health
RFK Jr., Oz claim fraud crackdown drove ACA enrollment drop, but analysts cite rising costs
August 3, 2026 / 5:00 AM EDT / KFF Health News
TL;DR
- Enrollment in Affordable Care Act (ACA) plans decreased by nearly 3 million, with average monthly premiums rising 58% and deductibles climbing 37%.
- The Trump administration claims 5.6 million people were fraudulently enrolled and that 2.9 million were removed due to fraud, correlating with the enrollment drop.
- Policy experts argue that the administration exaggerates ACA fraud and that rising costs, not fraud, are the primary driver of decreased enrollment.
- The administration has implemented measures to tighten enrollment processes, including halting year-round enrollment for low-income individuals and removing those not meeting tax filing requirements.
- The debate over ACA enrollment is a key issue in upcoming elections, with differing perspectives from Democrats and Republicans on affordability versus fraud prevention.
- Under the Biden administration, enhanced tax subsidies led to a significant increase in ACA coverage, but Republicans argue these subsidies and relaxed verification requirements invited fraud.
- New anti-fraud measures are being implemented, such as requiring Social Security numbers for broker-initiated enrollments and verifying suspicious accounts with zero premiums.
- Experts question the assumptions behind the administration's fraud indicators, noting that missing Social Security numbers or low healthcare claims may have other explanations.
- Insurance agents suggest focusing on better enforcement of existing rules and implementing stronger security measures like multi-factor authentication on the federal marketplace.