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This article seeks to understand how the “welfare elite“ have governed the French health insurance system, gradually becoming the custodians of such policies over time. It sheds light on the institutionalization of the health insurance system, based on the creation of new agencies allowing for the circulation of its members within an “iron triangle“. This process explains why neither the dual supervision of the Directorate of social security as of 2007, nor the subsequent events of 2008 financial crisis, did not call into question the capacity of this elite for acting autonomously. These social managers, whose profile and trajectories are analyzed for the period 2007-2020 on the basis of an empirical survey using a programmatic action framework, were able to resist the senior civil servants in Bercy with regard to health insurance expenditure control, while also expanding health insurance coverage.