ACA Enrolment Drops as Trump Administration Pushes New Health Plan Rules
Enrolment in the Affordable Care Act (ACA) has dropped again this year, with around 23 million people signing up during the latest open period. Dr. Mehmet Oz, the Trump administration's top official overseeing the programme, claims the numbers remain too high and may include fraudulent or incorrect sign-ups.
The administration has now proposed new rules to adjust premiums and expand access to catastrophic health plans, which offer low monthly costs but come with steep deductibles.
The latest ACA open enrolment saw a noticeable decline in participants, falling from previous years. Officials attribute this drop to rising monthly premiums, which have made coverage less affordable for many. Dr. Oz has repeatedly argued that the current enrolment figures—though lower—still exceed expectations and may include inaccuracies.
In early 2026, the administration unveiled a 577-page regulatory proposal aimed at reshaping parts of the ACA. Key changes include raising the age limit for catastrophic plans, which currently carry deductibles of roughly $10,600 for individuals and $21,200 for families. Dr. Oz dismissed claims that these deductibles could climb as high as $31,000 under the new rules, calling such estimates exaggerated.
Health care experts have raised concerns about whether people fully grasp the differences between plan types. Many worry that consumers might choose coverage without understanding the financial risks, particularly with high-deductible options. The administration's proposal also focuses on tightening provider networks and adjusting premium structures, measures Oz describes as improving accountability for taxpayer funds.
Despite past warnings about improper enrolments—with estimates suggesting 4 to 5 million people were incorrectly signed up for subsidised coverage—no concrete actions were taken in 2024 to address fraud or eligibility issues. The new regulations mark the first formal attempt to reform the system since those concerns were first highlighted.
The proposed changes could further reduce ACA enrolment, with Dr. Oz predicting numbers may fall to around 19 million. The administration's focus remains on expanding cheaper, high-deductible plans while introducing stricter oversight. The full impact of these adjustments will depend on how quickly the rules are implemented and how consumers respond.
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