Mehmet Oz says Obamacare enrollment may be ‘too high’

Even though Obamacare enrollment has declined significantly this year due to skyrocketing monthly premiums, Dr. Mehmet Oz believes enrollment numbers are still too high. Oz, the top Trump administration official overseeing the Affordable Care Act, told NBC News that millions of people could be fraudulently enrolled or eligible for other types of coverage.

About 23 million people signed up for ACA coverage during this year’s open enrollment period, which ended in January, according to the latest data from the Centers for Medicare and Medicaid Services. This represents approximately 1.2 to 1.3 million fewer registrations than last year. ACA coverage is generally for people who are self-employed or do not receive coverage through their employment.

In a phone interview, Oz said some people enrolled in ACA plans shouldn’t be there and expects enrollment to decline further — to about 19 million.

“Actually, the fact that we have 23 million people makes me think we have too many ACA participants,” Oz said. “That’s too high a number.”

Oz believes some of the ACA enrollment may come from fraud in the enrollment process, as well as cases where people were enrolled in error, were enrolled in duplicate coverage, or received tax credits for which they were not eligible. Others, he said, may qualify for Medicaid or obtain insurance through employment but choose ACA plans instead.

Last year, the administration said 4 to 5 million people were “incorrectly” enrolled in subsidized ACA coverage in 2024, costing U.S. taxpayers as much as $20 billion. The administration cited the Paragon Health Institute, a conservative health policy think tank. The administration has also pushed for a number of changes to the program, including changes to income verification and a shortened open enrollment period, measures it says are intended to maintain the “integrity” of the ACA.

“Either their income didn’t make them eligible, or they earned too much or too little, or they hadn’t filled out the forms, perhaps on purpose, or they were dual enrolled in Medicaid or, more likely, other states’ ACAs,” Oz said in the interview. “These are major concerns for us. »

“Fraud, waste and abuse” is Oz’s mantra, which says communities in California and Minnesota are linked to health care fraud. Last month, Vice President JD Vance, joined by Oz, announced that the federal government would withhold $259 million in Medicaid funding for Minnesotans due to concerns about fraud — a claim Democrats called politically motivated.

Health policy experts say fraud exists throughout the health care system, but caution that its scale may not be as great as the administration suggests.

“Fraud is a real problem in the ACA marketplace and no one disputes that,” said Cynthia Cox, director of the ACA program at KFF, a nonpartisan health policy research group. She said there are at least a few hundred thousand cases of fraudulent registration, not counting fraud that might go unnoticed, but probably not millions.

“The magnitude of this situation is perhaps sometimes exaggerated,” she added.

Richard Frank, a senior fellow in economic studies and director of the Center on Health Policy at the Brookings Institution, a nonpartisan think tank, said it was probably “implausible” that 4 to 5 million people, the figure cited by the administration, were wrongly enrolled in the ACA.

“Obviously the number is not zero, it’s not nothing,” Frank said. “But what we call fraud are very often just accounting errors.”

The decline in ACA enrollment this year comes after Congress failed to extend enhanced tax credits that kept premiums lower, leading to double-digit premium increases for millions of Americans. Some experts worried that higher costs would push more people to drop coverage or switch to cheaper plans with higher deductibles — something state officials say they’re already seeing.

Lower monthly bills, higher deductibles

Even though Oz says millions of Americans should not be eligible for ACA plans, the administration is taking steps to attract more people into the program.

In February, the administration proposed changes to the ACA marketplace for next year, a move that Oz said could bring younger, healthier Americans — people currently excluded from the marketplace and uninsured — into the system.

The proposal includes increasing the age limit for so-called catastrophic health plans.

Catastrophic plans are the lowest level of ACA coverage, generally limited to people under age 30 and offering low premiums but very high deductibles. According to KFF, the average annual deductible for a catastrophic plan in 2026 for an individual was $10,600 and $21,200 for a family.

Oz said he wasn’t sure whether CMS had publicly disclosed how much deductibles could be raised under the proposal, but he disputed an estimate reported by The New York Times that they could be as high as $31,000 for a family.

“How can I get people to participate in the ACA away from people who otherwise wouldn’t?” » Oz said. “So right now we’re leaving a lot of people in the private sector, those who work in the hot dog stands. They can’t afford to participate in the silver plan.”

KFF’s Cox said that while the proposal could attract more young, healthy people to the ACA, she worries it could also attract older adults and people with underlying health conditions who need more comprehensive coverage.

According to Cox, health care literacy is low in the United States and some people don’t understand exactly what they’re getting into.

Frank echoed those remarks, saying “people are not very good consumers of insurance.”

“These are very complicated policies,” he said. “Even high-deductible plans are really complicated. They have all kinds of bells and whistles around preventive care, medications, vaccines.”

Asked about those concerns, Oz said transparency would be important, adding that President Donald Trump’s “Big Health Plan” calls for insurance companies to publish “plain English” summaries of their benefits.

Oz also argued that people are intelligent enough to make their own healthcare decisions.

“Most older people, who have comorbidities, will not want catastrophic plans for obvious reasons,” he said.