ELLEN ALLEN paid $1,967 a month for health insurance from January through August, drawing on retirement savings after enhanced federal subsidies for Affordable Care Act plans expired. Now 65 and enrolled in traditional Medicare, the West Virginia health-care advocate has received a $500 check from the Trump administration — and expects another, smaller payment tied to Medicare. Allen, executive director of West Virginians for Affordable Health Care, said the $500 check arrived with a letter from President Donald Trump. She called the payments a “political stunt” and said they do not match the year-round strain of medical expenses. “People are hurting. People are feeling the cost of healthcare all year long,” Allen said. She plans to deposit the check into her health savings account, but said the administration should focus on making coverage affordable rather than sending occasional payments. The $500 payments went to some people in the 30 states that use the federal HealthCare.gov marketplace and earn too much to qualify for subsidies — including people who were exposed to higher premiums after Congress did not extend the enhanced assistance. The administration has also announced $90 payments for about 20 million Medicare beneficiaries enrolled in Part B; people with Medicare Advantage coverage will not receive those checks. The payments are arriving weeks before the November midterm elections. The accompanying letter promotes Trump’s health policies and criticizes the Biden administration, prompting Kathleen Clark, a legal and governmental ethics professor at Washington University in St. Louis, to question whether the mailing amounts to electioneering. Clark said the effort could violate the Hatch Act, which restricts the use of federal resources to influence partisan elections, and may involve spending that Congress did not authorize. The $500 payments come from fees insurers paid to participate in the federal marketplace; the Medicare checks are funded through a general improvement fund. Neither fund had previously been used for direct payments to enrollees, according to the reporting. The White House did not directly address questions about electioneering or the legality of the payments. Spokeswoman Allison Schuster said in an email that Americans had been “overcharged” for the Obamacare exchange and that Trump was returning their money. The checks also do not represent a broader change in how health coverage is financed, said Joseph Antos, a senior fellow emeritus at the conservative American Enterprise Institute. The money is not restricted to health expenses, and many people — including lower-income workers with employer-sponsored insurance — will receive nothing, he noted. A KFF poll released Tuesday found that health-care costs are a major concern for voters ahead of the election. Forty-two percent said they trust Democrats to handle health care, compared with 22% who said they trust Republicans, a 20-point difference. KFF survey methodology director Ashley Kirzinger said Democrats’ advantage among independent voters could matter in the midterms. Allen, who has a serious eye condition requiring costly medication, had previously urged Congress to extend the enhanced ACA subsidies. After turning 65, she enrolled in Medicare as soon as she was eligible. She said she will keep the $500 but continue advocating for broader access to affordable care.