Once upon a time, in a less polarized Washington, protecting health-care access for vulnerable Americans was bipartisan. No more.
The Trump Administration’s announcement this week that it has removed roughly 760,000 enrollees from the ObamaCare exchanges is being sold as a fraud crackdown. It is the opposite. It is a politically engineered decision to strip coverage from hundreds of thousands of low- and middle-income Americans—working families, people with chronic conditions, cancer patients, and survivors who could not navigate the paperwork—under the thinnest possible pretext.
This is not enforcement. It is a cull.
Trump officials say they found 40 insurance agents at a single company who generated tens of thousands of enrollments without identification numbers. Outrageous. The proper response is broker discipline, consent enforcement, consumer notification, and verification outreach. The Administration chose mass cancellation instead.
Brokers earn about $25 per month for each individual they enroll. That creates an incentive to sign up more people, eligible or not. Reform the commission structure. Prosecute fraudulent brokers. Do not turn a commission dispute into a humanitarian disaster.
The Administration says the 760,000 canceled accounts lacked Social Security or immigration numbers. They also showed no record of contact with insurers, paid no premiums, and generated no medical claims.
Read that again.
No medical claims.
The Administration reads those facts as proof of fraud. The humane reading is that the enrollment system never reached these people. They may have been healthy workers who never finished the paperwork, families confused by a bureaucracy, or people scared off by identity-document requirements. None of those technical gaps proves fraud. They prove administrative failure.
The right response was verification outreach. Insurers sent notices asking people to confirm their eligibility. The Administration canceled them anyway.
“We’re actually making sure that the people receiving ObamaCare subsidies are actually entitled to receive them,” Vice President JD Vance said.
That is the rhetoric of cruelty, not the language of stewardship. The Administration is not merely pursuing scammers. It is defining eligibility so narrowly, and verifying it so aggressively, that legal enrollees disappear in the same mass action as anyone who might genuinely be ineligible.
The ObamaCare exchanges doubled in enrollment during the Biden years, owing in part to enhanced subsidies that made plans free. That growth saved lives. The federal exchange, overseen by the Centers for Medicare and Medicaid Services, failed to verify identities, immigration status, and incomes adequately. That was a failure of administrative capacity. It was not a license to punish the people trapped inside the failure.
The Government Accountability Office reported last December that 23 of 24 fictional applications it submitted were approved by the federal exchange. Yes. Controls are weak.
The sane response is to tighten the controls without yanking coverage from existing enrollees.
The GAO also found that roughly 29,000 Social Security numbers in 2023 and nearly 68,000 in 2024 were used to obtain more than one year of coverage in a single year. Identity fraud is real. So are data-entry errors, family members sharing coverage, dependents enrolled through parental records, and people using whatever route remained open to obtain care.
The Administration chose the interpretation that justifies cancellation.
Consumers filed some 300,000 complaints last year with CMS about brokers who enrolled them in or switched them to new plans without authorization. Real harm. Real victims. The fix is broker discipline, consent enforcement, and consumer notification rules—not the wholesale removal of hundreds of thousands of people from coverage.
The Paragon Health Institute estimated that roughly a quarter of ObamaCare sign-ups this year were improper. Paragon is a political organization with a policy agenda. Even taking that figure at face value, roughly three-quarters of sign-ups were appropriate.
The cleanup operation will inevitably sweep in vast numbers of people who genuinely needed coverage.
The Administration insists this protects consumers and taxpayers. It protects neither. The truly eligible people inside the canceled 760,000 are now uninsured. Some will receive cancer diagnoses this winter. Some will skip medication refills. Some will die.
The Administration invokes Wells Fargo, where employees opened millions of accounts without customer consent. The analogy inverts itself. Wells Fargo employees profited by forcing unwanted products on customers. Here, brokers and a broken federal system created unwanted or unverified enrollment accounts, and Washington is responding by canceling coverage from the people caught inside the machinery.
In both cases, the customers were victims.
The Administration’s framing treats them as perpetrators.
A bank that lacked such controls would be held accountable. Wells Fargo required remediation, restitution, and institutional correction. It did not establish that every customer whose account raised a red flag should be stripped of access to banking. Yet the Administration uses Wells Fargo to justify the precise opposite of a corrective response.
The same partisan framing now drives the attack on state Medicaid programs.
In Minnesota, operators running nontraditional autism treatment clinics and housing services are being branded sham operations milking Medicaid. The antifraud task force has surfaced examples of hospice providers billing for services officials say were not rendered and enrolling patients without their knowledge. Real bad actors deserve prosecution. But these accusations have not been tested in court. They are being presented as if conviction had already occurred.
A single armed robber does not justify searching every home in the county. A phony hospice provider does not justify treating every Medicaid recipient as a suspect.
States are also being attacked for expanding in-home care. Many states pay for disabled and elderly Medicaid beneficiaries to hire aides or family members to help with everyday tasks such as cooking and shopping. People who cannot care for themselves deserve assistance. Medicaid in-home-care programs are expanding because the need is real.
Take California. The number of in-home-care recipients has increased by some 330,000 since 2019. That is what expanded coverage looks like. The number of providers has increased along with it, most of them related to beneficiaries but not parents or spouses, because demand has grown.
Medicaid coverage of in-home care has grown at three times the rate of California’s population over age 65 since 2019. The average number of hours billed per recipient each month has increased by 13 percent. Annual Medicaid spending on in-home care has climbed from roughly $9.2 billion seven years ago to roughly $25 billion today.
None of those figures, standing alone, constitutes evidence of fraud.
They describe more care reaching more people.
The Administration reads growth as guilt. The honest reading is unmet need finally being met: a population aging into disability, families stepping in to provide care that institutional nursing homes cannot, and a public program expanding to meet the demand.
The federal government pays, on average, 70 percent of state Medicaid bills. That creates a real incentive for states to police fraud. States should strengthen oversight and prosecute providers who steal.
But as Medicaid spending climbs to meet growing need, states are also cutting payments to legitimate providers. That reduces access and drives the people who provide care out of the system. The answer is better auditing, transparent billing, due process, and protection for legitimate providers—not a campaign that turns disabled and elderly Americans into collateral damage.
The Administration is throwing people off a cliff it keeps pretending to see.
The 760,000 cancellations. The Medicaid harassment. The broker scapegoating. The GAO statistics. The 70 percent federal share. The sham clinics and phony providers. The supposed cleanup.
None of it adds up to cleanup.
It adds up to a deliberate project of making health care for the poor, the sick, the disabled, and the old as scarce as the political imagination can manage.
That is the policy.
Everything else is the cover story.
