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.

WASHINGTON — President Donald Trump this week will journey out West in an effort to galvanize support for Republican candidates three weeks before the midterm elections and convince voters to support his party amid low presidential approval ratings.

As the deeply unpopular war in Iran enters month eight, resulting in spiking prices at the gas pump and skyrocketing fertilizer prices for the agriculture industry, Trump is scheduled to rally in Alaska on Tuesday and Arizona and Montana on Wednesday, following stops earlier this month in GOP-friendly states that kicked off the last weeks before the election. On Friday, Trump is expected to campaign in Georgia.

Presidents typically sustain electoral losses in midterm election years and in addition, Trump’s approval rating is currently hovering around 37% percent, according to an analysis by The New York Times.

Those low approval rates, and polls, have shifted several Senate races to toss-ups. 

The Cook Political Report with Amy Walter rates Alaska, Iowa, Kansas, Maine, Michigan, Ohio and Texas as toss-up Senate races. Republicans are not only trying to maintain the House, but their 53-seat majority in the Senate as well. 

The president’s travel also follows a federal judge’s ruling over the weekend that ordered the Trump administration to stop airing ads funded by taxpayer dollars that portrayed Trump in a favorable manner. Trump used about $20 million in Department of Homeland Security funds to pay for the ads. 

Trump’s comes after a campaign rally in Tennessee over the weekend. During his remarks in Clarksville, he focused on accusing Democrats of being communists and socialists. 

On Monday, Trump is heading to Youngstown, Ohio to deliver remarks. GOP Sen. Jon Husted, who was appointed to fill out the term of Vice President JD Vance, is in a tight race against former Ohio Democratic Sen. Sherrod Brown. 

Trump is not only in Ohio to support Husted, but also to throw his support behind gubernatorial candidate Vivek Ramaswamy, who is up against Democrat Amy Acton.

Vance is also hitting the campaign trail this week. On Wednesday, he’ll visit Georgia and on Thursday will make another stop in Michigan. 

Trump is also likely to bring up in his campaign rallies Monday’s joint Department of Justice and Homeland Security Investigations raid of Minnesota Democratic Rep. Ilhan Omar’s house in Washington, D.C. It’s a rare move from the Justice Department only several weeks out from the election, given the department generally doesn’t conduct such raids unless in extreme circumstances. 

She, along with the broader Somali community in Minnesota, are regularly targeted by the president and disproportionately accused of widespread fraud. Recently, the president used violent rhetoric in a social media post that called on Minnesotans to “fight back” against Somali immigrants.

The president directed DHS to Minneapolis, where there is a large Latino and Somali refugee population. A months-long aggressive deportation drive there resulted in then-Homeland Security Secretary Kristi Noem stepping down from her position after federal immigration officials shot and killed two U.S. citizens, Alex Pretti and Renee Good.

President Donald Trump is scheduled to kick off a month-long blitz of campaign stops with a Thursday rally in deep-red Oklahoma before heading to other states with strong Republican leanings.

The first events in the closing stretch of the midterm election campaign suggest his strength with swing voters is limited, as even some Republican candidates seek distance, political analysts said. 

Trump’s low approval ratings amid growing consumer costs, spiraling gas prices and an unpopular war in Iran have put U.S. Senate races in typically GOP-leaning states like Alaska and Iowa in play.

After the Oklahoma rally, the president will travel to Alabama and Ohio through the weekend. On Monday, he will be in Nebraska.

He has vowed he would make another stop in Texas soon as part of 32 days of travel before the Nov. 3 elections that will determine control of Congress. 

Vice President JD Vance also rallied voters in Texas on Wednesday before a planned event in Florida on Thursday.

The red-state itinerary makes it appear Trump will be used to rally the base, rather than attempt to win over voters who switch preferences from one election to another, said Chandler James, a political science professor at the University of Oregon. 

“These are places where Trump has the most support that he’s retained, and probably has the most influence,” he said. “Trump still has a lot of sway within the Republican Party, and he has a pretty sizable political base, many of whom don’t traditionally show up for elections besides when Trump is on the ballot.”

In more traditionally contested states, such as North Carolina, Michigan or New Hampshire, the median voter may be further to the left and have a lower opinion of Trump, James said. 

“He can still help, but he has to do so in different ways,” Christopher Stout, a political science professor at Oregon State University, said. “Going to places where you might be able to recruit supporters rather than places where it’d be easy for Democrats to say, ‘Look how closely this candidate is tied to a president whose popularity is pretty low.’”

Trump’s approval rating was hovering Wednesday near 37%, with 60% disapproving, according to The New York Times polling average.

‘They all want me’

Trump told reporters Tuesday he was strongly in demand for campaign appearances.

“I’m one person. They all want me to go campaign,” he said. “In about two days, I’m starting a literally 32-day tour. … I’m going to Texas. I’m going to Ohio. I’m going to all different places.”

Candidates from a president’s party typically face strong headwinds in midterm elections, a phenomenon that is likely to be especially true this year as Trump faces historically low approval ratings, James said. 

