In the weeks before a midterm election shaped by economic anxiety, the Trump administration announced $500 payments to nearly one million Americans enrolled in ACA health plans across 30 states — framing the disbursements as refunds for fees it says were improperly passed on to consumers during the Biden years. The gesture speaks to a genuine hardship: millions of middle-income households have faced sharply higher premiums since enhanced subsidies expired, with some abandoning coverage altogether. Yet the payments will reach only about 5% of those enrolled in ACA exchanges, raising the older q