The human toll of those individual decisions has now registered as a national statistic. According to the latest federal data, 1.2 million people have dropped their Obamacare coverage since the start of the year, bringing total enrollment down to 24.3 million as of March.
The numerical fact is one of the few points of agreement between the Trump administration and state officials. Beyond it, a sharp partisan divide has opened over what is driving Americans away from the health insurance marketplaces, a debate that is likely to intensify as the fall midterm elections approach. Democrats are already framing the losses as evidence that President Donald Trump’s policies are making health care less affordable, while Republicans are pointing to a crackdown on fraud as evidence of fiscal stewardship.
Health and Human Services Secretary Robert F. Kennedy Jr. told Congress last month that the enrollment decline is a direct result of better federal policing. “The only people who lost coverage were people who were never entitled to coverage,” Kennedy said during an April 21 hearing before the House Energy and Commerce Committee, referring to individuals who were illegally enrolled in two states or simultaneously on the ACA and Medicaid. The Centers for Medicare and Medicaid Services has echoed that argument, asserting that its fraud detection efforts are cleaning up the rolls without harming legitimate enrollees.
State marketplace officials and insurers offer a starkly different explanation. They point to the expiration of enhanced premium subsidies, which Congress allowed to lapse on Jan. 1. Those subsidies had lowered costs for higher-income enrollees, and their removal has hit middle-income working Americans and legal immigrants particularly hard. Marketplace directors in several mostly blue states told reporters they are hearing directly from people who say they can no longer afford their plans.
“You look at all of the data coming out across the country, and I think there is a very tangible sense that is emerging that the enhanced subsidies were designed to help working families who heretofore fell between the cracks,” said Karen Ignagni, executive board chair for EmblemHealth, a nonprofit ACA plan based in New York City. The implication, she and other state officials argue, is that the people losing coverage are not fraudsters but legitimate policyholders priced out of the market.
The competing narratives are unfolding against a political backdrop that makes the stakes unusually high. Democrats are betting that rising health care costs will be a potent issue in the fall, and the enrollment drop gives them a concrete data point to wield against the administration. Republicans, in turn, are leaning into the fraud argument as a way to demonstrate that they are saving taxpayer money by rooting out abuse that Democrats tolerated for years.
The full picture of who is dropping coverage and why is expected to become clearer in the coming months as more detailed enrollment data emerges. For now, the gap between the two accounts remains wide. What is not in dispute is that more than a million Americans have left the marketplaces, and the reasons they left are becoming a central front in the battle for control of Congress.
