In several congressional races, Republican ads are claiming that Democratic candidates support “sex changes” for children or support taxpayer money being used for such surgeries. But the allegations of support for those claims are flawed.

Some of the ads cite politicians’ votes against measures that went beyond prohibiting surgeries. Also, it’s worth noting that gender-affirming surgeries typically take place after age 18, according to experts and studies on the prevalence of gender-affirming care, as we’ve reported before.

Republican politicians and outside groups are spending millions on TV, streaming and digital ads pushing these claims. Our search of AdImpact’s ad-tracking database identified more than $100 million in spending on more than 200 ads since Aug. 1 that contain the words “sex change.” In federal Senate races alone, the spending totaled more than $77 million.

We’ll look at ads in three toss-up Senate races:

• In Ohio, ads from the Senate Leadership Fund, a super PAC connected to the Republican Senate majority leader, say that Democrat Sherrod Brown “supports sex changes for minors,” citing a 2023 TV interview in which Brown said that “a child’s health care decisions are between them, their parents, their families, their doctors — not politicians.” One ad, featuring a woman who is suing her medical providers in Texas, leaves the false impression that she had surgery as a minor without her parents’ consent.

• In Texas, ads from an SLF-associated group, Texas PAC, say that Democrat James Talarico “supported using taxpayer dollars for sex change surgeries on young children.” The ads cite his vote against state legislation that went beyond that, broadly prohibiting gender-affirming care for kids. Talarico, a state representative, voted for an amendment that would have restricted the bill to banning surgeries.

• In Alaska, ads from No Going Back PAC Inc., which is linked to the MAGA Inc. super PAC, claims that Democrat Mary Peltola “voted against prohibiting taxpayer funded sex changes for minors,” citing her votes on amendments that pertained to gender-affirming medications or surgeries. In another vote cited by the PAC, Peltola, a former U.S. representative, voted against a defense spending bill because of an amendment that would have limited abortion access for military personnel.

These ads are a continuation of Republican messaging during the 2024 presidential campaign and reflect President Donald Trump’s repeated claims that Democrats want “transgender for everybody.” Some of the messages being pushed in the midterms suggest that surgeries are performed on children, even young children, without parental consent. “The law generally requires the consent of a parent before medical care can be provided to a minor,” according to the National Center for Youth Law. There are exceptions, such as state laws allowing minors to consent to emergency care and care for certain services, including abortion, contraception and substance use care.

People who are transgender — meaning they identify with a gender that doesn’t match the sex they were assigned at birth — make up a small percentage of the U.S. population. A 2025 report by the University of California, Los Angeles School of Law’s Williams Institute estimated that more than 2.8 million people in the U.S. age 13 and older identify as transgender. That’s 0.8% of adults and 3.3% of youth ages 13 to 17.

We’ll look at ads in three Senate races in which the Democrats are hoping to flip the Republican seats.

Ohio Ads

Several ads attacking Brown in the Senate race in Ohio claim that he supported “taxpayer-funded sex changes” on children, citing an interview he did with WSYX-TV in Columbus on July 19, 2023.

Brown didn’t say he supported that. Rather, he was asked about a broader federal bill, introduced by then Sen. JD Vance, that aimed to “prohibit gender-affirming care on minors,” defined as both surgeries and medication, including hormones and puberty-blocking drugs. The bill called for fines and/or prison time for anyone prescribing or administering such care. It also aimed to prohibit federal funding being used for any gender-affirming care.

In a 21-second clip of that interview, posted online by the Senate Leadership Fund, Brown says: “A child’s health care decisions are between them, their parents, their families, their doctors — not politicians. I will never agree with anybody that wants to bring politics into the family situation with health care, period.”

Vance’s bill never received a vote.

In 2024, SLF PAC made similar claims about Brown and also pointed PolitiFact to a March 2023 letter nine Democratic senators, including Brown, sent to then President Joe Biden. But that doesn’t show Brown necessarily supporting “sex-change surgeries for minors” either. Instead, the senators expressed concern about discrimination against LGBTQ+ individuals and state laws blocking gender-affirming care for youth and adults. As we’ve explained, gender-affirming care encompasses counseling, social transitioning and medication — in addition to surgery.

