With the midterms counting down and Republican approval trending downward, President Donald Trump is pursuing unconventional tactics to rally support for the GOP. Last week, Trump disbursed $90 payments to more than 20 million Americans enrolled in Medicare Part B—which covers doctor visits and routine health checks. The funds were described as aid to help seniors cover their Medicare Part B premiums, which amount to $202 per month.
In a Truth Social post, Trump asserted that the money originates from a meaningless ‘Slush Fund’ known as the Medicare Improvement Fund, a characterization that, while dramatic, aligns with how lawmakers have utilized the account.
The fund was established in 2008 “to improve program management” of Medicare. However, as a 2023 report from the Congressional Budget Office (CBO) observes, this fund has largely served a single purpose far beyond supporting Medicare: covert government accounting.
As the CBO noted, “No funds have been spent by [Centers for Medicare & Medicaid Services] from either improvement fund since their establishment in 2008.” Rather than financing Medicare programs, Congresses have filled the fund with money slated for use far in the future, then diverted that money to other legislation. Under CBO accounting rules, canceling or redirecting future spending counts as a “credit” to the bill’s total cost—a convenient tactic for lawmakers who want to present their initiatives as affordable. This maneuver helped finance nearly $21 billion of the Affordable Care Act and has been used for a variety of legislation since.
While Trump contends that the disbursement is necessary to assist enrollees with premiums, the timing—weeks before the midterms—and his record of using taxpayer funds to win over senior citizens raise doubts about the claim. In the One Big Beautiful Bill Act, for example, seniors were given a $6,000 tax deduction. Trump has also consistently defended entitlement programs for seniors such as Social Security and Medicare, which are both facing funding challenges in the near future. Trump diverting public money to mobilize voters has not been limited to seniors either. Last month he pledged to hand out $5,000 checks to all Americans—contingent upon Republican victory in the midterms.
Despite grumbling from some Democrats about Trump’s decision to tap the Medicare Improvement Fund, the move seems unlikely to undermine Medicare’s ability to provide services. The larger concern is that the president is using his office to issue personally signed checks to voters just weeks before an election. Pre-election vote grabbing through irresponsible spending is not unprecedented, but it has rarely been so emblematic.
The fiscal implications of Trump’s unorthodox spending are also worrisome. Medicare is already teetering toward insolvency, and entitlement spending continues to balloon. Neither Congress’s devious accounting nor Trump’s vote-buying will resolve these problems. Without raising taxes or reducing benefits, these programs cannot continue in their current form.
Yet raising taxes or cutting benefits is no winning strategy for an election. Trump recognizes this and appears ready to sacrifice the nation’s fiscal stability for a short-term polling boost.
