Mehmet Oz on ACA Enrollment Drop: Fraud Crackdown or Rising Costs?

The Trump administration, including figures like Mehmet Oz and RFK Jr., has a straightforward explanation for why millions of people left the Affordable Care Act marketplace this year: fraud. A Department of Health and Human Services report released in June, written mostly by political appointees, asserts that 5.6 million people were fraudulently enrolled in ACA plans in 2025, and that the administration removed 2.9 million of them — the same number as the 2026 drop in enrollment.

But policy experts and healthcare analysts see a different story. Enrollment in ACA plans fell by nearly 3 million this year to about 19.2 million, following steep premium increases by insurers and the Republican-led Congress' unwillingness to extend more generous premium subsidies. On average, ACA customers pay $178 a month in premium payments this year, a 58% increase from 2025, according to KFF, while their deductibles have climbed 37% to nearly $3,800 a year.

The gap between the administration's fraud narrative and the affordability reality has significant political and health policy implications. If the decline is primarily cost-driven, then the administration's focus on fraud enforcement may be addressing a real but secondary problem — while millions of Americans simply can't afford coverage. If the decline is primarily fraud-driven, then the administration's actions are protecting taxpayer dollars and program integrity. The evidence, however, leans heavily toward the former.

Mehmet Oz and the Fraud Claim: What the HHS Report Says

Mehmet Oz, who oversees the Centers for Medicare and Medicaid Services, has been a vocal proponent of the fraud narrative. The HHS report, released in June, claims that 5.6 million people were fraudulently enrolled in ACA plans in 2025, and that the Trump administration removed 2.9 million of them — a number that conveniently matches the 2026 enrollment drop. The administration has taken concrete steps to tighten the enrollment process, including halting a Biden-era initiative in August 2025 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.

There's little dispute that the ACA suffers from some fraud, as do most government programs. The administration said it has taken actions to thwart brokers who fraudulently enroll people without their knowledge. But the scale of the alleged fraud — and whether it explains the enrollment decline — is where the disagreement lies.

The Cost Reality: Premiums Up 58%, Deductibles Up 37%

The numbers from KFF paint a stark picture. Average monthly premiums for ACA customers rose 58% to $178, and deductibles climbed 37% to nearly $3,800 a year. These increases followed the expiration of more generous subsidies at the end of last year, which made premiums more expensive and led many people to drop coverage.

“These are real people who are now forced to make impossible choices,” said Annalyse Keller, a spokesperson for Keep Americans Covered, a large coalition of lobby organizations for the healthcare industry, including insurers and patient advocacy groups.

The timing is telling. The enrollment decline came after the subsidy expiration, not after the fraud crackdown began. The administration's own actions — halting year-round enrollment and removing people for tax filing non-compliance — also contributed to the drop, but those are administrative decisions, not fraud removals.

What About the One Big Beautiful Bill Act?

Democrats have claimed that 8 million Americans have lost healthcare coverage as a result of the Trump-backed budget reconciliation bill that passed a year ago, known as the One Big Beautiful Bill Act. Enrollment in Medicaid and the ACA marketplace has indeed declined by about 8 million since the start of President Donald Trump's second term. But experts told FactCheck.org that the enrollment declines seen to date are largely due to other factors — including other Trump administration policies.

“We're seeing this before the direct effects of H.R. 1 are kicking in,” said Joan Alker, a research professor at Georgetown University and director of the school's Center for Children and Families, referring to the bill number of the OBBBA.

Most of the healthcare-related provisions of the OBBBA — which are eventually expected to cause millions of people to lose insurance — haven't yet taken effect. The nonpartisan Congressional Budget Office has projected that the law's Medicaid provisions will result in 7.5 million more people without health insurance by 2034. But that's a future projection, not a current cause.

The decline in ACA enrollment came after the expiration of more generous subsidies, which were set to lapse whether or not the OBBBA passed. Democrats have sought to tie the expiration of those subsidies to other healthcare cuts in the OBBBA, but the subsidy expiration was a separate policy decision.

The Political Stakes

The political implications are significant. Democrats blame the OBBBA for the enrollment declines, while Republicans credit fraud control. But experts say the primary cause is affordability. The administration's fraud narrative serves a political purpose: it frames the enrollment drop as a positive development (removing waste, fraud, and abuse) rather than a negative one (people losing coverage they need).

For Republicans, the fraud claim justifies continued enforcement and deregulation. For Democrats, the cost narrative supports arguments for restoring enhanced subsidies and expanding coverage. The truth, as usual, is more complex.

The administration's actions have real consequences. Halting year-round enrollment and removing people for tax filing non-compliance may be defensible policy choices, but they also reduce coverage. The question is whether those reductions are justified by fraud prevention or are simply collateral damage in a broader effort to shrink the ACA's footprint.

What the Numbers Tell Us

The enrollment drop of nearly 3 million matches the 2.9 million fraud removals cited in the HHS report. But correlation isn't causation. The premium increases and subsidy expiration happened at the same time, and they provide a more direct explanation for why people would voluntarily leave coverage.

If fraud were the primary driver, you'd expect the removals to be concentrated among people who were fraudulently enrolled — those who didn't know they had coverage or who were enrolled by rogue brokers. Instead, the administration removed 1.5 million people for reasons like not filing taxes or being dual-enrolled, which are administrative issues, not fraud.

The affordability argument is also supported by the broader trend. Medicaid and ACA enrollment combined have declined by about 8 million since the start of Trump's second term. That's a massive number, and it's hard to attribute all of it to fraud. The expiration of enhanced subsidies, combined with rising premiums and deductibles, makes it more likely that people simply couldn't afford to stay covered.

The Bottom Line

The debate over why ACA enrollment dropped is not just an academic exercise. It determines whether the government should focus on fraud enforcement or on making coverage more affordable. If the administration's fraud narrative is accepted, then the enrollment decline is a success story. If the analysts' cost narrative is accepted, then the decline is a policy failure.

The evidence suggests the latter. The premium increases and subsidy expiration are well-documented, and they align with the timing of the enrollment drop. The fraud removals, while real, are a smaller part of the story. The administration's focus on fraud may be politically convenient, but it doesn't change the fact that millions of Americans are now without health insurance — and many of them are uninsured because they can't afford it.

As the OBBBA's provisions take effect in the coming years, the enrollment declines are likely to continue. The CBO projects 7.5 million more uninsured by 2034 due to Medicaid changes. That's a future problem, but the current decline is already a present one. The question is whether policymakers will address the root cause — affordability — or continue to debate the symptoms.