Two SLF PAC ads feature Soren Aldaco, who is suing her medical providers over the “top surgery,” or double mastectomy, she had at age 19 in Texas. One ad leaves the false impression that Aldaco had surgery as a minor without her parents’ consent. She was an adult at the time.

Aldaco, who has said she was “gaslit” into receiving gender-affirming care, says in the ad: “Sherrod Brown supports sex changes for minors, irreversible surgery on kids. Like me. At 11, I was groomed by strangers online. At 15, a doctor told my family I was transgender. Hormone injections, then surgery without my parents’ consent. I was a kid. I was confused.”

We asked SLF PAC about the ad’s suggestion that Aldaco wasn’t an adult when she had surgery. Communications Director Chris Gustafson pointed us to information about when Aldaco received medication, not surgery. He pointed to Aldaco’s February commentary piece in the Wall Street Journal, in which Aldaco said a nurse practitioner prescribed testosterone and estrogen blockers when she was 17. Also, in an interview with Fox News, Aldaco said her stepmother took her to that appointment, but the nurse practitioner should’ve gotten consent from her biological mother.

In the ad, Aldaco says, “Ohio’s kids deserve better.” But gender-affirming care, defined as both medication and surgery, for minors is illegal in the state. The law, with exceptions for children with sex development disorders, was enacted in 2024, after the Ohio Legislature overrode Republican Gov. Mike DeWine’s veto. The state Supreme Court is considering a lawsuit challenging the legislation.

In vetoing the bill, DeWine said, “These are gut-wrenching decisions that should be made by parents and should be informed by teams of doctors who are advising them,” while noting that he was against surgeries before age 18. Among the families he spoke to before deciding to veto the bill, “none of them … talked about surgeries,” DeWine said. “I think that’s frankly a fallacy that’s out there that it goes right to surgery. It just doesn’t. All of the children’s hospitals say, we don’t do surgeries.” (See the 17:45 mark of the video.)

One response ad from the Brown campaign makes the point that these surgeries are illegal in Ohio for kids. A second response ad shows an image from the Aldaco ads and says they’re “a complete lie. Records show not only is this woman actually from Texas, she didn’t have any surgery as a minor.”

(The ad goes on to misleadingly say that Brown’s opponent in the Senate race, Republican Sen. Jon Husted, voted to block the released of the Epstein files, a claim we’ve written about before.)

Texas Ads

In the Senate race in Texas, an ad from Texas PAC, which is affiliated with SLF PAC, says, “Talarico supported using taxpayer dollars for sex change surgeries on young children.” It, as well as other ads making such a claim, cites Talarico’s vote against a 2023 state law that, like the law in Ohio, prohibits gender-affirming medications and surgeries for minors and using state money for it. In Texas’ version, doctors could lose their medical licenses if they violate the law. The state Supreme Court upheld it in 2024.

The ad above includes “puberty blockers” on screen, but the narrator only says that Talarico supported “sex change surgeries.” Another ad by the same group says he “supported using taxpayer dollars for sex change surgeries on kids.”

JT Ennis, press secretary for Talarico’s campaign, told us: “These ads are lies. As James has said, he opposes gender reassignment surgery for minors.”

Talarico said that in June in a podcast interview.

In September, Talarico told Fox News that he opposed the 2023 Texas legislation because it was “overly broad” and that at the time he “voted for a major amendment to limit the bill to banning surgeries for minors.” He did vote in favor of such an amendment, which failed. He also told Fox News that he would “absolutely” support a national prohibition on gender-affirming surgery for minors.

In 2023, Talarico said the state law “would deny, many times, life-saving healthcare from our trans youth” and that “the reason that I opposed that bill is because I trust parents and doctors to make decisions for kids and not politicians in Austin.”

The Texas law included exceptions for administering treatment for certain medical conditions, such as premature puberty or sex development disorders, but, according to the Texas Tribune, at least one family had trouble accessing such care after their physician was sued by state Attorney General Ken Paxton, Talarico’s opponent in the Senate race.

