Ellen Allen has mixed feelings about the check from the U.S. Treasury and letter from President Donald Trump that arrived at her house near Charleston, West Virginia, on Monday.
"I just can't believe it; I mean, that's crazy," says Allen, who's the executive director of a small nonprofit called West Virginians for Affordable Health Care. She says, in her opinion, sending out these checks is a "political stunt."
NPR first spoke to Ellen Allen in the summer of 2025. She was 63 years old at the time and knew she needed coverage from Healthcare.gov even as generous federal subsidies for her premiums were ending. She has a serious eye condition and needs expensive drops to preserve her vision. She advocated for the Republican-controlled Congress to extend the subsidies. It didn't. She ended up using retirement savings to pay $1,967 every month for her premiums from January through August 2026.
Then her birthday came; she turned 65 and was eligible for Medicare. "I was ready at midnight — the first day I could apply, I did," she laughs.
A second check on the way?
Allen chose traditional Medicare, which means she could soon be getting another check from the U.S. Treasury. Last week, President Trump announced that $90 checks will be sent to 20 million people enrolled in Medicare.
"The $90 is — I mean, that's just nothing," Allen says. In her work, she talks to people about healthcare costs all over West Virginia. "People aren't going to be fooled by this," she predicts. "People are hurting. People are feeling the cost of healthcare all year long."
"If they wanted to do something meaningful, they would work on affordable healthcare instead of just sending out checks every now and then," Allen says.
Both checks are directed to select groups. The $500 checks mailed by the Trump administration last week were only sent to people who live in one of the 30 states that use Healthcare.gov for their insurance marketplace. They also make more than $64,000 annually for an individual, which is too much money to qualify for subsidies. These are people, like Allen, who were likely to be hard hit when Congress failed to extend the extra financial help put in place under President Joe Biden.
The $90 checks that will be sent to Medicare beneficiaries are only going to certain people enrolled in Medicare Part B. People in Medicare Advantage plans, which are managed by insurance companies, will not get checks.
Can Trump do that?
The checks are hitting people's mailboxes just a few weeks before the midterm elections. The text of a letter sent along with the money touts the Trump administration's efforts on health policy and criticizes the Biden administration.
"This reads like electioneering," says Kathleen Clark, a professor of legal and governmental ethics at Washington University Law School in St. Louis, Mo. "This reads as though it's intended to influence votes. 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 explains. It may also be a use of funds that's unauthorized by Congress.
The money for Healthcare.gov enrollees is from fees insurance companies paid to participate in the marketplace, and the money for Medicare beneficiaries is from a general improvement fund. Neither of these funds has been used for direct payments to enrollees before.
"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 adds.
An empowered executive branch
The checks and letters are arriving in people's mailboxes, whether they're legal or not. Clark notes 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 says.
The White House did not respond directly to NPR's questions about electioneering, whether the action is a violation of the Hatch Act or if it is a "political stunt," as Allen put it.
"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."
'Half a tank of gas'
Some Republicans in recent years have advocated for giving more money directly to people rather than to health insurance companies, although the party has yet to settle on a particular approach.
In any case, sending these checks is unrelated to that effort, says Joseph Antos, senior fellow emeritus at the conservative think tank American Enterprise Institute. There's nothing that requires people to use this money for their health.
"From the perspective of the average senior citizen, when they get a $90 check, it's money," he adds, referencing the forthcoming checks for Medicare beneficiaries. "You can go out to McDonald's and buy probably two hamburgers and a shake for $90 [and] maybe buy a half a tank of gas."
A widening trust gap, poll says
A few weeks from the midterm elections, voters say they are struggling with health costs and want candidates to address them, according to a poll released Tuesday by the nonprofit health research organization KFF.
"The cost of healthcare is what's going to be front of mind as they're casting their votes in November," says Ashley Kirzinger, director of survey methodology for KFF. "And what we are seeing is that the Democratic Party has the advantage overall among all voters on which party voters trust to handle healthcare, but they also have the advantage among independent voters, and that's a really important voting bloc for midterm elections."
She says there is "a widening gap" between the Democratic Party and Republicans when it comes to which party voters trust to handle health costs. "It was just a 10-point margin back in April, and now we're seeing it to be a 20-point margin," she says. The poll found 22% of voters trust Republicans on the issue, compared to 42% who trust Democrats.
Where's the credit for GOP candidates?
Antos, of AEI, calls the Trump administration's decision to send out these checks "inexplicable." He describes 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 notes that most Americans won't be getting these checks. "How about the average, lower-income worker who has employer coverage?" he asks. "They're not getting anything. Why is that? Is that fair?"
He is doubtful the move will have a political benefit for Republican candidates. "For one thing, Trump is not saying that your local congressman did this for you, Trump is saying he did it for you," Antos says. "I don't get it, and I don't see any advantage to anybody, including Donald Trump."
Despite her mixed feelings, Ellen Allen of West Virginians for Affordable Health Care is planning to deposit the $500 check she just received. "I'm not going to send it back," she says. "I'm going to put it in my health savings account and keep working towards healthcare for all."
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