Heading into the midterm elections, high healthcare costs rank among voters’ biggest concerns. But lately, there’s a twist giving the issue new momentum on campaign agendas: a focus on fraud in government health programs.

The administration of President Donald Trump has used claims of widespread wrongdoing to justify investigations, suspensions of billions of dollars in payments to states, and the cancellation of Affordable Care Act health coverage for hundreds of thousands of people.

The effort has opened a broader political fight over the extent of fraud and the administration’s response to it. Republicans say they’re safeguarding taxpayer dollars by going after bad actors. Democrats contend the administration has relied on insufficient evidence to target blue states and cut programs Republicans have long tried to shrink. Meanwhile, Trump’s pardons of executives convicted of healthcare fraud, administration moves to weaken some protections against abuses, and a high-profile error by Trump regulators stand in contrast with the administration’s proclaimed fraud-fighting goals.

The dispute is becoming a talking point for both parties leading up to the November election.

Republican candidates are trying to win voters’ confidence by emphasizing their efforts to halt what they say is the misuse of taxpayer dollars in federal health programs.

“Going after fraud gives Republicans a healthcare message when they would otherwise just be defending cuts to Medicaid and the Affordable Care Act,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News. The approach, he said, helps “blunt” those attacks.

Democrats, however, traditionally have an advantage on healthcare in general, with polls showing voters are more likely to trust them with such issues. Now Democrats are portraying Republicans’ fraud crackdown as a cover for the GOP’s weakening of safety net programs. But the GOP messaging could resonate at the ballot box.

About 44% of voters — and 54% of Republican voters — say say fraud in government programs is “extremely important” for candidates to talk about, according to a KFF poll conducted in mid-September, suggesting the fraud focus might be connecting with the GOP base. Such fraud is also the top issue rural Republican voters want candidates to talk about, based on a separate survey by KFF and the Associated Press.

It’s an issue that is hardly new, and government watchdogs have repeatedly documented fraud by health providers and brokers, as well as improper enrollment in government health programs. A report by the Government Accountability Office in March warned that the “sheer amount of payments in the Medicare program creates significant fraud risks.” And in a separate probe, GAO investigators were able to get subsidized insurance for fake ACA enrollees.

What has changed is the prominence the issue now occupies in national politics.

Administration’s Fraud Targets

Trump administration authorities have this year charged hundreds of people, including doctors, in alleged billing schemes. It has announced audits of state Medicaid fraud units and increased scrutiny of enrollment in federal programs, withholding billions of dollars in federal Medicaid payments over claims of lax oversight — with what Democrats say is a laser focus on blue states despite a lack of evidence.

The administration’s more expansive claims about fraud — and the actions it has taken in response — have generated fierce political clashes.

Most recently, the Centers for Medicare & Medicaid Services canceled ACA enrollments covering 760,000 people. While Democrats have questioned the methods that found them to be fraudulent, federal officials said they included nonexistent consumers whose applications were submitted by brokers or agents who can earn commissions from insurers.

CMS Administrator Mehmet Oz said at a press event that the cancellations included people who had coverage through the ACA but hadn’t used it. He also said some had no Social Security numbers, calling that evidence of problems.

“About 35% of current people on the Obamacare system — 35%, more than a third — had never used the program. They haven’t bought a prescription medication. They haven’t seen a doctor. That just is not possible,” Oz said. “So we know there is fraud.”

Democrats and some health policy analysts challenge that conclusion. They say that younger and healthier people are much less likely to use their insurance and that not using their coverage doesn’t mean they were improperly enrolled. Critics also say the absence of Social Security numbers doesn’t necessarily establish fraud; for example, newborns can be added to their parents’ plans before receiving a number.

“This is yet another attempt by the Trump administration to kick hundreds of thousands of vulnerable Americans off their healthcare,” Rep. Melanie Stansbury (D-N.M.) posted on the social media site X. “Millions are already struggling to access healthcare—and this is their plan?”

There are political risks for the GOP as well. The disenrollment of alleged phantom accounts is likely to ensnare legitimate consumers, say health analysts and ACA advocates, leading to a potential backlash against Republicans if scores of people lose coverage just before the midterm elections.

States that tend to deliver for GOP candidates will be hit especially hard, they say, because ACA enrollees are concentrated in those states. The 4.5 million people in Florida and 4.1 million in Texas who have marketplace coverage account for nearly 40% of the country’s ACA enrollment, according to a KFF analysis.

Conservative health policy advisers say the administration took multiple steps to avoid canceling legitimate coverage, including attempts to contact consumers and requirements that additional criteria be met before coverage was terminated.