Alaska Ads

In Alaska, Peltola, a former U.S. representative for the state, is being attacked over several votes. But as in the other races, the ads misrepresent her votes. Pelota is running against incumbent Republican Sen. Dan Sullivan.

Two ads from No Going Back PAC, a super PAC linked to Trump, claim that Peltola “voted against prohibiting taxpayer funded sex changes for minors.” One ad says she did this “time and again,” citing three votes.

Two of those votes were against amendments in 2024 to prohibit gender-affirming surgeries or medication for minors under two military healthcare programs. One of those programs — TRICARE — was already “explicitly prohibited from covering gender-affirming surgical care for beneficiaries,” according to a 2023 report from the Congressional Research Service. Both amendments, which were attached to the fiscal year 2025 National Defense Authorization Act, a defense spending bill, passed.

Peltola’s campaign pointed us to statements by an advocacy group for LGBTQ+ service members, which said the amendments would hurt military readiness and retention. The campaign also noted that Peltola was one of six Democrats who ultimately voted for the final House version of the NDAA that year.

The third vote cited in the ad was in July 2023 against passage of a version of the NDAA that year. But as we explained previously, Peltola specifically criticized Republican amendments, including one that would have limited abortion access for military personnel.

“We shouldn’t be pitting pay raises that they [military members] deserve against the reproductive freedoms that they also deserve,” Peltola said in a prepared statement at the time. “That is a false choice, created for purely political reasons, and I look forward to negotiations with the Senate’s version of the bill where this issue will be discussed further. I will advocate strongly to return to the bipartisan, policy-focused bill that came out of committee, and will gladly vote for a bill that fully protects our troops and their families.”

Democrats had objected to the limitation on abortion and several other amendments that they called “poison pill riders,” including one prohibiting gender-affirming surgeries or hormones under TRICARE. Peltola didn’t mention the latter amendment in her statement.

The Senate didn’t pass the House version of the bill. Instead lawmakers negotiated a compromise defense bill that stripped out many of the Republican amendments. Peltola voted in favor of that.

In a statement, a spokesperson for Alaskans for Mary — her campaign committee — told us: “Let’s be clear: Mary does not support gender re-assignment surgeries for children, and she believes those decisions should be in the hands of parents and doctors, not DC politicians. Mary thinks both parties have spent far too long obsessing over this issue, and that’s why she’s focused on cracking down on corruption in both parties and lowering costs for Alaskans.”

In a response ad, Peltola also says: “I’m a mom, and I know that parents know what’s best for their kids. These attacks are lies. No, I don’t want kids getting surgeries to change genders.”

More Context on Gender-Affirming Care

As we’ve explained before, gender-affirming surgeries for children are rare. Before puberty, there are no medications or surgeries offered to children. Instead, families are offered counseling. Children may change their name, pronouns, or hair and dress as part of a social transition.

The American Academy of Pediatrics, the Endocrine Society and the World Professional Association for Transgender Health have published guidance recommending care at different ages. In terms of medication, puberty blockers, which delay the beginning of puberty, can be offered between ages 8 to 13 for girls and 9 to 14 for boys. Gender-affirming hormone therapy typically wouldn’t be given until around age 16.

In terms of surgery, one expert previously told us that older adolescents sometimes may be able to get surgery to remove their breasts, also known as top surgery, and may want to do this before college. But genital surgeries wouldn’t typically happen until age 18 or older. The Endocrine Society’s guidance for care specifies that surgeries involving removing the testicles, ovaries or uterus shouldn’t occur before age 18. In February, the American Society of Plastic Surgeons issued a position statement recommending that all gender-affirming surgeries be done at age 19 or later, while saying that “physicians should also use their personal and professional judgment.”

Studies have found that neither surgery nor medication is common for minors. “The politicization of gender-affirming care for transgender youth has been driven by a narrative that millions of children are using hormones and that this type of care is too freely given. Our findings reveal that is not the case,” said Landon Hughes, a fellow at the Harvard T.H. Chan School of Public Health and a co-author of studies published in JAMA journals in 2024 and 2025, on the utilization of care among transgender and gender diverse adolescents in the U.S.

