The Trump administration said Tuesday it would remove more than 1 million people from Affordable Care Act marketplace coverage as part of what officials described as the largest anti-fraud crackdown in the program's history, arguing many people enrolled with the system had never knowingly signed up. Speaking at a news conference as part of his anti-fraud efforts, Vice President JD Vance said the administration was stopping Obamacare registration for over 700,000 people who it believes are fraudulently enrolled, while Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz said some of those being removed from the program had "never filed a claim." Republicans have long claimed that the ACA has been open to fraud and abuse, and there have been cases where this has been proven.
The tougher approach from the Trump administration has raised concern, however, that eligible people will lose coverage. "It is entirely possible that many of these people were enrolled without their knowledge or were so-called phantom enrollees," Cynthia Cox, senior vice president and director of the Program on the ACA at KFF, told Newsweek. "It is also entirely possible that many of these people were legitimately enrolled and simply did not respond in time.
There is no way to know how many legitimately enrolled people had their plans canceled." Newsweek reached out to CMS for further comment via its contact form Tuesday afternoon. The administration says that the federal health insurance marketplace has become vulnerable to increasingly sophisticated fraud schemes that allow brokers and bad actors to enroll consumers without their knowledge, so those behind the efforts can then collect federal premium subsidies. According to a fact sheet released by CMS on Tuesday, officials have identified hundreds of thousands of unauthorized enrollments and reported widespread evidence of eligibility problems, unresolved verification issues and suspicious enrollment patterns.
"We are stopping Obamacare enrollment for about 750,000 people, who we believe are fraudulently enrolled in the program," Vance said. "The second thing we're going to do is we're going to do some additional verification…on about 419,000 people. We're going to make sure that they're, first of all, legal residents of the United States of America, and second of all we're going to make sure they meet the income threshold requirements in order to receive these Obamacare benefits." Oz highlighted consumers who had allegedly never used coverage that federal taxpayers were subsidizing, arguing this suggested many did not know they had been enrolled in the first place.
The administration argues that its efforts are necessary to protect taxpayers and preserve the long-term integrity of the marketplace, with CMS predicting around $2.2 billion in returned funds. "The administration sent a list of about 1 million people who they suspected could be fraudulently enrolled to insurers. These were people who were enrolled by a broker or agent, had 100% of their premium payment coverage by the tax credit, and who had no SSN or had no immigration document that CMS was able to verify in real time," Cox said.
"Insurers were asked to try to make contact with those people and families. Insurers were allowed to filter out people who had a claim or had communicated with the insurer. If the enrollees did not make contact within 30 days of outreach, their coverage was canceled." The government has presented substantial evidence of ongoing fraud risks within ACA marketplaces.
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