“Those criticizing the action either don’t understand it or see some political advantage in mischaracterizing it,” said Brian Blase, president of Paragon Health Institute and a former Trump health policy adviser.

Democrats, meanwhile, highlight inconsistencies in the administration’s broader anti-fraud campaign.

They note that the Department of Health and Human Services last year recertified hundreds of insurance brokers and agents who had been suspended in 2024 by the Biden administration for suspected fraud or abuse. The Trump administration also laid off about 200 employees from a CMS office involved in regional oversight of the ACA marketplace.

On Oct. 3, Trump called on Congress to pass legislation with mandatory prison terms for defrauding Medicare and Medicaid, eliminating probation as an option.

But Trump has also pardoned health industry executives convicted of major fraud schemes, including people who are connected to his political allies or who spent heavily on lobbying on their behalf. The pardons included a nursing home operator sentenced to three years in prison for a nearly $40 million tax scheme and, in Trump’s first term, five executives at a Florida company convicted for Medicaid fraud.

Trump’s pardons in 2021 of executives who profited from massive public healthcare fraud spurred criticism from the National Health Care Anti-Fraud Association. Critics now say the administration is portraying cuts to Medicare and Medicaid as necessary for weeding out waste, fraud, and abuse while exonerating criminals who have engaged in some of the biggest schemes in federal health programs.

Blue State Allegations

HHS has raised concerns about Medicaid fraud and program integrity in several states, and the administration has deferred or threatened to cut federal Medicaid funding while disputes are investigated.

Democrats say the administration is itself engaging in fraud by using unsubstantiated allegations of abuse to politically target blue states.

One of the most striking clashes occurred in New York.

Federal officials launched an investigation of the state’s Medicaid program after claiming that personal care services — including help with bathing, dressing, and meal preparation — had been provided to more than 5 million people, which would have amounted to roughly three-quarters of the state’s Medicaid population — an almost impossibly large proportion.

“It is time for New York to come clean about its Medicaid program,” CMS’ Oz posted in March on X.

CMS later acknowledged its calculations were wrong. The agency said that it had misunderstood the state’s billing codes and that the actual number of beneficiaries who received the services was closer to 450,000. The administration continued its scrutiny of the New York program, however, and later suspended millions of dollars in federal funding for the state’s Medicaid fraud unit, saying the division wasn’t producing enough indictments.

The administration also withheld about $2 billion in Medicaid funding from California, citing concerns about program integrity and oversight of some home medical services. State officials deny the allegations, saying spending on home services has grown because of factors such as higher wages for home health aides and an increase the number of older people receiving care.

The White House announced plans to defer more than $500 million in federal funds from Minnesota, claiming the state had failed to protect its Medicaid program from abuse. State officials have defended their oversight and gone to court to challenge the decision.

Vice President JD Vance, who chairs Trump’s Task Force to Eliminate Fraud, and other administration officials announced the state deferrals at the White House, giving what traditionally would have been technical disputes between state and federal health officials a much higher political profile. Vance’s office did not respond to KFF Health News questions about the administration’s anti-fraud activities related to healthcare.

“I’ve never seen anything like this,” said Andy Schneider, a Georgetown University research professor and a senior adviser at CMS during the Obama administration. “It’s a deferral, not a finding of fraud. This is being elevated by political decision-makers.”

Republican candidates have pounced on the investigations and allegations. In Minnesota, Republican gubernatorial candidate Lisa Demuth, who is speaker of the Minnesota House, released a September ad claiming that her Democratic opponent, U.S. Sen. Amy Klobuchar, “has never done anything to stop the fraud here in Minnesota.” Klobuchar has said that as governor she would “launch a top-to-bottom audit of state government to root out fraud.”

In New York, Attorney General Letitia James, a Democrat whose office runs the Medicaid fraud unit, criticized the decision to withhold funds and said weakening the operation would benefit criminals. Her Republican challenger in the November election, Saritha Komatireddy, has cited the Trump administration’s claims during her campaign, telling Fox News Digital that James is “totally failing to prosecute Medicaid fraud.”

The administration says its actions are necessary because fraud diverts taxpayer money from people who legitimately qualify for government programs.

“The fraud doesn’t just steal money — it steals our trust,” Oz said in August on CBS’ Face the Nation.

Democrats and healthcare advocates say the White House’s anti-fraud crusade is being used by Republicans to distract from criticisms over its sweeping funding cuts to Medicaid, the ACA, and other federal health programs.

Republican-backed legislation enacted last year is projected to reduce federal Medicaid spending by hundreds of billions of dollars over a decade.

