Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, says the Affordable Care Act marketplaces may be “too high” on enrollment, hinting that millions of people now covered under Obamacare might not actually qualify. The comments land as the administration moves to tighten eligibility checks and reshape which plans are offered, a shift that has already led to enforcement moves such as temporarily holding back hundreds of millions of dollars in Medicaid payments to Minnesota and stoking a fresh national fight over fraud, coverage and cost.
Oz's Comments And The Agency's Forecast
In an interview with NBC News, Oz said marketplace enrollment "may be too high" and predicted that stricter verification could drag sign-ups down toward roughly 19 million. He cast the coming crackdown as an anti-fraud push aimed at brokers and others who he says are enrolling people improperly or gaming zero-premium plans.
Administration Points To Paragon Analysis
To back up that stance, the administration has leaned on analyses cited in its rulemaking. A June 2025 HHS notice highlights a Paragon Health Institute study that estimated roughly 4 to 5 million improper enrollments in 2024 and billions of dollars in premium tax-credit payments going to people who should not receive them. That Paragon estimate appears in the final Marketplace Integrity and Affordability rule and is used as a core justification for tighter verification and eligibility rules, according to the Federal Register.
Analysts Urge Caution On The Math
Plenty of health policy watchers say the numbers need a strong asterisk. Cynthia Cox, who directs the Program on the ACA at KFF, has warned that quirks in federal data, including double-counting people who switch plans midyear, mean the headline figure for fraudulent or unauthorized enrollment is probably inflated and that the real number is likely in the hundreds of thousands, not millions, according to KFF.
What Shoppers Would Actually Feel
The regulatory package would push the market toward lower monthly premiums paired with much higher deductibles and out-of-pocket limits by opening the door wider to catastrophic plans. Healthcare Dive reports that the proposal would send catastrophic out-of-pocket maximums well above today’s caps of roughly $10,600 for an individual and $21,200 for a family. Coverage analysts warn that the tradeoff cheaper premiums in exchange for potentially crushing cost sharing could push some people out of the market, especially after sign-ups dipped this year, according to Healthcare Dive.
Minnesota Pause And Legal Fights
Vice President JD Vance joined Oz in announcing that the administration would temporarily withhold about $259.5 million in Medicaid reimbursements to Minnesota while it digs into alleged program-integrity problems, according to the AP. Minnesota officials have pushed back hard, disputing the accusations and heading to court after prior federal actions threatened even larger swings in the state’s Medicaid matching funds, The Washington Post reported.
What’s Next
CMS says the new rules will be finalized after a public comment period this spring, although resistance from states and likely legal challenges could delay or trim their real-world impact. Federal snapshots put open-enrollment sign-ups at roughly 23 million for the 2026 plan year, a benchmark the agency will be watching closely as it tests whether tighter rules actually cut down on what officials describe as improper enrollment, according to KFF.
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