Dr. Oz says some of the people losing their Obamacare coverage in a new fraud crackdown “never filed a claim,” and that line has quickly become the most talked about part of the announcement.
Oz, who runs the Centers for Medicare and Medicaid Services, the federal agency over programs like Medicare, Medicaid and Obamacare, made the announcement Tuesday at a White House press conference alongside Vice President JD Vance. The administration is cutting off subsidies for about 750,000 people the administration claims were signed up fraudulently or improperly. Officials are also investigating roughly 440,000 more, which means more than 1 million people could ultimately be affected.
Obamacare is the nickname for the Affordable Care Act, the law that created government run marketplaces where people can buy health insurance. Most people who buy through those marketplaces get federal tax credits, which are payments that lower or even completely cover their monthly premium, the amount a person pays each month to keep their insurance.
According to Oz, never filing a claim was not the only reason people were cut. He said the administration flagged enrollees who checked several boxes at once: they were signed up through a broker, a middleman who helps people pick a plan and earns a commission for it; their entire premium was paid by federal tax credits; they had never filed a claim; and they had no Social Security number or immigration document the agency says it could verify.
Oz framed it as cleaning up fake accounts. “These are not real people. We’re not paying insurance for nonexistent ghosts,” he told reporters. Vance claimed the move will save the federal government about $2.2 billion. Oz also announced a six month freeze on new brokers selling Obamacare plans, pointing to cases where he says brokers signed people up without their knowledge just to collect commissions.
The administration also admitted it relied partly on artificial intelligence to help decide which enrollees met eligibility standards, a detail that has raised even more questions about how accurate the list really is.
Oz has been making the no claims argument for a while. Last October, he said about half of Obamacare enrollees filed no claims the year before and asked why anyone with insurance would never use it.
Critics say the answer is simple. Plenty of real people never file a claim because they are healthy, only had coverage for part of the year, or had claims that were delayed in processing. A study done for America’s Health Insurance Plans, the trade group representing health insurers, found all three are common legitimate reasons for zero claims, especially among people enrolled for only a few months. Liberal news influencer Alex Cole summed up the backlash on X, writing that filing zero claims is not proof someone never needed coverage.
The crackdown comes as Obamacare enrollment is already shrinking. Enrollment jumped from about 11 million to a record 24 million under Joe Biden after pandemic era tax credits made plans cheaper for more people. Those extra credits expired, premiums went up, and about 3 million people dropped their coverage this year.
Oz has argued the growth itself was a red flag, saying enrollment sat around 10 million from 2015 to 2020 before climbing to 22 million during Covid because the rules were loosened and not enforced.
Anyone who buys insurance through the Obamacare marketplace and has received a notice or call from their insurer should respond and confirm their information to avoid losing coverage.