Republicans could minimize that disadvantage, while still appealing to Trump’s supporters, by keeping him focused on redder states and districts.

The base-focused strategy could also help recruit volunteers who can work across state lines or raise money, Stout said.

Texting and other technology allows volunteers to be active remotely, meaning that volunteers fired up in Oklahoma or Alabama could be helping mobilize Republican voters in Georgia or Iowa.

No longer a change agent

But there are indications Trump’s support is cracking even in red areas.

U.S. Rep. Maria Elvira Salazar, a Republican from Florida, released a campaign ad in September in which she said Trump’s immigration policy had “gone too far.” 

Iowa U.S. Rep. Ashley Hinson, a Republican nominee for U.S. Senate, criticized the Iran war in a social media post last week.

The Cook Political Report with Amy Walter in late September moved Salazar’s race to “lean Republican,” a shift signaling a more competitive race. The open Senate seat in Iowa is rated as a tossup, although the state’s entire congressional delegation is currently Republican.

Even Ken Paxton, the far-right Texas attorney general who is running for U.S. Senate, privately groused that Trump’s two-night midterm convention in his state hurt his polling in the close race against Democrat James Talarico, according to leaked audio obtained by The New York Times. 

Paxton, a polarizing figure who defeated the more moderate incumbent Sen. John Cornyn in the GOP primary this year, also faces a tossup race against Talarico, even though the last Democrat to win a Senate seat in the reliably Republican state resigned to run for vice president in 1988.

Part of the challenge for Republicans is that swing voters in recent elections are looking for change, Stout said. That has helped Trump in the elections he ran while not in office, but that advantage has evaporated.

“A lot of those swing voters, many of them just want change,” Stout said. “They want things to be different. So in 2016 and in 2024, he represented that change. In 2026, he represents the status quo. And so if people want change, he’s not the person you want there.”

President Donald Trump’s escalating trade war with Canada is creating headaches for Republicans ahead of November’s midterms as high prices remain a top concern among voters.

Responding to Trump’s increased tariffs, Canadian officials have said they’re deliberately targeting goods from states where there are close elections. And GOP candidates in Kansas, Maine and Ohio among others have been forced to balance supporting Trump with defending local manufacturers.

Trump has repeatedly targeted Canada, traditionally a close American ally, since returning to the White House last year. But his August move to impose 50% tariffs on billions of dollars of Canadian imports has heightened tensions, pushing Canada to retaliate with its own tariffs on hundreds of American-made products that went into effect Tuesday.

Nearly $28 billion in U.S. exports to Canada now carry up to 50% tariffs, a dollar-for-dollar match on Trump’s taxes on Canadian goods imposed last month, according to Canadian officials. 

Trump has long argued that Canada is taking advantage of the United States because of a longstanding trade deficit — meaning more Canadian products are imported here than American products are exported to Canada.

“They don’t pay for anything, and they want to be treated like a state, but they’re not a state,” Trump said last month after trade talks fell apart.

The fallout could affect consumers and businesses across the country, but Canada targeted many of its tariffs to inflict political pain just ahead of the crucial U.S. midterm elections that will determine control of Congress. 

The trade standoff has put Republican candidates in a tough position with an electorate already fed up with high prices and underscores ongoing concerns about how federal trade policy will affect American business and state economies.

On Labor Day, Trump threatened to halt sales of the Canadian airplane manufacturer Bombardier, saying its planes weren’t good enough and the company was treating America as a “piggybank.”

That became immediate political fodder in Kansas, home to Bombardier’s U.S. headquarters and competitive races for governor and U.S. Senate this year. The company employs more than 1,000 people in Wichita, the state’s most populous city that calls itself the “Air Capital of the World” with a local economy dominated by aerospace and aviation manufacturing. 

Trump’s trade war with Canada escalates as new tariffs launch

The state’s senior Republican U.S. Sen. Jerry Moran immediately defended Bombardier, as did Ty Masterson, the Republican nominee for governor and current state Senate president. But the issue has put pressure on the state’s junior Sen. Roger Marshall, a close Trump ally running for reelection in a competitive race. 

“We cannot allow this chaotic economic policy to continue to hurt Kansans; they deserve so much better. As your Senator, I will always stand up for Kansas workers,” the Democratic nominee in the race, Adam Hamilton, wrote on X Monday. 

On Tuesday, Marshall said he would fight to keep Bombardier’s jobs in Kansas, posting on social media, “I’ve already taken that concern inside the Oval Office.” Marshall said he agreed with Trump’s aim of bringing more manufacturing jobs, particularly in Bombardier’s case because the company sells half its products in the United States.

Tariffs on Canadian and American goods are poised to especially hurt Northern and Midwestern states, according to an analysis from Oxford Economics. It identified North Dakota, Montana, Michigan, Illinois and Vermont as the states most likely to be affected because they trade the most with Canada. 

Minnesota State Auditor Julie Blaha, a Democrat, said the trade feud is just the latest federal move to push up costs for businesses, consumers and local governments. Her office oversees some $56 billion in local government spending through financial integrity audits and budget analyses. She said Minnesota cities and townships have had no choice but to raise property taxes as they encounter rising prices.

