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An insurance agent talks with clients inside a shopping center in Miami, on Dec. 5, 2025. Once someone enrolls in an Affordable Care Act plan, they can get help with sticky insurance issues from caseworkers at the federal government. Many caseworkers were cut in the recent round of federal layoffs. Rebecca Blackwell/AP hide caption
toggle caption Rebecca Blackwell/APThey're the fixers, the ones who step in when Affordable Care Act enrollees have a problem with their coverage, like a newborn incorrectly left off a policy or discovering that a rogue broker had signed them up or switched their plan without consent.
Specially trained caseworkers help resolve such issues, which might otherwise cause consumers to rack up large doctors' bills or prevent them or their family members from getting care.
Now, though, the broad federal reduction in force set in motion by the Trump administration has cut the ranks of those caseworkers, slashing two out of six divisions of caseworkers, according to one affected worker and a former Centers for Medicare & Medicaid Services official familiar with the situation, Jeffrey Grant.