Tangle - The ACA cancelations.

Episode Date: September 30, 2026

Last Tuesday, September 22, the Centers for Medicare and Medicaid Services (CMS) said it had canceled healthcare enrollments for roughly 760,000 people under the Affordable Care Act (ACA) due to alleged fraud or improper documentation. In a press briefing announcing the cancelations, Vice President JD Vance and CMS Administrator Mehmet Oz said that Covid-era subsidies and relaxed verification under President Joe Biden led to rampant abuse of the federally regulated ACA marketplace. The vice president’s White House Task Force to Eliminate Fraud estimates the enforcement action will save $2.2 billion in taxpayer-funded subsidies.Weapons in space?Earlier this month, Air Force Secretary Troy Meink made waves when he disclosed that the United States military currently has “space control weapons” in Earth’s orbit. Meink’s announcement instantly prompted questions about the nature of these space weapons — not to mention how they might be deployed. To learn more, Senior Editor Will Kaback sat down with aerospace defense expert Clayton Swope. You can listen to the interview here.Ad-free podcasts are here!Get 20% off your first year of ad-free episodes, exclusive interviews, and deep dives with Tangle’s podcast membership!You can read today's podcast⁠ ⁠⁠here⁠⁠⁠ and today’s “Have a nice day” story ⁠here⁠.You can subscribe to Tangle by clicking here or drop something in our tip jar by clicking here.Take the survey: Do you support this action? Let us know.Our Executive Editor and Founder is Isaac Saul. Our Executive Producer is Jon Lall.This podcast written by: Will Kaback and audio engineered and edited by Dewey Thomas. Music for the podcast was produced by Diet 75.Our newsletter is edited by Managing Editor Ari Weitzman, Senior Editor Will Kaback, Bailey Saul, Audrey Moorehead, and Carina Pacheco. Hosted on Acast. See acast.com/privacy for more information.

From executive producer Isaac Saul, this is Tangle. Good morning, good afternoon, and good evening, and welcome to the Tangle podcast, a place where you get views from across the political spectrum, some independent thinking, and a little bit of our take. I am your host today, senior editor, Will K back, and I've got to say, we are entering a pretty dangerous period for my productivity here at work. football is already in full swing. The MLB playoffs kicked off yesterday. Unfortunately, my team, the Red Sox, got beat pretty handily by our hated rivals, the Yankees, but we're back at it tonight.

And of course, the NBA tip-off is less than a month away. I can't believe the season is almost here. Now, I know that's a bit of an aside. Being a sports fan doesn't really lend much to my work covering U.S. politics. It may not be super relevant for you as a Tangle listener. But I will say, If I were ever part of a congressional hearing,

I think I would at least know the difference between the Atlanta Hawks and the Iowa Hawkeyes. Sorry, I had to fit that barb in. If you didn't follow the hearing involving special counsel Jack Smith and Missouri Senator Eric Schmidt yesterday, that reference might not make sense. I recommend you go and check that out. Now on a completely different note,

our main topic today sits neatly at the intersection of health policy, Obamacare, and fraud, which is a topic we've talked and written a lot about here at Tangle over the past year. Last week, you may have seen that Vice President J.D. Vance announced the cancellation of hundreds of thousands of Obamacare enrollments that he said were fraudulent or ineligible for coverage, a move that immediately drew backlash and scrutiny. So today we're going to explore what actually happened there and what you should know about this move. Then later on, Associate Editor Karina Pacheco is going to answer a question from the Tangle audience about those White House national TV spots that you may have seen last weekend. And then we'll wrap things up, as always, with a have a nice day story.

One more note before we get into today's main topic. Earlier this month, you may have seen Air Force Secretary Troy Mank made a pretty surprising announcement when he disclosed that the U.S. military currently has what he called space control weapons in Earth. Earth's orbit. Now, that announcement instantly prompted questions about the nature of those weapons, not to mention how they might actually be deployed. So to learn more, I sat down with aerospace defense expert Clayton Swoke from CSIS last week. We talked about the announcement, what went into it, what it could cover, and the context that you should know. And you can listen to that interview on

our podcast platform now. We'll drop the link to it in today's show notes. You can also see it if you just go to the Tangle podcast page. All right, now I'm handing it over to Audrey to get us into today's main story, and I'll be back to read my take. Thanks, Will. First up, we have today's quick hits. Number one, former special counsel Jack Smith testified before the Senate Judiciary Committee on his investigations into President Donald Trump, reaffirming his stance that he collected sufficient evidence to prosecute the president. Number two, the Supreme Court agreed to hear arguments in a case challenging the Trump administration's practice of deporting non-citizens to places different than their country of origin. The court allowed the administration to continue the third country removals