Congressional Republicans also declined to extend enhanced ACA premium subsidies that expired at the end of 2025, increasing premium costs for many people who buy insurance through the marketplaces. Enrollment has since declined by millions.

Overall, the combined effect of GOP-led changes will result in 16 million more uninsured people by 2034, according to an analysis by the Congressional Budget Office.

Those changes have given Democrats an opening to campaign on protecting healthcare coverage and affordability while Republicans seek to shift some of the debate toward fraud and government spending.

“It’s really a way to distract and reframe the cuts in a different way, to say it’s part of an anti-fraud effort,” said Anthony Wright, executive director of Families USA, an advocacy group focused on expanding health coverage. “Fighting fraud shouldn’t result in people losing coverage.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

The Wisconsin Department of Natural Resources and a group of environmental organizations announced a settlement agreement Monday that would require stricter environmental impact assessments of future data center developments and initiate a statewide review of how data centers use the state’s resources. 

In June, the Sierra Club and Midwest Environmental Advocates sued the DNR in Ozaukee County court, arguing that the agency approved the permits for Vantage’s massive data center currently under construction in Port Washington without conducting a proper environmental impact statement. 

“AI data centers are massive, thirsty, energy hogs and have popped up all over Wisconsin,” Elizabeth Ward, director of the Wisconsin chapter of the Sierra Club, said in a statement. “They could completely change our landscape and use unprecedented amounts of water and energy. Wisconsinites and our regulators need to understand the impacts and opportunities to reduce harm before allowing data centers to move forward. Wisconsinites deserve an informed, transparent process for decisions that could shape their communities and environment for decades.

A report this summer by the state Public Service Commission found that the Port Washington data center and data centers being built by Microsoft in Mount Pleasant and Meta in Beaver Dam are set to be responsible for a 40% increase in statewide energy demand over the next six years. 

As part of the settlement agreement in the lawsuit, the DNR will conduct full environmental impact statements of individual data center proposals moving forward and complete a statewide strategic analysis of how data centers consume resources. 

State law and the DNR’s administrative rules allow the agency to conduct such an analysis when conflicts arise over resource demands for a  “complicated or complex issue; an issue that is new to the state; an issue or policy that will likely lead to future department actions that will require an environmental impact statement; issues for which there is a high potential for legislation or new department policy and the planning and development of controversial resource-oriented projects.”

“What started as a lawsuit over the environmental review of one data center has become an opportunity to address the data center issue on a much bigger scale,” MEA attorney Michael Greif said. “Looking at these impacts holistically is important because the impacts of data centers are statewide. State regulators will now have to examine the cumulative impacts of data center development across Wisconsin.”

Wisconsin will become one of a few states assessing the statewide impacts of data centers on their resources. In July, New York Gov. Kathy Hochul signed an executive order that initiated a similar analysis and last December, the Maryland Legislature enacted a law that requires a number of state agencies to study “the likely environmental, energy, and economic impacts of data center development.”

A perfect storm of harsh immigration enforcement, aging journeymen and a building boom for data centers is wreaking havoc on the nation’s supply of skilled trade workers. 

Automakers and construction contractors say they need more access to workers through accelerated training, steady immigration and a cultural shift to encourage young people to do the hard, dirty work of skilled trades. They’re looking for plumbers, electricians, carpenters, machinists and technicians — specializations increasingly in short supply. 

Worker shortages are the top reason for construction project delays, a September survey by the Association of General Contractors of America found. Applicants are there, but half of the contractors who were surveyed said too many job candidates are unqualified and need more training. 

The association cited both the demand for workers building data centers and tougher immigration enforcement as contributing causes for the shortage.  

“Over 50% of craft workers are born outside the United States. We don’t know that they’re illegal but frankly DHS (the Department of Homeland Security) is not being that discriminating in whom they pick up or who feels threatened by them,” said Ken Simonson, the chief economist for the Association of General Contractors of America. One answer is for the government to allow more worker visas for construction and other trades, he said. 

“We’ve been stymied for 20 years or longer trying to get construction treated similarly to agriculture, where if you can demonstrate that there isn’t enough Americans interested in a job you can bring in somebody,” Simonson said. 

Pay is rising for the skilled trades, but it’s hard to say how soon higher wages would attract more people. On social media, trades workers complain of long commutes to work sites, long waits through low-paid apprenticeships and a feeling they’re not valued as much as office workers.

“Getting up at 4am-5am. Driving 50 plus miles to random job sites. Obviously the dirty part which is construction sites and inhaling dust and dirt all day. Seeing people in corporate jobs in nice clothes while I’m dirty going on lunch break,” wrote a 30-year-old on a Reddit social media post in July, concluding that they should have finished a college chemistry degree.

