RFK Jr. and Dr. Oz Blame Fraud for ACA Enrollment Decline, but Experts Aren’t Buying It, Citing a More ‘Straightforward’ Reason

Nearly 3 million people vanished from Obamacare’s rolls this year, and the Trump administration says it knows exactly why: fraud. Health Secretary Robert F. Kennedy Jr. and Medicare chief Dr. Mehmet Oz point to millions of supposedly fake sign-ups as the culprit behind the drop. Health policy experts looking at the same numbers see something else driving people away, and it has nothing to do with scammers.

ACA enrollment fell to about 19.2 million people this year, a steep drop from 2025. During that same stretch, premiums climbed sharply, with customers now paying an average of $178 a month, according to KFF, a 58% jump from last year. Deductibles rose too, up 37% to nearly $3,800 annually. For many families already stretched thin, those numbers translate into an impossible math problem.

“These are real people who are now forced to make impossible choices,” said Annalyse Keller, a spokesperson for Keep Americans Covered, a coalition representing insurers and patient advocacy groups. But a Department of Health and Human Services report released in June tells a different story, one built almost entirely by Trump’s own political appointees, and its conclusion points the finger somewhere else entirely.

This article was created with the assistance of AI and reviewed by our editorial team for accuracy and clarity.

HHS Claims 2.9 Million Fraudulent Sign-Ups Match Exactly the Enrollment Drop

The HHS report asserts that 5.6 million people were fraudulently enrolled in ACA plans in 2025. It claims the administration removed 2.9 million of them, a figure that lines up precisely with this year’s enrollment decline. Regulators have already stripped 1.5 million people from the rolls since 2025 for reasons like failing to file taxes or being double-enrolled in Medicaid. Fraud, the administration insists, explains the missing millions.

Health policy experts see the timing as too convenient. Matthew Fiedler, a senior fellow at the Brookings Institution, called the administration’s central claim implausible on its face. “The top-level claim” that fraud accounts for the entire decline “is not remotely credible,” he said, adding that strong evidence links rising premiums directly to people dropping coverage.

The report leans on shaky assumptions to reach its numbers. It treats every sign-up made through a Biden-era, year-round enrollment option for low-income people as potentially fraudulent, without verifying whether those enrollees were real. That single assumption inflates the fraud count dramatically, and it conveniently sidesteps a much simpler explanation staring analysts in the face.

A UNC Professor Says the Fraud Story Offers ‘Cold Comfort’ to Families Losing Coverage

Under President Biden, Congress passed enhanced subsidies in 2021 that slashed premiums, letting millions pay nothing monthly. ACA coverage nearly doubled, climbing from just over 11 million enrollees in 2021 to more than 22 million by 2025. Republicans argue that surge wasn’t organic growth, but conservative groups and the administration disagree sharply with health economists over what actually happened next.

Republicans and groups like the Paragon Health Institute argue that loosened verification rules invited brokers to sign people up without their knowledge, chasing commissions. Paragon’s president, Brian Blase, wrote that the HHS fraud estimate likely undercounts the real total and rejected the idea that rising premiums explain the enrollment drop, insisting subsidies remain generous enough for most people.

Jonathan Oberlander, a health policy professor at the University of North Carolina, doubts the fraud narrative will survive contact with voters’ wallets. “It will be cold comfort to the very real persons who could no longer afford coverage and dropped their plans,” he told KFF Health News. Meanwhile, insurance agents on the ground describe a very different reality than the one described in Washington.

Florida Agent Jason Fine Says Clients ‘Can’t Afford to Pay $15’

The administration’s fraud hunt zeroes in on specific red flags: enrollees with no Social Security number, no medical claims filed, or a switch to zero-premium plans. HHS Secretary Kennedy called a missing Social Security number a glaring sign of fraud in a June video, while CMS chief Oz warned potential scammers, “Don’t walk away from us, run! Because we are going to find you.”

Experts push back hard on those markers. Fiedler noted that a missing Social Security number could just as easily belong to a newborn added to a parent’s plan before receiving one, or reflect a simple clerical oversight. Younger and lower-income enrollees often file no claims simply because they rarely use healthcare, especially once high deductibles force them to pay thousands out of pocket first.

Florida insurance agent Jason Fine sees the pattern up close every day. “People are hurting for money,” he said. “I literally have people who can’t afford to pay $15. I would not immediately assume that a person who went from a silver plan to a bronze plan, that it’s fraud.” He argues the real fix is stronger enforcement against agents who switch clients without permission, not blanket suspicion of low-income enrollees.

Two-Factor Authentication Still Missing From Healthcare.gov After Years of Requests

Fine has reported dozens of unscrupulous agents to regulators for switching clients’ plans without consent. None, he said, were barred from selling ACA policies. He and other agents have pushed for years to add multifactor identification to the federal marketplace, the same security layer banks use, arguing it would stop unauthorized switches before they happen.

States that run their own ACA exchanges with two-factor authentication haven’t reported the same unauthorized-switching problems. Yet Healthcare.gov, the federal marketplace, still lacks that safeguard under both the Biden and Trump administrations. Rep. Glenn Grothman introduced legislation in June to require it, though its prospects in Congress remain uncertain. Ronnell Nolan, who leads Health Agents for America, said the bill “might encourage CMS to do it themselves.”

Voters aren’t waiting for that fix. A recent KFF poll found Americans trust Democrats over Republicans to handle healthcare costs by 37% to 26%, even as 55% of Republican voters still rank fraud as their top healthcare concern. That gap reveals the real stakes heading into November: a fraud story can dominate a press conference, but it cannot pay a family’s insurance bill. The premiums still climbed. The coverage still lapsed. And no amount of rhetoric about brokers and scammers changes what millions of Americans now find in their mailboxes each month.