in the interim. Number three, the White House launched America.gov, an AI-powered website that centralizes information about government services. Number four, Dutch police arrested a suspected member of the hacking group that accessed Federal Bureau of Investigation data. Number five, Defense Secretary Pete Hegseth will reportedly announce a 20% reduction in generals and admirals in an address at Marine Corps Base Quanticoe today. Today on Capitol Hill, contentious debate over the future of the cost of health care. The Senate voting on dueling health care plans and advancing neither. Hanging in the balance says Capitol Hill debates are enhanced Affordable Care Act subsidies

set to expire at the end of the year. Last Tuesday, September 22nd, the Centers for Medicare and Medicaid, services, or CMS, said it had canceled health care enrollments for roughly 760,000 people under the Affordable Care Act, or ACA, due to alleged fraud or improper documentation. In a press briefing announcing the cancellations, Vice President J.D. Vance and CMS administrator, Mehmet Oz, said that COVID-era subsidies and relaxed verification under President Joe Biden led to rampant abuse of the federally regulated ACA marketplace. The Vice President's White House task force to eliminate fraud, estimates the enforcement action will save $2.2 billion in taxpayer-funded subsidies.

For more context, in 2010, President Barack Obama signed the Patient Protection and Affordable Care Act, also known as Obamacare, into law. The ACA increased coverage and expanded Medicaid benefits for more people through government-regulated markets. In 2021, during President Joe Biden's administration, Congress passed the American Rescue Plan, which offered premium subsidies and tax credits for those enrolling in the ACA. Then, in 2022, Congress extended the enhanced subsidies through 2025 with the Inflation Reduction Act. Congress allowed those subsidies to expire at the end of 2025. ACA enrollment increased from 11 million to 24 million people under the Biden administration.

Oz alleged in March that as many as 5 million enrollees received ACA benefits and subsidies fraudulently. Just over 19 million people received benefits through the federally managed exchange as of June in 20206, meaning the enforcement action targeted roughly 4% of enrollees. Those colds from the program were enrolled through third-party brokers, had zero premium plans and lacked verifiable social security numbers or immigration status documents, leading the anti-fraud task force to suspect the beneficiaries were fraudulent. Oz said, quote, we call them phantoms because we believe most of them don't exist or they had no idea they had coverage, end quote.

Vice President Vance identified the role of brokers who receive a payment for enrol people in ACA programs as a key to the problem. Vance said, quote, on the one hand, brokers are paid money to feed patients into the system, while on the other hand, the government isn't even checking whether the people enrolled

are actually eligible for the program, end quote. Critics of the move argue that CMS cast too wide a net and could be removing coverage for many legitimate cases. Cynthia Cox, ACA researcher at Health Policy Center KFF, said, quote, there is widespread agreement that unauthorized enrollments

should be canceled. The question is whether these were all indeed unauthorized enrollments and whether this was the appropriate process for determining whether an enrollee was legitimate or not, end quote. Next up, you'll hear from the left and the right on the ACA cancellations. Then, senior editor Will Will Kayback will be back for his take. We'll be right back after this quick break. First up, what the left is saying. The left criticizes the cancellations, with some saying they will hurt the health care system. Some say Vance's anti-fraud task force shares flaws with Doge. Others recognize the need to address fraud, but say this action ignores underlying issues. In The Guardian, Melody Schreiber said Trump is threatening the entire U.S. health system. No details were provided about how many enrollees were

fictional, enrolled by fraudulent brokers without their knowledge, or expelled because of income restrictions. The people were identified by three factors. They'd been enrolled by a broker or agent, had all of their ACA premium paid by the tax credit, and they had not supplied social security numbers or immigration documents. About 35% of ACA enrollees have never used their health insurance, said Medicare and Medicaid Administrator Memit Oz. But it's not unusual for healthy people to be enrolled in insurance and not need to use it, according to public policy researcher Edwin Park. By removing lower risk enrollees, insurance premiums could increase or insurers could decide to leave markets entirely, he said. When people lose their health insurance, it has ripple effects, including

