The Trump administration has begun mailing $500 checks to people enrolled in Affordable Care Act plans through Healthcare.gov in 30 states who earn more than $64,000 annually, with $90 checks for 20 million Medicare beneficiaries announced the previous week. Both sets of payments arrive in voters’ mailboxes weeks before the November midterm elections.

The $500 payments to ACA marketplace participants are drawn from fees paid by insurance companies to participate in Healthcare.gov. The $90 Medicare payments come from a general improvement fund. Neither fund had previously been tapped for direct payments to enrollees. The $500 checks were mailed only to people in the 30 states that use Healthcare.gov who earn more than $64,000 annually — too much to qualify for premium subsidies. These are the enrollees Congress failed to help when it did not extend enhanced subsidies originally put in place under President Joe Biden. The $90 Medicare checks will go to certain Medicare Part B beneficiaries; people in Medicare Advantage plans will not receive them.

Ellen Allen, executive director of the West Virginia nonprofit West Virginians for Affordable Health Care, received a $500 check and a letter from President Trump at her home near Charleston on Monday. Allen, who spoke to NPR in the summer of 2025 at age 63, paid $1,967 per month from January through August 2026 to maintain her Healthcare.gov plan because she needs expensive prescription eye drops to preserve her vision. She is bracing to pay $2,800 per month for ACA health insurance next year. She recently turned 65 and enrolled in traditional Medicare on the first day she was eligible. “I was ready at midnight — the first day I could apply, I did,” she said.

Allen characterized the check as a “political stunt.” “I just can’t believe it; I mean, that’s crazy,” she said. “If they wanted to do something meaningful, they would work on affordable healthcare instead of just sending out checks every now and then.” She said the $90 Medicare payment she may soon receive is similarly insignificant. “The $90 is — I mean, that’s just nothing,” she said. “People aren’t going to be fooled by this. People are hurting. People are feeling the cost of healthcare all year long.”

The letter accompanying the check touts the Trump administration’s health policy efforts and criticizes the Biden administration. Kathleen Clark, a professor of legal and governmental ethics at Washington University law school in St. Louis, said the letter “reads like electioneering.” “This reads as though it’s intended to influence votes,” Clark said. “That is prohibited by law.” Specifically, it would violate the Hatch Act, “the statute that prohibits using federal power and money to influence partisan political elections,” she said. Clark added that the payments could also constitute an unauthorized use of funds by Congress. “It looks like a pretty desperate effort to, in essence, bribe the recipients of this letter to vote in gratitude to Trump in the upcoming midterm elections,” she said. Clark noted that the Supreme Court has enabled Trump’s illegal actions many times in the past. “So, of course, he feels empowered to go ahead and do this,” she said.

The White House did not respond directly to NPR’s questions about electioneering, possible Hatch Act violations, or whether the payments are a political stunt. “This is an out-of-touch criticism,” Trump administration spokeswoman Allison Schuster wrote in an email. “Americans were overcharged for the operation of the Obamacare exchange, and President Trump returned their hard-earned money. This President will never stop enabling Americans to take control of their health by implementing policies that put money back in their pockets.”

Joseph Antos, senior fellow emeritus at the conservative American Enterprise Institute, called the Trump administration’s decision to send out the checks “inexplicable.” He described the move as politically strange, since a Republican administration that disparages Obamacare is investing more money into it, and “unreasonable from a fiscal standpoint,” because of the growing national debt. He also noted that most Americans won’t be getting these checks. “How about the average, lower-income worker who has employer coverage?” he asked. “They’re not getting anything. Why is that? Is that fair?”

Antos described the forthcoming $90 Medicare payment as a small sum. “You can go out to McDonald’s and buy probably two hamburgers and a shake for $90,” he said, “[and] maybe buy a half a tank of gas.” He said he does not see a political benefit from the checks. “I don’t get it, and I don’t see any advantage to anybody, including Donald Trump,” he said. Some Republicans in recent years have advocated for sending money directly to people rather than to insurance companies, but Antos said the checks are unrelated to that effort. “There’s nothing that requires people to use this money for their health,” Antos said.

A KFF poll released Tuesday found healthcare costs loom large for midterm voters. “The cost of healthcare is what’s going to be front of mind as they’re casting their votes in November,” Ashley Kirzinger, KFF’s director of survey methodology, said. The poll found 22% of voters trust Republicans on healthcare compared with 42% who trust Democrats, a gap Kirzinger said had widened from 10 points in April to 20 points. Kirzinger described it as a “widening gap” that gives Democrats an advantage among independent voters, “that’s a really important voting bloc for midterm elections.”

Despite her criticism, Allen said she will deposit the $500 check she received. “I’m not going to send it back,” she said. “I’m going to put it in my health savings account and keep working towards healthcare for all.”