The Trump administration claims its fraud control efforts are responsible for the decline in Obamacare enrollment, rather than the significant increase in premiums. Enrollment in Affordable Care Act plans fell by nearly 3 million this year to about 19.2 million.
On average, ACA customers pay $178 a month in premium payments this year, a 58% increase from 2025, according to KFF. Their deductibles have climbed 37% to nearly $3,800 a year.
Annalyse Keller, a spokesperson for Keep Americans Covered, a large coalition of lobby organizations for the healthcare industry, said “These are real people who are now forced to make impossible choices.”
A Department of Health and Human Services report released in June asserts that 5.6 million people were fraudulently enrolled in ACA plans in 2025, and that the Trump administration removed 2.9 million of them. However, health policy experts say the administration is overstating the extent of ACA fraud.
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Matthew Fiedler, a senior fellow at the Brookings Institution, said the claim that all the decline in enrollment since 2025 is because of improper or fraudulent enrollees leaving the market “is not remotely credible.” They point out that ACA enrollment fell off a cliff because of escalating prices for insurance plans.
Jonathan Oberlander, a professor of health policy and management at the University of North Carolina, questioned whether the fraud narrative will hold up as voters continue to struggle with rising costs. “It will be cold comfort to the very real persons who could no longer afford coverage and dropped their plans,” he said in an email.
The administration has taken actions to tighten the enrollment process to thwart brokers who fraudulently enroll people without their knowledge. For example, the administration in August 2025 halted a Biden-era initiative that allowed low-income people to sign up for coverage year-round.
Regulators also have removed 1.5 million people since 2025 for reasons such as not meeting a requirement to file their taxes over two years or being concurrently enrolled in another health program, such as Medicaid. The administration’s efforts to address fraud are ongoing.
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The issue of healthcare costs is a big concern for voters ahead of November’s midterm elections. According to a recent KFF poll, voters trust Democrats over Republicans to address healthcare costs (37% vs. 26%). However, 55% of Republican voters consider it extremely important for candidates to address healthcare fraud.
Florida insurance agent Jason Fine said the administration needs to focus on better enforcement of existing rules, rather than just relying on anti-fraud efforts. He has reported to regulators dozens of unscrupulous agents who have switched clients without authorization, yet none were barred from selling ACA policies.
Fine and other agents continue to push for adding identification verification, as banks and other financial institutions use, to the federal ACA marketplace. Some states that run their own exchanges have two-factor authentication or other types of ID verification and have not reported problems with unauthorized switching.
CMS has not added two-factor authentication to the federal marketplace, healthcare.gov. Rep. Glenn Grothman (R-Wis.) introduced legislation to require it in June, but its prospects are murky.
