ACA Health Plans: 760K Booted, Some Reinstated

The Trump administration has quietly restored coverage to some of the 760,000 people it booted from ACA health plans last month, an acknowledgment that its sweeping Obamacare fraud crackdown swept up legitimate enrollees too.

Late last month, the administration announced it had cut 760,000 people from Affordable Care Act rolls, covering about 315,000 marketplace enrollments, with cancellations taking effect Aug. 31 — the largest ACA enrollment cut on record. Officials cited fraud and improper enrollments and touted billions of dollars in potential taxpayer savings.

But not everyone removed was fraudulently enrolled, KFF Health News has learned. Insurance industry sources said CMS, the Centers for Medicare and Medicaid Services, has reinstated a small number of people whose coverage should never have been canceled, and more could follow as enrollees discover they are uninsured.

How ACA health plans enrollees got caught in the sweep

Policy experts say legitimate consumers may have been caught in the dragnet because they failed to open a letter from their insurer or answer a phone call during the verification push. The administration has disclosed little about how robust its outreach was, how long reinstatement takes, or how many cancellations have been reversed.

David Merritt, senior vice president of external affairs at the Blue Cross Blue Shield Association, confirmed that some BCBS members are among those reinstated. He said CMS has set up an expedited review process for people who discover they were improperly disenrolled.

The lack of transparency has frustrated insurers and consumer advocates alike. Without public data on the criteria used to flag enrollments, it is impossible to know how many of the 760,000 removals were justified and how many were errors, according to experts interviewed by KFF Health News.

ACA health plans face a second review wave

Questions continue to swirl even as a second phase of the Obamacare fraud crackdown gets underway. An additional 419,000 sign-ups are being scrutinized, and insurers must tell the agency how many enrollees do not respond to outreach efforts by mid-to-late November, after the midterm elections.

Supporters of the crackdown, including Brian Blase of the Paragon Health Institute, argue the sweep was long overdue and cite research alleging widespread fraud in ACA enrollment through the health insurance marketplace. Critics counter that aggressive purges inevitably punish real families.

The timing has drawn particular scrutiny. With insurers reporting results only after voters go to the polls, the full scale of the second wave will not be known until the elections are over.

What ACA health plans members should do now

Anyone who bought coverage through the federal health insurance marketplace at Healthcare.gov should check that their policy is still active. More people could discover they are uninsured only when they try to use their coverage, and those improperly removed can seek expedited review through CMS or Healthcare.gov.

The episode highlights the tension at the heart of policing the health insurance marketplace: cutting fraud without cutting off real families. As the second review wave begins, the number of wrongful cancellations in the first wave of ACA health plans terminations remains unknown.

For the administration, the quiet reinstatements are a tacit admission that speed came at a cost, and that the true scale of fraud in ACA health plans is still an open question.