Mehmet Öz faces a shrinking Affordable Care Act marketplace as enrollment in ACA plans fell by nearly 3 million this year to about 19.2 million. The Trump administration attributed the drop to fraud enforcement, while people who track the market point to higher prices.
Customers paid an average of $178 a month in premium payments this year, up 58% from 2025, and deductibles climbed 37% to nearly $3,800 a year. Annalyse Keller, a spokesperson for Keep Americans Covered, said, "These are real people who are now forced to make impossible choices".
HHS report on ACA rolls
A Department of Health and Human Services report released in June asserted that 5.6 million people were fraudulently enrolled in ACA plans in 2025. The report said the Trump administration removed 2.9 million of those people, and regulators removed 1.5 million people since 2025 for reasons including not meeting a requirement to file taxes over two years or being concurrently enrolled in another health program such as Medicaid.
The administration said it halted a Biden-era initiative in August 2025 that allowed low-income people to sign up for coverage year-round. That change narrowed the enrollment process and became part of the explanation for the smaller total this year.
Matthew Fiedler on premiums
Matthew Fiedler, a senior fellow at the Brookings Institution, said the administration's explanation is not persuasive. "The top-level claim" he used for the enrollment drop "is not remotely credible," and he said, "We know that lots of people have seen higher premiums, and there's really good evidence that when premiums go up, people drop coverage."
Those competing explanations leave affected customers with a practical question: whether the drop came from removals of improper enrollments, or from prices that pushed people out of the market. For people buying coverage on the marketplace, the answer determines whether the pressure comes from eligibility checks or from the cost of staying enrolled.