added pressure on health systems that affect all patients. In MS now, Steve Bannon wrote about what Vance's task force has in common with Musk's Doge Gambit. Independent estimates show billions of dollars are lost every year to fraud and abuse. If the vice president believes he can help address the problem, more power to him. The trouble is, Vance claims he has already made extraordinary headway in uncovering fraud, to the tune of more than $260 billion. But those boasts aren't standing up well to scrutiny. If this sounds at all familiar, it's because a similar story unfolded last year. Elon Musk was put in charge of Doge, and it too created an online resource that purported

to show all of the billions of dollars the endeavor was saving American taxpayers. To be sure, the underlying point of these resources sounds great. The trouble is both initiatives seem wholly unprepared for what might happen when people people who know what they're talking about bothered to review their work. In MS Now, Miranda Javer suggested a heavy dose of skepticism. The first Trump administration helped empower the very brokers that now claims are fraudulently enrolling people. While the second Trump administration is taking aim at perverse incentives that may have arisen, sweeping disenrollments ignore the failures of policy design. That is, when the previous Trump administration gave brokers more power as intermediaries,

the government failed to build a regulatory regime that would police their behavior. CMS's decision to impose a moratorium on new agents and brokers may prove to be a band-aid solution. An appropriate response would not just penalize actors who are in the wrong, such as this, but also impose greater regulatory protection to prevent this in the future. The Trump administration, ideologically inclined against consumer protection, has largely opted for piecemeal responses while leaving systemic failures in place. Now, what the right is saying. The right supports the cuts, with many saying the administration is effective,

fighting fraud. Some argue that this effort should have bipartisan support. Others push back on Democrats' characterization of the cancellations. In the Federalist, Chris Bray said the administration is doing normal anti-fraud work with increased focus. Federal regulations that were first written during the Obama administration in 2012 explicitly described the process by which fraudulent Obamacare enrollments can be terminated by government officials. And here's the funny part. Every administration does this. The termination of fraudulent Obamacare enrollments is a normal CMS activity. The Biden administration routinely announced the termination of fraudulent Obamacare enrollments. By the standard Democrats are applying this week, cruel Joe Biden viciously stripped

health care coverage from tens of thousands of Americans. But not really because the whole fake panic is completely made up and stupid. The Trump administration is doing normal anti-fraud work with increased focus in seriousness, which is only a scandal if you're dumb enough to be elected to Congress as a Democrat. The Las Vegas Review Journal editorial board suggested fraud shouldn't be a partisan issue. Just because a government agency allocates money for a noble sounding cause doesn't mean the money is well spent. Elected officials and government employees have a duty to ensure that taxpayer money is spent carefully. Politicians from both parties talk about the need to eliminate

waste, fraud, and abuse, but notice their reaction to the Trump administration's efforts to actually do just that. The DOJ alleges that more than $10 million intended to help low-income families pay for child care was instead funneled to bogus staycare providers. Yes, this White House has a tendency to exaggerate for political purposes, but fraud against the taxpayers is a serious problem. Democrats should work with the Trump administration to root out fraud, not attack Mr. Trump and Mr. Vance when they work to do so. The Washington Post editorial board argued J.D. Vance is not ripping away anyone's health insurance coverage. Former House Speaker Nancy Pelosi wrote on social media that using the false pretext

to fighting fraud to strip Americans of their health care is as cynical as it is cruel. Except, that's not what's happening. Even if the account met all of the requirements for removal, the insurer was still required to reach out to the individual via two forms of communication. Only when insurers received no response after 30 days was the account removed, according to CMS. Fraud grew rampant in recent years because the Biden administration increased Obamacare enrollment by expanding eligibility for zero premium plans while failing to perform sufficient due diligence. Money given to scammers is money that doesn't help needy people receive health care. Democrats should wholeheartedly support throwing the book at these criminals.

Downplaying the scale of abuse undermines public confidence in the safety net. That's it for the views from the left and the right. Now back to Will for his take. Thanks, Audrey. All right, here's my take. The headline, Trump officials eject $750,000 from Obamacare markets claiming fraud is one of those news stories that rolls down the conveyor belt of daily items and snatches your attention, particularly if you or a loved one are enrolled in a government health care plan. It's also a story that could create more confusion than clarity at first glance.

