02/16/2026
The congressional hearing before the Ways and Means Committee two weeks ago, summoning the chief executives of UnitedHealth, Cigna, Elevance, Humana, Centene, and Molina, followed a pattern familiar to students of legislative oversight.
When public anger reaches sufficient intensity, elected officials subpoena the most recognizable figures in the offending industry.
The spectacle serves a dual function: it satisfies the public demand for accountability while leaving the deeper architecture of the problem untouched.
Consider what congressional scrutiny has not reached. Five individuals serve as the authorized official for ten separate Medicaid billing entities.
Their combined billing on a single service code totals $11.8 billion.
One operates two entities from the same building, four doors apart.
Another controls two entities bearing the same name at the same address, differentiated only by the placement of a comma.
This is not an anomaly at the margins.
This is the structure through which billions in taxpayer-funded Medicaid claims flow without congressional examination, public testimony, or institutional oversight of any kind.
The Big 6 insurers, whatever their failings, operate under layers of regulatory compliance, SEC disclosure requirements, and public accountability.
These five entities operate under none.
The history of financial regulation is consistent on this point: the actors who attract legislative attention are rarely the actors who represent the greatest systemic risk.
The subprime mortgage crisis was not caused solely by the large banks.
It was caused by thousands of unregulated mortgage originators operating beneath the threshold of institutional visibility.
The Medicaid billing apparatus presents an uncomfortable parallel.
Chairman Smith would do well to extend his committeeโs attention to Suite 305 and Suite 309.