Thousands agreed, including a 31-year-old tradesperson from Michigan who said top pay in their field, plumbing and HVAC, is attractive but that many make less than $70,000. 

“Been in the trades since I was 16 and recently started going back to college,” the person wrote. “Everybody I know who chose a degree over an apprenticeship is starting to outpace me in life buying houses and having kids while we’re check to check and getting less healthy by the day. “

These are the concerns employers have to address if they’re going to find enough workers to build homes, cars and data centers for artificial intelligence. Ford Motor Company and the Ad Council announced a publicity campaign to bring more young people into the trades, with a video declaring “millions of skilled trade jobs are waiting for people ready to do something, with great pay, job security and work you can take pride in.” 

Ford and the alliance didn’t mention immigration enforcement as an issue, but the Association of General Contractors and an unrelated survey of roofers both mentioned it as a prominent factor in reducing the supply of skilled workers. 

John Burns Research and Consulting, an independent housing research company, reported that many of the roofers it surveyed earlier this year saw immigration enforcement as hurting their business. 

“There are no American kids willing to install roofs in Central Texas,” said one roofing contractor in anonymous quotes published by the group. 

“Tough immigration reform and not enough Americans to fill the void,” said another. 

“A lot of these people have been deported. The next generation is complacent and does not want to do physical work,” said a Florida roofer. 

Elizabeth LaJeunesse, vice president of building products research at John Burns, said the vehemence of responses about immigration was surprising. 

“Most of these firms are pretty conservative, so this is a real phenomenon we’re picking up on, that level of concern over immigration enforcement,” LaJeunesse said.

Duane Musser, vice president for government relations for the National Roofing Contractors Association, said the responses are typical of what he hears from members. Immigration as well as better trade education are critical to roofing, he said. 

“Advocating for solutions to workforce shortages, including expanded career and technical education programs and bipartisan immigration reform, is a top priority,” Musser said. 

The DHS told Stateline in an unattributed statement that “those who are here legally and are not breaking other laws have nothing to fear” and that “we will continue to enforce our nation’s laws and remove illegal aliens from American communities.” 

In September a Trump-appointed federal judge stayed a federal practice of entering construction sites without a warrant to investigate immigration status. One construction worker of Mexican descent in Alabama complained that he had been detained three times since 2025 despite showing a state driver’s license demonstrating that he was a citizen born in Florida. 

Immigrant workers make up a majority of roofers, painters and stucco masons, according to a Stateline analysis last year.  

The nation will need 1.7 million new skilled trade workers every year through 2035, according to a September report by Alliance for America’s Skilled Trades, a trade group including Ford Motor Company, toolmakers and other businesses. Training programs produce just more than half the numbers needed, and only half of those who enroll in skilled training programs finish, the report found.  

Nine states were identified by the alliance report as having high demand but low supply of skilled labor: Arizona, Colorado, Delaware, Florida, Georgia, New Jersey, North Carolina, South Carolina and Texas. 

Florida ranks first for demand for skilled workers, but nearly last for supply, higher only than Maine. Not enough new Florida workers are coming online as building in the state booms and current workers near retirement age. The state’s Association of General Contractors’ chapter hopes the advancements in workforce AI will drive more young adults into construction jobs since those can’t be replaced by chatbots.

Other states have the opposite issue: ranking high for new workers but low in demand for them, based on recent hiring and future projections. 

In the top 10 for worker supply but bottom 10 for demand: Indiana, North Dakota, Oklahoma and Wyoming. 

The alliance report suggested employers themselves need to help train future workers. The companies building data centers, in particular, want those tradespeople.

“America needs hundreds of thousands of electricians, welders and fiber technicians to build AI infrastructure,” said Dina Powell McCormick, president and vice chairman of Meta, in a statement, adding that the alliance is “paying for the training, removing the barriers that keep people from stepping into these careers, and guaranteeing a job at the end of it.”

Shoua Thao, 40,  is straddling the line between trades and AI as a machinist in the computer-assisted manufacturing business known as CNC machining, which uses computer code to control production. The son of Hmong refugees in the Twin Cities area of Minnesota, Thao is now experimenting with AI production techniques. 

“Trades are the one career path that doesn’t lie,” he said. “You can’t hide lower skills in a trade, whereas middle management and white collar jobs are protected by the vagueness of the job.”

Eventually trades could become a more valued career path than college, Thao said, though he has been discouraged at times by low pay and long hours that take time away from family.

“I think it will be a slow process but eventually, sometime in the future, maybe my children’s future, trades will take over,” Thao said. 

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.