WASHINGTON, D.C. – U.S. Senator Tammy Baldwin (D-WI) joined her colleagues in opening an inquiry into the actions of the 10 largest insurers on the Affordable Care Act (ACA) marketplace, following their decision to work with the Trump administration to terminate coverage for 760,000 ACA enrollees without due process.

“Aligning with Republicans and their so-called ‘war on fraud,’ insurance companies chose to participate in a collaborative effort with the Trump administration to inject yet more chaos and damage into the ACA Marketplace,” the senators wrote in letters to the insurance companies. “This year, nearly 3 million people have lost coverage while millions more are paying sky-high premiums and higher deductibles for insurance that covers less.”

The letters, sent to the chief executives of 10 of the largest health insurance companies participating in the federal marketplace enrollment, detail the troubling nature of these companies’ compliance with the Trump administration’s directive to strip some eligible Americans of their health coverage. The senators note that this move was based on discredited, partisan analyses suggesting zero-dollar premium plans and zero-claims enrollees are reliable proxies for fraud.

The letters outline how insurers took specific steps to assist the Centers for Medicare & Medicaid Services (CMS) in this likely illegal effort by sending unsolicited communications, including in some cases asking enrollees to verify their Social Security numbers. Individuals who did not respond were deemed fraudulent and their coverage was terminated. The senators emphasized that the companies carried out these communications months before the federal agency attempted to change its guidance to support the request, bypassing the established process for midyear eligibility determinations.

“We have many questions about the role of [insurance company] in this flawed process used to terminate coverage for 760,000 enrollees, and the judgment exercised by insurance companies that chose to cooperate with CMS officials without requesting clarification about the specific authorities being relied on to support this request or raising concerns to Congress on behalf of their customers, enrollees that your companies receive billions of dollars in premiums and taxpayer support each year to serve,” the senators continued.

To understand the full scope of this scheme and the insurers’ failure to raise concerns to Congress on behalf of their customers, the senators called on the companies to provide information such as:

  • When CMS first contacted them to evaluate unauthorized enrollments and whether the agency provided a legal basis for the request.
  • Why the companies carried out mid-year eligibility redeterminations that conflicted with the existing federal exchange manual at the time.
  • Whether they view zero-dollar net premiums, a lack of claims, or missed unsolicited communications as reliable proxies for fraud.
  • How many terminated enrollees have made a health care claim or requested reinstatement.
  • Whether they are participating in a second phase of these terminations that is currently underway.

The letters were sent to Cigna, UnitedHealthcare, AmeriHealth Caritas, Centene, Elevance, Florida Blue, Health Care Service Corporation, Imperial Insurance Companies, Oscar Health, and Molina Healthcare.

The letters were led by Senate Finance Committee Ranking Member Ron Wyden (D-OR) and Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Bernie Sanders (I-VT).

Full text of the letter is available here.

An online version of this release is available here.