More than a million people enrolled in Obamacare plans do not have a Social Security number on file. The Health and Human Services Secretary, Robert F. Kennedy Jr., and the Centers for Medicare and Medicaid Services Administrator, Dr. Mehmet Oz, presented that figure in a video this weekend as proof the marketplace is, in Kennedy's words, "plagued by fraud." [1] Oz pointed to the missing numbers and called them "a huge red flag." [1]
There is a simpler explanation, and it is written into the rules of the program they run: some people who enroll in marketplace coverage are not supposed to have a Social Security number on file, because they do not have one. [2]
The rule they are describing as fraud
Federal marketplace rules ask an applicant for a Social Security number only "if they have one." [2] A lawfully present immigrant who does not have an SSN is told, in the official guidance, to "skip the question in the application," and to skip it again each time the form asks. [2] These are not undocumented immigrants. They are people lawfully in the country who are eligible to buy marketplace coverage: green-card holders, refugees and people granted asylum, people with temporary protected status, survivors of trafficking and domestic violence, and people on valid work or student visas. [3] Many of them file their taxes with an individual taxpayer identification number, an ITIN, precisely because they do not have an SSN. [2][3]
A marketplace record with no Social Security number, then, is not a glitch or a forged identity. For a large share of the people in that count, it is the system working exactly as it was designed to.
What the number actually measures
"More than a million enrollees lack a Social Security number" is a count of people without an SSN. It is not a count of fraud. Those are two different things, and the slide from one to the other is the whole move. To turn the first number into the second, you would have to show that some specific share of those enrollees were ineligible, or invented, or double-claimed. The rollout did not show that.
Their own announcement undercut it
Here is the detail that did not make the soundbite. In the reporting on the announcement, the officials "didn't say how many of the 1 million Obamacare enrollees who lacked Social Security numbers were suspected of fraud." [1] They led with a fraud charge and then declined to attach a fraud number to it. Kennedy asked, "Why are we paying people we don't know if they actually exist?" [1] For the lawfully present enrollees who file taxes with an ITIN, the government knows exactly who they are. It just knows them by a different number.
The bottom line
None of this means a marketplace can never be defrauded, or that program integrity does not matter. It means the specific evidence offered here, a missing Social Security number, does not carry the weight put on it. The marketplace accepts enrollees who legitimately have no SSN, the rules instruct those applicants to leave the field blank, and the people making the fraud claim did not say how many of the million they actually suspect. A red flag is supposed to mark something that should not be there. This one marks people the law lets in.
