Trump Plans $500 Obamacare Rebates Before Midterms. Up to 1 Million Americans Could Get Checks.

President Donald Trump's administration is preparing to send $500 health care rebate payments to as many as 1 million Americans in the weeks leading up to the November midterm elections.

According to an exclusive report from Axios, the payments would go to certain Affordable Care Act enrollees in 30 states who the administration says were overcharged for their health insurance coverage. The rebates are expected to be delivered through direct deposit before the November 3 election.

The timing puts the unusual health care payments squarely in the middle of the midterm campaign, as Trump and congressional Republicans seek to focus voters on the administration's economic and health care policies.

Health care costs have become an increasingly prominent campaign issue, with recent polling cited by Axios showing medical expenses are among Americans' leading economic concerns.

The administration says the money will come from roughly $500 million in excess Affordable Care Act fees that were collected from consumers and subsequently returned to the federal government. According to Axios, officials describe the money as funds that were over-collected and remained in government accounts.

The rebates would not be available to every American enrolled in an Obamacare plan. Administration officials told the outlet that the refunds are intended for ACA customers who do not receive federal premium assistance.

Among the states expected to have relatively large numbers of eligible recipients are Florida, Texas, Alabama, Alaska, Arkansas, Delaware, New Hampshire, Wisconsin, South Carolina, Michigan, Ohio, Mississippi and Missouri. In total, people in 30 states could receive payments, although the administration has not yet released a complete public list of recipients or detailed instructions for determining eligibility.

The plan represents a notable turn in Trump's long and complicated relationship with the Affordable Care Act. During his first term, Trump and congressional Republicans attempted to repeal major portions of Obamacare but failed to dismantle the law. Now, his administration is using money connected to the ACA as part of a broader health care strategy centered on directing federal assistance to consumers rather than insurers.

The Centers for Medicare & Medicaid Services continues to oversee the federal ACA exchanges and sets user fees for insurers selling qualified health plans through federally facilitated exchanges. Its 2027 rules include updated user-fee rates as well as other standards governing ACA marketplaces.

The money at the center of the planned rebates also has a political history. In 2023, the Biden administration proposed using money from the fund as part of an effort to provide no-cost contraception to people whose ACA insurance did not cover it, according to Axios.

Congressional Republicans objected, arguing that the fees were intended to support the operation of Obamacare exchanges and that CMS did not have authority to redirect them for that purpose. The proposal was ultimately withdrawn.

After Trump returned to office, some Republican congressional policy staffers who had opposed the contraception proposal joined his administration. Officials later reduced some ACA-related fees in an effort to lower premiums and determined that a substantial amount of money remained available, according to the Axios account.