2026-08-03T05:00:00-0400 / 哥伦比亚广播公司新闻
特朗普政府将奥巴马医改参保人数减少数百万归因于其反欺诈防控工作，而非保费的大幅上涨——这一说法遭到政策专家的质疑，他们认为政府掩盖了更多美国人如今失去医疗保险的现实。
根据凯撒家庭基金会（KFF）的数据，受保险公司大幅提价以及共和党主导的国会不愿延长更慷慨的保费补贴政策影响，今年《平价医疗法案》（ACA）的参保人数下降了近300万，降至约1920万。今年，奥巴马医改参保者平均每月需支付178美元保费，较2025年上涨58%；而他们的自付免赔额——即保险公司开始承担费用前消费者每年需自行支付的金额——也上涨了37%，达到每年近3800美元。
“这些真实的民众如今被迫做出不可能的选择，”“让美国人获得医保”组织的发言人安娜丽丝·凯勒说道。该组织是涵盖保险公司和患者维权团体在内的大型医疗行业游说联盟。
但美国卫生与公众服务部（HHS）6月发布的一份报告称，2025年有560万人通过欺诈手段参保奥巴马医改计划，特朗普政府已将其中290万人清除出系统——这一数字与2026年的参保人数降幅完全一致。该报告主要由特朗普总统的政治任命官员和盟友撰写。
几乎没人否认奥巴马医改和大多数政府项目一样存在欺诈问题。政府表示，已采取措施收紧参保流程，以打击未经参保者知情同意就为其办理参保手续的欺诈性经纪人。
例如，政府在2025年8月叫停了拜登时期一项允许低收入人群全年参保的举措。自2025年以来，监管机构还以未满足两年报税要求、同时参保医疗补助等其他医保项目（这是不被允许的）为由，移除了150万人。
但医疗政策专家表示，政府夸大了奥巴马医改欺诈的严重程度，HHS的报告依赖于有争议的假设，比如认为所有通过低收入人群全年参保计划完成的登记都存在潜在欺诈。政策分析师称，奥巴马医改参保人数暴跌是因为保险计划成本不断上涨，而政府并未采取任何措施遏制这一趋势。
“所谓2025年以来参保人数下降全是因为不合规或欺诈性参保者退出市场的‘顶层说法’，完全不可信，”布鲁金斯学会高级研究员马修·菲德勒说道。“我们知道很多人面临保费上涨，而且有充分证据表明，保费上涨时人们就会放弃医保。”
在11月中期选举前夕，医疗成本是选民极为关注的问题，两党都试图围绕这一议题为己方造势。民主党主张应采取更多措施降低消费者的医保负担，而共和党则试图将焦点放在打击欺诈、节省纳税人资金的必要性上。
凯泽家庭基金会最近的一项民调显示，选民更信任民主党人处理医疗成本问题（37%对26%）。不过民调还发现，55%的共和党选民认为候选人处理医疗欺诈问题极为重要，远超其他议题，这表明白宫将焦点从成本问题转移到欺诈问题的策略在其支持者中取得了一定成效。
但北卡罗来纳大学卫生政策与管理教授乔纳森·奥伯兰德质疑，随着选民持续面临成本上涨的困境，欺诈叙事能否站得住脚。
“对于那些再也负担不起医保费用、放弃参保的真实民众来说，这毫无安慰可言，”他在给凯泽健康新闻的电子邮件中说道。
事件背景
在乔·拜登总统任期内，国会于2021年起通过一项法律，为奥巴马医改参保者提供更慷慨的税收补贴。这些增强型补贴降低了保费支出，数百万参保者获得了足够大的税收抵免，可将月保费降至零。拜登时期的法律还允许更富裕的家庭获得补贴。
根据HHS的报告，奥巴马医改的参保人数几乎翻倍，从2021年的1100多万人增至2025年的2200多万人。
共和党和保守派团体认为，参保人数增长并非仅由保费降低带来的新增参保者推动。他们表示，增强型补贴以及拜登时期的其他政策——包括放松部分参保者的收入验证要求——为欺诈行为提供了可乘之机。不择手段、以佣金为目的的保险经纪人更容易未经参保者知情就为其办理参保手续，而普通消费者也更容易谎报收入，以获得最高额度的补贴。
保守派组织帕拉贡健康研究所所长布莱恩·布莱泽在最近的一篇网络文章中写道，HHS报告中关于不合规参保规模的结论可能被低估了。他仍不认同保费上涨是奥巴马医改参保人数大幅下降的原因，称补贴对许多人来说依然慷慨。
政府当前的打击目标
随着联邦医保市场和各州运营的医保交易所公布更多参保数据，这场争论还将持续。包括咨询集团韦克利在内的一些政策专家预计，今年年底奥巴马医改的参保人数将较去年下降多达26%。
特朗普政府的监管机构可能会将参保人数的进一步下降与反欺诈行动挂钩。HHS的报告称，仍有数百万人存在不合规参保问题。报告作者指出，政府的部分反欺诈提案已被法院裁决驳回。
