CMS Has Reinstated Some of the 760,000 Cut From ACA Plans, Insurers Say, as Review of 419,000 More Continues

Since the Trump administration announced late last month that it had cut about 760,000 people from the Affordable Care Act rolls, one fact has surfaced: not every cancellation held. Insurance industry sources told KFF Health News that the Centers for Medicare & Medicaid Services has reinstated a small number of people whose coverage should not have been canceled.

David Merritt, senior vice president of external affairs at the Blue Cross Blue Shield Association, confirmed that some BCBS members are among those restored. He said CMS runs an expedited review for people who find out they were improperly disenrolled.

More reinstatements could come in the next few weeks. People often discover a cancellation only when they try to use their coverage at a doctor's office or pharmacy.

What the administration has and hasn't said

The sweep covered about 315,000 enrollments representing more than 760,000 people. The administration says those enrollments were unauthorized, and it expects to recover roughly $2.2 billion in subsidies.

The administration has not said how many cancellations it has reversed. It has not said how long reinstatement takes, or how extensive the outreach was to the people it targeted.

Katie Keith, a director at Georgetown Law's Center for Health Policy and the Law, said the missing numbers matter. "It may be true that some of those enrollments were not authorized, but it can be equally true that people got lost in the shuffle and have a valid enrollment," she said. "Without more information, it's almost impossible to tell."

Policy experts cited by KFF Health News raised the possibility that some legitimate enrollees were swept up because they didn't open a letter from their insurer or answer a phone call.

The case for the crackdown

Supporters say the cleanup was overdue. Brian Blase of the Paragon Health Institute, whose research is often cited by people alleging widespread ACA enrollment fraud, called the sweep long overdue. His findings have been controversial.

The Government Accountability Office found that Biden-era controls failed to verify consumer consent, restrict broker access or notify consumers when plans changed, according to a Fox News opinion piece. The same piece said complaints involving confirmed unauthorized activity more than quadrupled from 2023 through 2025. In that account, brokers used basic personal information to enroll people or switch plans without permission, then collected insurer compensation.

Democrats call the effort cover for taking away coverage. Senate Minority Leader Chuck Schumer said the administration is kicking hundreds of thousands of people off their plans. Former Speaker Nancy Pelosi called fraud enforcement a "false pretext." Rep. Richard Neal, the top Democrat on House Ways and Means, said Republicans are "doubling down to take [coverage] away entirely."

The separate duplicate-coverage purge

At an Oct. 14 press conference, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz described a different action: removing ACA subsidies from about 189,000 people who were also on Medicare, Medicaid or the Children's Health Insurance Program, or who had died.

CMS officials broke the 189,000 down as roughly 120,000 with overlapping Medicaid coverage, about 58,000 with Medicare and about 11,000 deceased enrollees. CMS Deputy Administrator Peter Nelson projected another 3,500 deceased enrollees would come off by the end of October.

Officials put the savings at $738 million this year and $1.5 billion annually after that. Duplicate enrollees get 30 days to respond before subsidies end, and estates of deceased enrollees get the same window.

Oz said no one loses insurance under this action. "What we are doing is saving a lot of money," he said. HHS said people removed from marketplace plans keep their Medicare, Medicaid or CHIP coverage.

Officials framed the problem as a lapse in oversight. They said periodic data matching, which the first Trump administration required of exchanges twice a year, was paused under Biden and resumed in 2025. Oz told The Daily Wire that Biden officials "were sleeping on the job." A White House official said CMS found a backlog of 551,000 duplicate enrollments when Trump took office.

KFF Health News noted that officials cited a failure to look for concurrent enrollments and continued coverage for dead people, not fraud, as the cause of the 189,000 cases. Kennedy put it this way: "Some cases begin with an error, others reveal deliberate abuse."

The 419,000 still under review

A second phase is underway. CMS is scrutinizing another 419,000 enrollments. Insurers must tell the agency how many of those enrollees don't respond to outreach "around mid-to-late November, after the midterm elections," Merritt said.

The backdrop is a shakier marketplace. Republicans let the enhanced ACA subsidies lapse last year. KFF polling found about 1 in 10 enrollees dropped marketplace coverage as a result and are now uninsured.

The question CMS hasn't answered is how many of the 760,000 were actually reinstated, and how many people are still uninsured without knowing it. That count may not become clear until the November outreach results come in.