2.9M Removed: HHS Fraud Claim vs. 58% Premium Hike Spurs Legal Debate

For legal and regulatory professionals, the administration’s narrative raises immediate red flags. The assertion that 5.6 million ACA enrollees in 2025 were fraudulent—a number that perfectly matches the 2.9 million removed and the overall enrollment decline—seems tailored to deflect blame from Congress’s subsidy cutbacks. The lack of transparent, independent data could invite challenges under the Administrative Procedure Act, while the removal of 1.5 million individuals for tax or dual-enrollment issues prompts serious questions about procedural due process.

The Affordable Care Act’s insurance marketplaces suffered their worst enrollment crash in history this year, with nearly 3 million people dropping coverage — a decline that has ignited a fierce political battle over whether the exodus was driven by a fraud crackdown or by skyrocketing costs. In raw numbers, total ACA enrollment fell to about 19.2 million in 2026, down from a peak of roughly 22 million the year before. At the center of the dispute are Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, who have publicly credited aggressive anti‑fraud measures for the decline, while policy experts and healthcare advocates blame a 58% average premium increase and the Republican Congress’s refusal to extend enhanced subsidies.

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According to data from KFF, the average monthly premium for ACA customers jumped to $178 this year, up 58% from 2025.

The financial pain for consumers has been staggering. According to data from KFF, the average monthly premium for ACA customers jumped to $178 this year, up 58% from 2025. At the same time, deductibles — the amount enrollees must pay out of pocket before insurance kicks in — climbed 37% to nearly $3,800 a year. For a family living near the poverty line, such costs can be prohibitive. It is this sticker shock, experts argue, that caused millions to walk away from their plans, not a sudden discovery of fraud.

The Trump administration has offered a starkly different narrative. A Department of Health and Human Services report released in June, authored mostly by political appointees, asserted that 5.6 million people were fraudulently enrolled in ACA plans in 2025 and that the administration’s subsequent actions removed 2.9 million of them. The numbers are remarkable: the claimed fraudulent total in 2025 is many times larger than any previously documented fraud in the program’s history, and the 2.9 million removals exactly match the net enrollment decline this year. The administration points to concrete steps: in August 2025 it halted a Biden‑era initiative that permitted low‑income individuals to sign up year‑round, and regulators have booted an additional 1.5 million people since 2025 for reasons such as failure to file taxes two years running or concurrent enrollment in Medicaid.

Outside voices have pushed back forcefully. Annalyse Keller, spokesperson for the coalition Keep Americans Covered — a bloc that includes major insurers and patient advocacy groups — said bluntly, “These are real people who are now forced to make impossible choices.” Independent health policy analysts note that there is no independent verification of the 5.6 million fraud figure and that the HHS report did not undergo typical peer review or inspector‑general processes. They contend the administration is using fraud as a political shield to obscure the consequences of its own policy decisions, namely the expiration of the enhanced subsidies that had temporarily reduced premiums by hundreds of dollars per month for millions of buyers.