在6月27日HHS发布的一段视频中，卫生与公众服务部部长小罗伯特·F·肯尼迪拍了拍医疗保险和医疗补助服务中心（CMS）负责人穆罕默德·奥兹的后背，对目前已取消的奥巴马医改计划数量表示认可。奥兹向潜在的奥巴马医改骗子发出警告：“别想着溜掉，快跑吧！因为我们一定会找到你。”
在回复凯泽健康新闻提问的电子邮件中，CMS发言人克里斯托弗·克雷皮奇表示，该机构今年夏天将拦截没有社保号码的经纪人提交的奥巴马医改申请。在今年秋季的开放参保期前，CMS计划对经纪人参保时的身份验证提出更高要求，并限制经纪人访问账户，直到该人员“获得消费者授权代表其开展工作”。
凯泽健康新闻获得的6月份发给保险公司的电子邮件中，详细说明了将如何移除部分可疑参保记录。
CMS告知保险公司，该机构将向他们发送其认为存在潜在未经授权情况的奥巴马医改账户文件。每个被标记的消费者账户都有以下特征：通过销售经纪人参保、处于零保费计划、缺少社保号码或移民证明文件——肯尼迪在视频中称，这是明显的欺诈迹象。
保险公司必须尝试联系参保者，确认其确实自愿参保。60天后，保险公司必须向CMS报告无法核实的保单，CMS将予以取消。
克雷皮奇写道，保险公司正在配合调查信息缺失或未核实的账户。
包括菲德勒在内的政策专家指出，缺少社保号码并不自动证明存在欺诈行为。虽然这可能表明参保者是假的，但缺少社保号码也可能是消费者或经纪人的简单疏忽，例如新生儿在获得社保号码前被添加到父母的账户中。
“政府将这一点写入报告，却没有直接终止这些参保记录，这表明他们认为其中存在多种不同情况，”菲德勒说道。
政府报告还指出另一类参保记录存在可疑之处：收入极低、符合补贴资格的人群转而选择无需每月支付保费的计划，这表明“欺诈性代理商和经纪人正将他们转移到这类计划中，以持续获取佣金并避免被发现”。报告还称，未提交任何医疗索赔的奥巴马医改参保者也存在可疑之处。
政策专家对这些担忧背后的假设提出了质疑。
例如，年轻或低收入人群使用医疗服务的频率更低，这可以解释他们为何不提交任何索赔——尤其是当他们必须先自付数千美元以满足高额免赔额时。
而极低收入人群可能会转而选择免赔额更高但无需支付月保费的计划，因为他们难以承担其他计划可能要求的每月50或80美元的分摊费用。
“人们手头拮据，”佛罗里达州保险经纪人杰森·法恩说道。“我确实遇到过连15美元都付不起的人。我不会直接认定从银级计划转为铜级计划的人存在欺诈，”他指的是奥巴马医改的两种计划类型。
法恩表示，政府应该专注于加强现有规则的执行，称他已向监管机构举报了数十名未经授权就更换客户的无良经纪人，但没有一人被禁止销售奥巴马医改保单。
他和其他经纪人继续推动在联邦奥巴马医改市场中引入银行和其他金融机构使用的多因素身份验证功能。一些运营本州医保交易所的州已采用双因素认证或其他身份验证方式，并未报告未经授权更换保单的问题。
无论是拜登还是特朗普政府时期，CMS都未在联邦医保市场healthcare.gov中加入双因素认证功能。
众议员格伦·格罗思曼（共和党，威斯康星州）于6月提出了一项要求引入该功能的法案，但前景不明。
“这将有助于减少欺诈，”长期敦促CMS加入该功能的游说团体“美国健康经纪人”负责人罗内尔·诺兰说道。她说，格罗思曼的法案可能“会促使CMS主动采取行动”。
凯泽健康新闻是一家专注医疗议题深度报道的全国性新闻编辑部，是独立医疗政策研究、民调与新闻机构凯泽家庭基金会的核心运营项目之一。
RFK Jr., Oz claim fraud crackdown drove ACA enrollment drop, but analysts cite rising costs
2026-08-03T05:00:00-0400 / CBS News
The Trump administration credits its fraud control efforts for the disappearance of millions of people from Obamacare rolls rather than a sharp rise in premiums — a claim disputed by policy experts that glosses over the reality that many more Americans now find themselves without health insurance.
