The Trump administration has begun sending $500 Affordable Care Act refund payments to about 950,000 people, with a new analysis finding that 71% of the money is going to residents of 13 states hosting many of the nation’s most competitive midterm races.

The payments total $339 million in those battleground states, according to a Reuters analysis of federal data published Thursday. Those states include eight of the nine Senate contests and 10 of the 12 gubernatorial races that nonpartisan analysts rate as the most competitive. The checks are arriving roughly a month before the November 3 election that will determine control of Congress.

The geographic concentration is politically notable, but it does not by itself prove that recipients were selected by party or voting history. Eligibility is tied to residence in one of the 30 states using the federal HealthCare.gov marketplace and to having paid full-price premiums without federal premium assistance. States operating their own exchanges are excluded. The resulting map overlaps heavily with contested states because many of those states use the federal platform.

How the refund works

The White House says the payments return surplus user fees collected from insurers and passed through in premiums. It argues that the prior administration charged more than was needed to operate the federal exchange. Eligible consumers receive $500 per person, meaning a household may receive more than one payment if multiple members qualify.

President Donald Trump’s name and health-care message accompany the money. The Wall Street Journal reported that each check comes with a presidential letter promoting the administration’s record on health costs. That combination—a direct federal payment and a personalized political message immediately before an election—has prompted Democrats to call the program an attempt to influence voters. The White House did not answer Reuters’ questions about that criticism.

Using government payments as campaign evidence is not unique to Trump. Before Georgia’s January 2021 Senate runoffs, President-elect Joe Biden linked Democratic victories to delivering $2,000 in pandemic relief; Congress later approved $1,400 payments after earlier $600 checks. That precedent does not resolve whether the current mailing is appropriate, but it shows why the relevant distinction is between lawful policy advocacy and using public administration to confer a selective electoral advantage.

Administration officials describe the checks as refunds, not new economic stimulus. Federal exchange user fees are assessments on participating insurers that support marketplace operations. A separate CMS rule explains that the fee is calculated as a share of monthly premiums and will fall to 1.9% for the federal exchange in 2027, below the 2026 rate.

A test of affordability politics

The payments arrive as cost concerns are weighing on Trump and Republican candidates. An AP-NORC poll conducted September 24–28 found that 17% of U.S. adults approved of Trump’s handling of the cost of living and 26% approved of his handling of the economy. Sixty-five percent blamed his policies more than outside factors for persistently high costs. The survey of 2,140 adults had a margin of sampling error of 2.9 percentage points.

New Hampshire illustrates the potential electoral reach. Reuters reported that about 28,400 residents, or roughly 2% of the state’s population, are due payments while voters decide competitive Senate, governor and House races. Republican strategists told the news organization that the checks are unlikely to transform the election but could matter at the margins in close contests.

The value of the payment also depends on the recipient’s insurance costs. Most eligible people earn too much for premium tax credits or otherwise received no assistance. Research from KFF found that after enhanced tax credits expired, a 60-year-old earning just above 400% of the federal poverty level faced at least a doubling of benchmark-plan premium payments in 46 states and the District of Columbia. For many households, $500 offsets only a fraction of the annual increase.

What the data establish—and do not

The Reuters analysis establishes where the payments are concentrated and how that geography overlaps with competitive elections. It does not establish that the administration changed eligibility rules to favor Republican voters, nor does it show how recipients intend to vote. Because the program follows the federal-exchange map, the distribution excludes residents of state-run marketplaces regardless of their political importance.

Questions remain about the precise size and origin of the surplus, the administrative authority used to distribute it and whether an independent audit will verify the eligibility formula. The administration attributes the excess to Biden-era collections; outside health-policy analysts have said at least part of the accumulated balance dates to Trump’s first term. A complete accounting would need to identify when the fees were collected, which operating expenses they were intended to cover and how the $500 amount was chosen.

Politically, the program gives Trump a concrete affordability message at a time when public confidence in his economic management is weak. Substantively, it returns money to a limited group of full-price marketplace customers while leaving broader premium pressures intact. The checks may therefore function simultaneously as genuine financial relief and as carefully timed campaign-season communication—the electoral effect of which cannot yet be measured.