Administration Removed 760,000 Obamacare Enrollments for Fraud. Some Were Reportedly Restored.
CMS says it cancelled 760,000 unauthorized ACA enrollments, while KFF Health News reports that a small share were put back after errors.
Cleaning up phantom enrollees in Obamacare is the right goal. A new report shows that doing it at scale is messy.
According to the Daily Caller News Foundation, the Trump administration terminated 760,000 individuals from the Affordable Care Act exchanges in September, citing alleged fraud. KFF Health News reported Thursday, citing anonymous insurance industry sources, that the Centers for Medicare & Medicaid Services (CMS) has since restored a small share of people whose coverage should not have been scrapped.
CMS describes a methodical process. A spokesperson told the Daily Caller News Foundation that the agency identified 1.18 million potentially unauthorized enrollments, all agent or broker assisted and lacking a Social Security number or immigration document number. Those were reviewed against three criteria: the premium had to be covered 100% by advance premium tax credits, no claims could have been filed for anyone on the policy, and the insurer could have no record of the enrollee contacting the company. After that review, CMS determined 760,000 enrollments were unauthorized.
Insurers were required to contact enrollees using multiple methods and give them 30 days to respond. Those who did not were cancelled. CMS says a legitimate consumer who was affected can call the Marketplace Call Center, provide a verified Social Security number or immigration document number, and be reinstated.
Critics see risk. "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," said Katie Keith of Georgetown Law's Center for Health Policy and the Law. She added that the administration's lack of transparency "is telling too."
Dr. Mehmet Oz's CMS account said on Sept. 30 that the effort is saving taxpayers $2.2 billion. The Daily Caller also points to a June analysis from the Paragon Health Institute, which estimated that widespread exchange fraud is expected to cost taxpayers billions this year.
The takeaway: taxpayers deserve a marketplace without phantom enrollees, and real enrollees deserve a fast fix when the system gets them wrong. CMS says it is continuing to review enrollments.