HHS Flags 189,000 Improper Obamacare Enrollments as KFF Finds Individual Market Down 18%

Health and Human Services officials said at a Washington briefing on Wednesday, Oct. 14, that they identified 189,000 people improperly enrolled in subsidized Affordable Care Act coverage. The people were either enrolled in another government insurance program or were dead.

Health Secretary Robert F. Kennedy Jr. and other officials said the Centers for Medicare and Medicaid Services (CMS) found the cases by reviewing death records and other data.

"We will follow the evidence, correct mistakes, and pursue fraud whenever we find it," Kennedy said.

What HHS says it has removed

CMS Deputy Administrator Peter Nelson said that after a resolution process, the agency has removed 58,000 people from Obamacare this year because they already have Medicare. Another 11,000 subsidized plans were ended for dead people. Nelson projected 3,500 more deceased enrollees will be removed by the end of October.

HHS estimates the removals will prevent $738 million in improper subsidy payments this year and $1.5 billion in each year after that. Those are the department's projections, not audited savings.

The 69,000 removals announced so far are well short of the 189,000 identified. Officials did not detail at the briefing how the remaining cases will be resolved.

How the process works

People flagged as enrolled in both an ACA plan and a government program are notified and given 30 days to provide evidence. The estates of people who show up as deceased also get 30 days to respond.

The department said the people removed from Obamacare do not lose coverage because they maintain Medicare, Medicaid, or Children's Health Insurance Program coverage. The government pays for all or portions of those programs.

Officials also said individuals often do not know they are double-enrolled. In their account, insurance companies, brokers, and agents profit from the duplicate enrollments, not the enrollees. No charges or enforcement actions against any insurer, broker, or agent were announced at the briefing.

The audit history

Officials said periodic checks for dual enrollment were conducted at least twice a year during the first Trump administration, paused during the Biden administration, and resumed in 2025. The paused-checks account comes from the current administration.

In 2025, officials said, the government ended dual enrollment for about 551,000 people already covered by Medicaid or the Children's Health Insurance Program. This year's number is lower because "when you check, the system gets cleaner," CMS Administrator Dr. Mehmet Oz told reporters.

The bigger enrollment drop

The fraud-and-error numbers sit inside a much larger shrinkage. KFF reported today that individual-market enrollment, which includes ACA Marketplace plans and some off-exchange coverage, fell 18% between June 2025 and June 2026. That is a drop from 25.2 million to 20.5 million, or more than 4.6 million people, and the steepest annual decline since 2015.

Roughly nine in ten people in the individual market are enrolled through ACA Marketplaces. KFF's separate marketplace figure showed effectuated enrollment falling 12% in February, from 21.8 million to 19.2 million. Kennedy said Wednesday that about 20 million people currently rely on Obamacare.

KFF said the decline coincides with the expiration of the enhanced premium tax credits and other policy changes expected to reduce enrollment. Reuters reported that costs doubled or even tripled for some people after the extra subsidies lapsed.

Sign-ups during the 2026 open enrollment period fell by 1.2 million from 2025. KFF noted that some people who selected plans never paid and so never had coverage take effect. Returning subsidized enrollees also get a three-month grace period for nonpayment.

The 69,000 removals HHS announced are about 1.5% of the 4.6 million drop KFF measured, though the two figures use different measures and time frames.

Prices and insurer finances

Insurers asked for a median rate increase of 14% this year, the second-highest in nearly a decade, according to Reuters. Insurers that asked for higher payments pointed to a sicker, higher-risk mix of enrollees.

Centene and UnitedHealth have flagged rising medical costs in their Obamacare businesses this year. A KFF March survey found 17% of Obamacare enrollees were not confident they could pay premiums through the year.

KFF said members are expected to keep falling off the rolls through 2026. Nelson's projected 3,500 additional removals of deceased enrollees by the end of October is the next number HHS has said it will report against.