So I want to nail down a few key points up front. To start off, all of the enrollees whose coverage was canceled, received their health insurance through the federally facilitated Affordable Care Act marketplace, health care.gov. So that means that anyone who is insured through state-based ACA exchanges wasn't affected. And neither were those who signed up for a plan on their own. Vice President Vance's task force only looked into enrollments mediated by agents or brokers who serve as middlemen between the government insurance companies and individuals. Now, in theory, those brokers have a useful role. They identify people who are eligible for ACA benefits,

and they help them get health insurance. And then as a side note, they're paid on commission by the insurers themselves. But these agents have also become a burgeoning source of fraud. The Centers for Medicare and Medicaid Services, CMS, found that first-time brokers who registered for the 2026 plan year were disproportionately responsible for enrollment activity, flagged as high risk or fraudulent, including missing social security numbers, unverifiable citizenship status, and unresolved income verification. Those discrepancies may be explainable, but unverified information like that is also an alarm bell that brokers may be enrolling people without their knowledge and lying about their income so they can qualify for a $0 premium, thus not knowing that they'd been signed up at all.

alternatively, they could be switching people onto a different plan without their knowledge to collect a new commission from insurers, or they could be fudging personal data to make someone eligible who shouldn't have been. Concerns over this behavior are bipartisan, too. In 2024, Democratic Senator Ron Wyden of Oregon called on CMS to take urgent action to address brokers fraudulently enrolling people in ACA plans. And beyond bad broker behavior, other areas of the healthcare.gov marketplace have become hotspots for fraud. In 2024, the government accountability office, the GAO, tested whether four made-up applicants could get approved for coverage. And guess what, all four were accepted at a total cost of $2,350 per month. Then for 2025, GAO created 20 fake applicants and 18 were still receiving coverage nine months into that plan year at a cost of over $10,000 per month. GAO also found 30,000 applications in plan year 2023 and 160,000 applications in plan year 2024 that had, quote, likely unauthorized changes by agents or brokers. Separately, the Congressional Budget Office informed lawmakers in August of 2025 that an estimated

2.3 million enrollees intentionally misrepresented their income to qualify for ACA tax credits, up from an estimated $1.3 million in 2023. And the Office of the Assistant Secretary for Planning and Evaluation reported in June of this year that nearly half of ACA enrollment growth between 2021 and 24 was quote, suspected to be improper, phantom, or fraudulent. Now, considering the range and scope of these findings, it felt pretty disingenuous to me that Democratic politicians like Senator Chuck Schumer and Representative Nancy Pelosi suggested that the Trump administration is villainously trying to rip health insurance away from hundreds of thousands of people for no apparent reason. Yes, some people may have been

mistakenly caught up in this probe, but we just don't have enough information to say that yet. And one week after this announcement, I haven't seen any reports of people claiming that they were wrongly kicked off of their plan. Based on what we know right now, I think this effort was both justified and properly executed. When I reviewed the criticisms from the left about the cancellations, I noticed that the arguments were mostly based on suspicion of any fraud-related initiatives from the Trump administration. Consider the three pieces that we chose for today's edition that you just heard. In MS Now, Miranda Yavor wrote, quote, given the administration's track record, there are reasons to view this announcement with a heavy dose of skepticism. And then also in MS now,

Steve Benin alluded to, quote, ample reason for skepticism about Vance's fraud task force. And finally, the Guardian's Melody Schreiber dedicated the bulk of her piece to quoting experts who suggested ill intent by Vance and company. What struck me about this, though, was that these articles didn't offer evidence that the enrollments were improperly canceled, just that CMS may have made some mistakes and that the Trump administration doesn't deserve the benefit of the doubt. Now, I think both of those points have some credence, especially when the administration has misled the public about so many of its other anti-fraud initiatives. As Isaac documented in his retrospective on the Department of Government Efficiency last month, Elon Musk's ill-fated effort enacted sweeping

cuts with no apparent strategy, then lied about its savings, and likely cost taxpayers billions. Now, Vance's fraud task force has also made some dubious claims. The vice president has said that his group found roughly $250 billion in fraud already, but they haven't shared the basis for that number publicly. And notably, a New York Times analysis found that Vance has included cases that were identified and prosecuted under the Biden administration to account for that $250.5,000. billion number. Specific to this case, too, Vance and CMS could have headed off the skepticism from the left by offering more detail about those who were kicked off of their plans.

