Families stated that without detailed information, it is impossible to determine whether eligible individuals were improperly removed from coverage. Cynthia Cox of KFF, an independent health policy organization, noted that the administration provided no clarity regarding which enrollees were fictional versus those disenrolled due to other reasons. The administration used artificial intelligence tools to identify enrollees based on three criteria: enrollment through a broker or agent, full premium payment via tax credit, and lack of provided Social Security numbers or immigration documents. Enrollees received 30 days to respond to verification requests before coverage was terminated, though they can appeal and seek reinstatement by proving their identities.
The administration’s actions follow a pattern of recent efforts to reduce enrollment in federal health programs. According to the Center on Budget and Policy Priorities, nearly 3 million people lost ACA coverage between February 2025 and February 2026, even as approximately 19.2 million Americans remained enrolled in the marketplace. Officials also withheld $2.2 billion in Medicaid payments from California and Minnesota over alleged fraud in home health aide programs. Some enrollees appear to have been disenrolled due to income restrictions, affecting low-income individuals in states without Medicaid expansion who earn between $16,000 and $22,000 annually.
Administration officials contended that fraudulent broker practices warranted enforcement action, citing cases where brokers had been convicted of quietly enrolling individuals to collect commissions. However, critics noted that the Biden administration had previously decertified approximately 200 problematic brokers, only for Trump administration officials to recertify them. Oz cited data indicating 35 percent of ACA enrollees have not used their insurance as evidence of fraud, though Park countered that this is typical in insurance pools that include healthy individuals. Experts warned that removing lower-risk enrollees could increase premiums or prompt insurers to exit markets entirely.
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