When Barack Obama addressed a joint session of Congress on September 9, 2009, he had a direct response for critics who warned that his proposed health care overhaul would extend benefits to people who had no legal right to them. “There are also those who claim that our reform effort will insure illegal immigrants,” he said from the House chamber. “This, too, is false. The reforms I’m proposing would not apply to those who are here illegally.” From the Republican side of the aisle, Congressman Joe Wilson of South Carolina broke with decorum and shouted two words: “You lie!” History has been considerably kinder to Wilson than the Washington press corps was that evening.
The Affordable Care Act that passed in March 2010 did, in fact, contain explicit verification requirements designed to back up Obama’s assurance. The law required exchanges to submit applicants’ names, Social Security numbers, dates of birth, and citizenship attestations to the Social Security Administration, which would then cross-check the information against its own records and report back to HHS. If SSA could not confirm citizenship, the Department of Homeland Security was to step in. The statute read as a serious, layered verification system; the kind of architecture that, on paper, made it genuinely difficult to see how anyone without a verifiable identity could slip through and collect taxpayer-subsidized coverage.
What followed over the next fifteen years was a slow, quiet dismantling of those guardrails, achieved incrementally through regulatory choices that individually seemed defensible and collectively produced something extraordinary. HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced the result: a June 2026 HHS issue brief had identified more than one million broker-assisted enrollments through HealthCare.gov carrying no Social Security number on the application and no premium payment attached to the account. CMS labeled them “highly suspicious.” Investigators have a plainer word for what the data describes.
To understand how the number reached seven figures, it helps to follow the timeline of the decisions that made it possible.
The ACA marketplaces opened for enrollment in October 2013, and the catastrophic launch of Healthcare.gov dominated the news for months. What received considerably less attention was a quieter problem: the verification systems that Congress had mandated were not fully operational when enrollment began, and CMS quietly allowed applications to proceed on the basis of self-attestation while the data-matching infrastructure was brought online. Applicants who could not immediately verify their citizenship or immigration status were given extended windows to resolve what the agency called “data matching issues.” That grace period became a structural feature rather than a temporary accommodation, and it established an important precedent: enrollment could proceed without confirmed verification.
In 2017, the first Trump administration attempted to tighten things, proposing that all marketplaces conduct pre-enrollment verification of eligibility for special enrollment periods, requiring applicants to demonstrate qualifying life events before coverage took effect. The Biden administration reversed that requirement in its 2023 payment notice, citing concerns that documentation burdens were deterring healthy enrollees and harming the insurance risk pool. The administration also introduced, in September 2021, a year-round special enrollment period for individuals below 150 percent of the federal poverty level, allowing anyone in that income bracket to sign up for coverage in any month, without the triggering life events that had always limited special enrollment. The intent was to maximize coverage, and by raw enrollment numbers it succeeded. ACA marketplace enrollment stood at roughly 10 million when Biden took office. By 2024, the rolls showed more than 22 million enrollees, a figure the White House cited repeatedly as proof that the law was finally living up to its promise.
The Government Accountability Office found a different story when it looked more carefully. Investigators created fictitious applicants and submitted applications to HealthCare.gov as recently as late 2024, providing no real identification documents or substituting fake ones. Every single fake applicant was approved. According to a December 2025 report issued by House Republican committee chairs citing the GAO findings, 90 percent of those fabricated enrollees were still receiving coverage in 2025. Separate data in the same report showed that in 2023, a single Social Security number had been used to support applications for more than 125 separate insurance policies, the actuarial equivalent of 71 years of health coverage from one person. The same review identified 58,000 Social Security numbers actively receiving Advanced Premium Tax Credits that matched the Social Security Administration’s death records. The federal government was paying insurance subsidies on behalf of people who, by its own records, no longer existed.
The mechanism through which much of this fraud operated was the broker system. The ACA relies heavily on licensed insurance agents and brokers to enroll consumers, and it compensates those brokers per enrollment. Dr. Oz explained the scheme in the video announcement this week: “Shady insurance agents and other bad actors have been getting paid to enroll unsuspecting Americans in health plans they never signed up for. These rogue agents have been flooding into HealthCare.gov. They submit applications for fake people, enroll stolen identities, all to collect millions of dollars in improper fees from insurance companies for selling plans they never legitimately sold. Some of these agents refuse to follow basic rules like providing their clients’ Social Security number. That, my friends, is a huge red flag.”
The fraud, as Oz described it, was not even particularly sophisticated. The system simply did not require the most basic identity verification before money began to flow.
The June 2026 HHS issue brief puts numbers to the pattern. The administration estimated that improper, phantom, and fraudulent enrollments peaked at 5.6 million people in 2025, and that over a million of the 2.6 million improper enrollments still on the books as of this year carry no Social Security number at all. A Trump administration official attributed roughly $10 billion in annual losses to fraud between 2021 and 2024, a figure that has not been independently audited but is consistent with the Paragon Health Institute’s external estimates, which placed potential improper subsidy costs in 2024 as high as $20 billion. The administration has already removed nearly three million fraudulent enrollees from the rolls. Current ACA enrollment stands at approximately 19.2 million, which remains far above the 10 million baseline from early 2021, and suggests that even after the cleanup, tens of millions of legitimate enrollees remain in the system.
Kennedy framed the accountability question directly: “The Obamacare marketplace is plagued by fraud in large part because the Biden administration dismantled basic program integrity guardrails, while partisan lawfare blocked common sense efforts to protect taxpayers.” That last clause matters. A federal court in Maryland issued a nationwide stay blocking CMS from implementing several of the enrollment integrity provisions it sought to enforce in 2025, meaning that even after the fraud was identified, the agency was temporarily barred from acting on a meaningful share of it. The same legal infrastructure that once insisted the ACA’s verification requirements made fraud impossible has been deployed in federal court to prevent those requirements from being enforced.
Obama told Congress in 2009 that the law’s safeguards made coverage for ineligible individuals impossible. The statute on paper supported that claim. What the administration and its successors chose to do with those safeguards in the years that followed is a separate matter entirely, and the one million enrollees with no Social Security number are the most concrete evidence of the distance between what was promised and what was built.
The cleanup is overdue and, by the current administration’s account, underway. The fuller accounting, of which agency officials made which regulatory decisions, which brokers collected which fees, and how much money has permanently left the Treasury, has not yet arrived. But the basic arithmetic of a program that doubled in size in four years while its verification systems were being relaxed is no longer a matter of dispute. The receipts, as they say, are in.
