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U.S. efforts to remove Affordable Care Act marketplace enrollments deemed unauthorized could put pressure on health insurers and consumers if the actions disproportionately remove healthy people who use little medical care. A smaller pool with higher average medical needs can increase insurers’ costs per member, while unexpected enrollment changes may squeeze companies after annual premiums have been set.
The Trump administration says the effort targets improper enrollment and subsidy payments. Vice President JD Vance said last week that more than 760,000 people had been removed from coverage and another 400,000 cases were under review. The Centers for Medicare and Medicaid Services said the cancellations were confirmed through its existing process, while policy experts cautioned that people who simply had not used their insurance could also be affected.
CMS says cancellations covered 760,000 people
CMS said on Sept. 22 that it canceled about 315,000 enrollments on Aug. 31, covering more than 760,000 individuals. The agency said the decisions followed reviews with health insurers and confirmed the enrollments were unauthorized. It expects the cancellations to result in the return of about $2.2 billion in advance premium tax credit payments and said it would continue investigating potential cases and seeking to recover past payments.
The agency described the effort as part of a broader strategy to prevent improper enrollment, remove unauthorized coverage and enforce rules for agents and brokers. CMS said it had sent termination notices to more than 200 noncompliant brokers since January. It also issued 569 notices of intent to terminate Exchange Agreements to agents and brokers who submitted 2026 applications without identifying information such as a Social Security number.
CMS said the cases included missing identification and other verification concerns. It reported that agents and brokers who first registered for the 2026 plan year accounted for a disproportionate share of high-risk activity, including applications with unresolved income, citizenship or immigration status checks. The agency has imposed a temporary 2027 registration moratorium on new agents and brokers who lack an active 2026 Exchange Agreement.
Enrollment mix could affect insurer costs
The policy risk for insurers is not simply the number of policies canceled, but the health profile of members who remain. If healthy, low-use consumers leave the marketplace while people with greater medical needs retain coverage, average claims costs could rise. Reuters reported that investors and analysts see potential pressure on insurers including UnitedHealth and Centene during the remaining months of 2026 and in 2027.
That outcome is not certain. The administration says the cancellations were based on confirmed unauthorized enrollments, and CMS said legitimate enrollees can be reinstated after verifying their identity. But experts cited by Reuters warned that some people may have been removed because they had not used their plans, rather than because they knowingly participated in fraud.
The ACA marketplace has already faced enrollment and affordability strains. The law created subsidized individual health plans, with about 19 million people enrolled, according to Reuters. Millions have left the marketplace in 2026 after enhanced pandemic-era subsidies expired, while medical costs have also risen.
2027 premiums are already set
Insurers submitted 2027 premium requests in July, seeking a median increase of 15%, according to a KFF analysis of filings across the 50 states and Washington, D.C. Reuters reported that the rates have since been approved and locked down. The plans are scheduled to become available on Nov. 1.
That timing limits insurers’ ability to respond to unexpected changes in enrollment through 2027 premiums. Matt McGough, a KFF policy expert, told Reuters that rates for the coming year had already been filed and approved. Gabelli Funds portfolio manager Daniel Barasa said that unexpected changes in enrollment or policy after rates are set can create earnings risk, even when insurers can generally price for a sicker membership if they have reliable information.
Several investors and policy experts told Reuters that insurers may seek higher prices for 2028 if the number of enrollees falls and the remaining membership has higher medical costs. That is a projection, not an announced rate change. How much any future premium adjustment reflects the anti-fraud action, medical-cost inflation or other marketplace conditions remains unknown.
Broker restrictions raise concerns about access
Broker channels are significant in the individual market: government data cited by Reuters show brokers assist 75% of marketplace enrollees. CMS said its new safeguards include identity proofing for existing agents and brokers, verified identification details on applications they assist with, and a requirement for electronic consumer authorization before a broker can act on an application or enrollment ahead of open enrollment.
Mike Smith, president emeritus of Texas brokerage agency The Brokerage Inc., told Reuters that public attention to the fraud cases and restrictions on new brokers could discourage consumers from using brokers, including legitimate ones. People can also enroll directly through HealthCare.gov or state-run exchanges; the Department of Health and Human Services counted 84,000 brokers nationwide able to help individuals choose a plan this year.
Some investors see companies with businesses beyond ACA plans as better positioned to manage marketplace uncertainty. Reuters reported that UnitedHealthcare was expanding employer-backed plan choices as it moved away from ACA plans. UnitedHealth and Centene did not immediately comment to Reuters, and the eventual effect of the cancellations on enrollment, claims and future premiums will depend on how many affected consumers are reinstated and who remains insured.