Enrollment in Affordable Care Act plans fell by nearly 3 million this year to about 19.2 million, following steep premium increases by insurers and the Republican-led Congress’ unwillingness to extend more generous premium subsidies. On average, ACA customers pay $178 a month in premium payments this year, a 58% increase from 2025, according to KFF, while their deductibles — the amount consumers must pay annually before insurers pick up their share — have climbed 37% to nearly $3,800 a year.
“These are real people who are now forced to make impossible choices,” said Annalyse Keller, a spokesperson for Keep Americans Covered, a large coalition of lobby organizations for the healthcare industry, including insurers and patient advocacy groups.
But a Department of Health and Human Services report released in June, written mostly by President Trump’s political appointees and allies, asserts that 5.6 million people were fraudulently enrolled in ACA plans in 2025, and that the Trump administration removed 2.9 million of them — the same number as the 2026 drop in enrollment.
There’s little dispute that the ACA suffers from some fraud, as do most government programs. The administration said it has taken actions to tighten the enrollment process to thwart brokers who fraudulently enroll people without their knowledge.
For example, the administration in August 2025 halted a Biden-era initiative that allowed low-income people to sign up for coverage year-round. Regulators also have removed 1.5 million people since 2025 for reasons such as not meeting a requirement to file their taxes over two years or being concurrently enrolled in another health program, such as Medicaid, which is not allowed.
But health policy experts say that the administration is overstating the extent of ACA fraud and that the HHS report relies on debatable assumptions, such as that all sign-ups under the year-round enrollment program for low-income people were potentially fraudulent. ACA enrollment fell off a cliff because of escalating prices for insurance plans, policy analysts say, which the administration’s done nothing to stem.
“The top-level claim” that all the decline in enrollment since 2025 is because of improper or fraudulent enrollees leaving the market “is not remotely credible,” said Matthew Fiedler, a senior fellow at the Brookings Institution. “We know that lots of people have seen higher premiums, and there’s really good evidence that when premiums go up, people drop coverage.”
Healthcare costs are a big concern for voters ahead of November’s midterm elections, and both Democrats and Republicans are trying to spin the issue to their advantage. Democrats argue more needs to be done to make insurance less expensive for consumers, while Republicans are trying to focus on the need to save taxpayer dollars from fraud.
A recent KFF poll found that voters trust Democrats over Republicans to address healthcare costs (37% vs. 26%). The poll also found, though, that 55% of Republican voters consider it extremely important for candidates to address healthcare fraud, more than any other issue, showing that the White House’s effort to shift focus from costs has had some success with its own supporters.
But Jonathan Oberlander, a professor of health policy and management at the University of North Carolina, questioned whether the fraud narrative will hold up as voters continue to struggle with rising costs.
“It will be cold comfort to the very real persons who could no longer afford coverage and dropped their plans,” he said in an email to KFF Health News.
How we got here
Under President Joe Biden, Congress passed a law that included more generous tax subsidies for people enrolled in Obamacare, starting in 2021. Those enhanced subsidies lowered premium payments, with millions qualifying for a large enough tax credit to reduce their monthly payment to zero. The Biden-era law also allowed wealthier households to get assistance.
ACA coverage essentially doubled, from just over 11 million Americans in 2021 to more than 22 million in 2025, according to the HHS report.
Republicans and conservative groups argue that the growth wasn’t driven only by people newly enrolling because of lower premiums. Instead, they say, the enhanced subsidies, along with other Biden-era policies — including easing income verification requirements for some enrollees — invited fraud. Unscrupulous, commission-seeking insurance brokers found it easier to sign people up for coverage, often without their knowledge, while ordinary consumers could more easily fudge their income and qualify for the largest subsidy possible.
