Nancy Pelosi told us in 2010 that we'd have to pass the bill to find out what was in it. Sixteen years later, we're still finding out, and the answer keeps getting worse.

Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced this month that more than 1 million people enrolled in Affordable Care Act marketplace plans have no Social Security number on file. Kennedy called it a "glaring warning sign for fraud." He's not wrong. But he's also not telling the whole story, and neither is anyone shouting past him on cable news.

I spend my working life underwriting risk: private credit, factoring, litigation finance, the kind of lending where you learn fast that an unverified identity is the first flag, not the last. In my world, a portfolio built on a million unverifiable counterparties gets shut down before lunch. In Washington, it got expanded for five years and called a policy win.

Here's the shape of it. HHS says it has already pulled 2.9 million improper enrollments off the rolls, with another 2.6 million still under review, down from a peak of 5.6 million phantom, improper, and fraudulent enrollees in 2025. That's real progress, and credit belongs where it's due. But the honest caveat matters, too: a missing Social Security number isn't proof of fraud on its own. Some enrollees are lawfully present immigrants who qualify........

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