Specifically, knowing what proportion of the cancellations were for suspected broker fraud or ineligibility or improper documentation would have given a much clearer idea of where the biggest areas of concern currently are. However, acknowledging those points doesn't invalidate this specific. anti-fraud initiative. Remember, the affected enrollments met four criteria. They lacked a valid social security or immigration identification number, had 100% of their premium covered by tax credits,

hadn't used their coverage since it was activated, and had never made contact with their insurer. To me, that's a sharp approach to rooting out the areas of concern for fraud. And even after all four of those boxes were checked, the insurer of the suspicious plan still had to reach out to the enrollee through two different forms of communication and give them 30 days to respond before the government canceled their coverage. That's ample opportunity to correct a mistake,

and even if your plan was canceled improperly, you can still re-enroll with the correct documentation. So I don't blame anyone whose eyebrow twitched a little bit when they first read about these ACA cancellations. Honestly, I have the same reaction. But knowing the scale of the issue, issues that have long existed in the ACA marketplace, I'm glad that the administration took this action, and I think the criteria it used were sound. Am I skeptical of how the White House is

addressing purported fraud in other areas of the government? Absolutely. Do I think that Vance's task force is scrutinizing Obamacare with entirely pure intentions? I don't. But I can hold these reservations and still find this effort necessary and valid. All right, that is a very. That is it for my take. Now I am going to pass it over to Associate Editor Karina Pacheco, who's going to be tackling today's question from the Tangle audience. Karina, over to you. We'll be right back after this quick break. Thanks, Will. This is Associate Editor Karina Pacheco, and I'm answering a question from Eliza from Burlington, Vermont. What's the deal with these U.S. government-funded, aka taxpayer-funded Trump ads? Is that legal? Should we be worried about this?

Over the weekend, the Trump administration aired a video on national TV in which Trump vows to tackle the, quote, sick political class that hates our country and, quote, demolish the deep state. As you noted, the dramatic black and white commercial named, quote, Final Battle was stamped, paid for by the U.S. government. NBC News found that the advertisement is virtually identical to a campaign ad Trump posted to truth social back in 2024. The rhetoric isn't uncommon for. Trump. Nor is it uncommon for presidential administrations to run public service announcements for policy

initiatives. But it is uncommon and potentially unprecedented for an administration to use taxpayer funds for an advertisement that so closely resembles a campaign sizzle reel. The Associated Press reported that the Department of Homeland Security appropriated about $20 million from customs and border protections budget to pay for the TV spots. The administration has faced bipartisan and backlash. Trump-allied Republican senators object to the use of public dollars for apparent promotional materials, while Democrats equate the ad to government-sponsored pro-Trump propaganda and allege that the commercials violate anti-propaganda laws and the Hatch Act, a 1939 law that limits the partisan political activities by the executive branch. The White House has defended

these ads as PSAs that promote the president's policy achievements and has rebutted the claim but the video is campaign material by saying Trump is not on the ballot and the ads do not include a call to action. The administration also highlighted PSAs by past presidents, such as the Obama administration running national ads to promote the Affordable Care Act open enrollment period or the Biden administration issuing notices about COVID-19. The Trump administration certainly seems to be intentionally blurring the line between campaign advertising and public awareness initiatives. While the actual content of the advertisement will make it difficult to peg as partisan political material, the fact that the exact same video was previously used for a campaign purpose muddies those waters. And while it doesn't contain a call to action per se, the TV spot doesn't appear to have a clear public service purpose either. As of now, no full-fledged lawsuits have been brought,

but the artist of the song featured in the ad has sent a cease-and-dicist, and the consumer advocate, nonprofit, public citizen, has filed complaints with regulatory bodies. Now, passing it back to Audrey for the rest of the pot. Thanks, Karina. Last up today, we have our have a nice day story. The Black Robin is a tiny bird found in the lowland forests of New Zealand's Chatham Islands. In the 1970s, after habitat lost and pest introduction, the bird neared extinction, with just a single breeding pair left.

But a pioneering breeding program that used other species, to foster eggs proved successful, and the species population has climbed back to 350 birds. This year, the Black Robin won New Zealand's Bird of the Year competition. The Guardian has the story, and you can find the link in the show notes. That's it for today's podcast. If you would like to support our work, head over to reetangle.com, where you can pick up a newsletter subscription,

a podcast subscription, or a bundle membership that gets you a discount on both. We will be right back here tomorrow, but in the meantime, this has been editor, Audrey Moorhead. On behalf of Isaac, Will, Karena, and everyone else. Have a nice day and peace. Our executive editor and founder is me. Isaac Saul and our executive producer is John Lull. Today's episode was edited and engineered by Dewey Thomas. Our editorial staff is led by managing editor Ari Weitzman with senior editor Will Kback and associate editor's Audrey Moorhead, Bailey Saul. Music for the podcast was produced by Diet 75.

To learn more about Tangle and to sign up for a membership, please visit our website at retangle.com.