The conservative Paragon Health Institute’s president, Brian Blase, wrote in a recent webpost that the HHS report’s conclusion on the scope of improper enrollment is likely an undercount. He remains unconvinced by the arguments that rising premiums are to blame for the sharp drop in ACA enrollment, saying subsidies remain generous for many people.
The administration’s current targets
The debate will continue as more enrollment data emerges from the federal marketplace and the exchanges run by states. Some policy experts — including the consulting group Wakely — expect the year to end with the number of ACA policyholders down by as much as 26% from last year.
Trump’s regulators will likely connect further drops with anti-fraud efforts. The HHS report alleges there are potentially millions more who remain improperly enrolled. The report’s authors noted that some of the administration’s anti-fraud proposals have been blocked by court rulings.
In a videohttps://www.youtube.com/watch?v=zM9UF1mdcrQ HHS released June 27, HHS Secretary Robert F. Kennedy Jr. pats Mehmet Oz, the head of the Centers for Medicare & Medicaid Services, on the back for the number of canceled ACA plans so far. Oz threatens potential ACA hucksters: “Don’t walk away from us, run! Because we are going to find you.”
In an email responding to KFF Health News’ questions, CMS spokesperson Christopher Krepich said his agency this summer will block ACA applications made by brokers that lack a Social Security number. By open enrollment this fall, CMS plans to require more identify-proofing when brokers enroll people and will limit a broker’s access to accounts until that person “has been authorized by the consumer to work on their behalf.”
How some suspicious enrollments will be removed is spelled out in emails sent in June to insurance carriers and obtained by KFF Health News.
CMS told insurers that the agency will send them files for ACA accounts it believes are potentially unauthorized. Each flagged consumer account will have used a sales broker to enroll, be in a zero-premium plan, and lack a Social Security or an immigration documentation number — which Kennedy said in the video is a glaring sign of fraud.
Insurers must try to contact the enrollees to verify that they signed up for coverage. After 60 days, insurers must report policies they were unable to verify to CMS, which will cancel them.
Krepich wrote that carriers are cooperating with efforts to investigate accounts with missing or unverified information.
Policy experts, including Fiedler, note that the absence of a Social Security number doesn’t automatically prove fraud. While it could indicate a fake enrollee, a missing Social Security number might also be a simple oversight by the consumer or their broker, for example, or a newborn added to a parent’s account at birth, before they’ve received a number.
“That the administration put it in a report and did not summarily terminate these enrollments suggests they believe there is some mix of different circumstances,” Fiedler said.
The administration report singles out another segment of enrollments as suspicious: very low-income, subsidy-eligible people who shifted to plans that carry no monthly premium, suggesting “fraudulent agents and brokers are moving them to keep gaining commissions and avoid detection.” The report also cites ACA enrollees who file no medical claims as suspicious.
Policy experts question the assumptions behind those concerns.
Younger or lower-income people use healthcare less often, for example, which can explain why they may make no claims — particularly when they must first spend thousands of dollars out-of-pocket to meet high deductibles.
And very low-income people may switch to plans with higher deductibles in exchange for making no premium payment because they struggle to come up with the $50 or $80 monthly share that other plans might require.
“People are hurting for money,” said Florida insurance agent Jason Fine. “I literally have people who can’t afford to pay $15. I would not immediately assume that a person who went from a silver plan to a bronze plan, that it’s fraud,” referring to two types of ACA plans.
Fine said the administration needs to focus on better enforcement of existing rules, saying he has reported to regulators dozens of unscrupulous agents who have switched clients without authorization, yet none were barred from selling ACA policies.
He and other agents continue to push for adding multifactor identification, as banks and other financial institutions use, to the federal ACA marketplace. Some states that run their own exchanges have two-factor authentication or other types of ID verification and have not reported problems with unauthorized switching.
CMS — under both Biden and Trump — has not added two-factor authentication to the federal marketplace, healthcare.gov.
Rep. Glenn Grothman (R-Wis.) introduced legislation to require it in June, but its prospects are murky.
“It will help reduce fraud,” said Ronnell Nolan, who leads Health Agents for America, a lobbying group that has long urged CMS to add the feature. Grothman’s legislation, she said, might “encourage CMS to do it themselves.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.