In a study examining insurance claims in 2019 for tens of millions of U.S. adults and minors, Harvard researchers and colleagues found no gender-affirming surgical procedures in transgender and gender diverse minors under 12 years of age. Surgeries among older minors “were rare and almost entirely chest-related,” the study said. The rate of having a gender-affirming surgery among minors with a diagnosis of being transgender or gender diverse was 2.1 per 100,000 for ages 15 to 17 years and 0.1 per 100,000 for ages 13 to 14 years.

Another study of private insurance claims data by some of the same Harvard researchers found that, between 2018 and 2022, less than 0.1% of minors ages 8 to 17 with private insurance were transgender or gender diverse and received puberty blockers or hormones. No minor under age 12 received a hormone prescription.

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Multiple ads airing in Michigan attack Democratic Senate candidate Abdul El-Sayed for past statements he made, or positions he held, about policing and prisons. But the ads either omit context or exaggerate his past policy proposals.

El-Sayed and his campaign have said he is not pushing to “defund the police,” as the ads claim or suggest. He spoke and posted in 2020 about wanting to reallocate some police funding to other community services, but has campaigned in the 2026 midterms on investing in “recruitment and retention and retirement” for law enforcement.

In addition, he never “called for abolishing prisons,” as one ad says. The claim is based on his participation in a 2020 webinar in which he said there was a need to reduce Michigan’s prison population during and after the COVID-19 pandemic.

Another ad that claims El-Sayed has a “plan” to “commute sentences for murderers and rapists” refers to a proposal from his unsuccessful 2018 campaign for governor of Michigan. His plan was to consider commuting prison sentences for individuals convicted as minors who were “deemed low risk” or who had served more than 25 years of “lengthy or life sentences.” He has not proposed doing that during his 2026 Senate run.

The ads, all from Republican-aligned groups, began airing in late September and claim or suggest that El-Sayed, a former Detroit public health official, is “dangerous” or would not “keep us safe.” He is running for the open U.S. Senate seat in Michigan against former Republican Rep. Mike Rogers, an Army veteran who also worked for the FBI.

In the ad above, paid for by the National Republican Senatorial Committee, a woman says, “I’m raising four children, and I don’t trust Abdul El-Sayed with their safety.” She adds, “El-Sayed supported defunding our police. Then he called for abolishing prisons and releasing criminals into our neighborhoods.” That’s followed by a video of him saying in August 2020, “Any and all efforts to get people out of jails and prisons.”

That same El-Sayed clip about releasing people from jails and prisons is shown in an SLF PAC ad that includes audio of him saying in June 2020, “I believe that we do need to defund the police.” In between those two snippets, a man in a police uniform says, “El-Sayed said it himself. He wants to defund the police and let criminals out of jail early.” “Defunding the police. Releasing prisoners. That’s just crazy,” another man in police gear says.

A third ad, from No Going Back PAC Inc., a super PAC linked to President Donald Trump, plays the same audio of El-Sayed talking about defunding the police. Then the narrator says, “It gets worse. El-Sayed’s plan calls for reducing sentence length. And not just reduce. El-Sayed’s plan says he’d commute sentences for murderers and rapists, letting violent criminals free.”

We’ll explain what the ads leave out about what El-Sayed has said on the topics of funding for police and reducing the prison population.

No More ‘Defund the Police’

El-Sayed did previously embrace elements of the progressive “defund the police” movement that began after George Floyd was killed in May 2020 by a police officer in Minneapolis. The featured audio clip of El-Sayed saying “we do need to defund” law enforcement is from a June 2020 radio interview with Jake Neher for Detroit’s NPR station. (Jump to 7:45 in the recording.)

El-Sayed’s fuller statement from the interview was: “I believe that we do need to defund the police insofar as defunding the police is disinvesting in the means of incarcerating someone or killing them on the streets, and investing more in the means of educating and empowering, engaging communities.” He went on to say, “I like to talk about it as re-funding, right? I want to re-fund on the taxpayer dollars that I pay to police who use that to buy war materiel to wage war in our streets, and I want to re-fund public health and public libraries and public schools and the means of uprooting poverty.”