“It’s just one wave after another. And it’s piling up,” she said. “All these rising costs are just coming home to roost, and they’re hitting Main Street.”

Minnesota shares a 547-mile border with Canada. Blaha said the state’s crucial agricultural industry is especially threatened as businesses constantly send products back and forth for processing. She highlighted General Mills, the maker of well-known cereals, including Cheerios. The firm buys Canadian grain that is processed in Minneapolis before being distributed to domestic cereal plants and sold across the U.S. and Canada. 

Grain is not on Canada’s list of targeted products for retaliatory tariffs, but the country did enact new tariffs on agricultural equipment, dairy and other food products. 

“These tariffs have a bigger impact than just one just one hit on a price,” she said. 

Canada’s political pressure

Canada’s retaliatory tariffs were aimed at pressuring the White House by targeting certain states and industries.

“We’re being wise and strategic to put political pressure,” Canada’s Industry Minister Mélanie Joly said last week. 

Canadian data show countermeasures will hit Ohio harder than any other state, the Canadian Broadcasting Corporation reported. Ohio is home to one of the most competitive Senate races this cycle as Republican Sen. Jon Husted defends his seat from former Democratic Sen. Sherrod Brown. 

Husted has largely defended Trump’s tariffs in the Senate. In an August interview with MS Now, he acknowledged the president’s decision-making was not in line with how he would negotiate, but declined to second guess Trump’s stance on Canada. 

Canadian tariffs to further raise prices, a top concern for voters

“It depends on how it ends,” the senator said. “If we get a good deal, both Canada and America can come out of this well, but it’s going to require both sides.”

Canada is Ohio’s biggest export market, sending $17.5 billion in goods across the border — roughly a third of the state’s total exports. More than half of the state’s exports to Canada come from the equipment and machinery and the transportation industries. Ohio is a leading producer of automobiles, an industry deeply affected by tariffs because of interconnected supply chains that span American, Canadian and Mexican factories. 

Trump’s tariff “decision is going to make it very difficult for folks in the automobile supply chain to be able to succeed in Ohio,” Rob Moore, principal at public policy firm Scioto Analysis, told the Ohio Capital Journal.

While Canada’s countermeasures were politically targeted, they will sweep across the country, affecting solidly conservative and liberal states. 

Connecticut State Treasurer Erick Russell, a Democrat, said the trade war will especially hurt New England states that trade more with Canada. He said the tariffs could raise prices of everything from electricity to consumer goods. 

Though tariffs will hit businesses and consumers first, Russell said they will eventually put more strain on local and state government budgets.

And the president’s on-and-off-again history with imposing and rescinding tariffs injects more uncertainty for both business and government, he said.

“Where things are right now, there isn’t any certainty or clarity around where this is ultimately going to land,” he said. “What is consistent through all of this is that consumers in Connecticut and all across the country are going to continue to pay for this tariff war.”

Concerns across New England states

The trade standoff could further hurt New England’s tourism industry that depends on steady Canadian traffic. 

In New Hampshire, Maine and Vermont, tourism is big business year-round as travelers flock to beaches in the summer, leaf peeping in the autumn and skiing in the winter. Those businesses have suffered a drop in Canadian visitors amid Trump’s ongoing aggression with the country.

Steve Wright, general manager of Jay Peak Resort in Vermont’s Green Mountains, recently assured Canadians that they were welcome to the resort that sits just a few miles from the border and a roughly two-hour drive from Montreal.

“The border may feel different right now,” Wright wrote online. “We do not. You are our neighbors. You are our friends. You are part of this place.” 

Vermont Republican Gov. Phil Scott recently characterized the president’s executive order to rename Lake Ontario to Lake America as “petty and disappointing.” Scott, who is favored in polls to win reelection in November, said the trade war harms communities on both sides of the border.

“Further escalating tensions does nothing to help American or Canadian families and businesses,” he added. 

In neighboring Maine, U.S. Sen. Susan Collins has criticized the tariffs and urged the administration to resolve its dispute with Canada. A Republican in a competitive race for reelection, Collins grew up just 20 miles from the Canadian border. 

Troy Jackson, her Democratic opponent, has blamed Collins for not stopping Trump’s trade policies. 

Last week, Collins told reporters that the White House viewed tariffs in a macro sense without appreciating how damaging they are to border states such as Maine. Collins said Trump’s tariffs were already hurting local governments that rely on Canada for imported salt to treat roads in winter and could further hurt the state’s crucial lumber and blueberry industries.

While Maine’s important lobster industry was spared retaliatory tariffs, Canada did impose 50% tariffs on wood products and agricultural products. 

“Canada is not China. It is not an adversarial nation,” Collins said. “It is our closest ally, our neighbor, our friend. And our economy is so intertwined with Canada that I am very worried about what the impact will be.”

Stateline reporter Kevin Hardy can be reached at khardy@stateline.org.