Earlier he said that investing more in social services, public schools and public libraries “means investing less in police.”

In July, CNN’s KFile, which reviewed El-Sayed’s past comments, said, “Throughout 2020, he repeatedly endorsed some of the movement’s goals in interviews, speeches and writings, often describing them as shifting government resources away from policing and incarceration and toward public health, education and anti-poverty programs.” The KFile analysis also found that he had deleted several of his old social media posts about defunding the police, which he later said he did because he “didn’t want them to be taken out of context.”

But while campaigning for the Senate this year, El-Sayed has talked about wanting to invest in – not defund – law enforcement.

“No, Abdul El-Sayed does not support defunding the police,” his campaign spokesperson Cole Wozniak told us in a statement. Wozniak added, “As he’s consistently said, Abdul believes we absolutely need to fund law enforcement to identify, prosecute, and protect communities from violent crime.”

In a July 2 CNN interview in which he addressed his deleted posts, El-Sayed explained his position this way: “Too often the conversation we have is fund or defund. The question that we don’t ask is, ‘What kind of system do we really want?’ I want us to be investing in the kinds of interventions that actually protect people, whether you’re talking about people on the streets or people in law enforcement. That means investing in recruitment and retirement for law enforcement. It also means investing in community violence intervention, investing in behavioral health response, investing in public health and anti-poverty measures. Those are things that are not mutually exclusive.”

And later that month, in a conversation with Politico, he said, “If we want really good law enforcement, we have to increase the amount of funds that we put into things like recruitment and retention and retirement, so that folks in local communities might want to actually work in law enforcement in their local communities.”

It’s also worth noting that the vast majority of funding for policing comes from local and state governments — not the federal government.

Not ‘Abolishing Prisons’

El-Sayed has not “called for abolishing prisons” or the blanket release of “violent criminals,” as some of the ads claim or suggest.

The clip of him saying “any and all efforts to get people out of jails and prisons” is from August 2020, when he participated in a webinar hosted by the Carceral State Project at the University of Michigan. He and the other two panelists, who were previously inmates, were discussing the Carceral State Project’s July 2020 joint report with the American Friends Service Committee, titled “‘I Don’t Want To Die in Prison’: Prison Conditions, Decarceration, and Mutual Aid in the Age of COVID-19.”

El-Sayed’s fuller comment was: “Any and all efforts to get people out of jails and prisons and to keep people out of jails and prisons is policy that we need to be investing in, particularly right now. But this doesn’t end when the pandemic’s over, right? We shouldn’t have to have a global pandemic to force us to find our humanity. This should just be what we do because it’s the right thing.”

He had been responding to a question about recommendations in the report that needed to be “enacted immediately” during the pandemic. He started his answer by agreeing with another panelist that the infirm and elderly should be considered for release from prisons because of the spread of COVID-19. But he went on to say “decarceration generally is really, really critical” because “there are so many ways that society has failed to deal with real problems and has used policing and jails as a stopgap for all of these failures.” 

As we’ve written, President Donald Trump released more than 13,000 federal prisoners during the pandemic as part of the Coronavirus Aid, Relief, and Economic Security Act that he signed in late March 2020. That legislation excluded releases for any prisoners convicted of violent crimes, sex offenses or terrorism-related crimes.

El-Sayed also made a point in the webinar about people “languishing in prison facilities who don’t need to be there” because of laws that keep them there for longer than necessary. He gave the example of people who remain in prison because they can’t afford to post bail while awaiting trial, and he mentioned the state’s “Truth in Sentencing” law that he said makes it hard to reduce minimum sentences for felony convictions.

“We’ve got to think about them all systematically,” he said.

But El-Sayed — who is against for-profit prisons — never said he favored “abolishing prisons.”

An Old Commutation Plan

The claim that El-Sayed’s “plan” is to “commute sentences for murderers and rapists” is another misrepresentation. It doesn’t reflect something he proposed during his current Senate run. According to a citation in the No Going Back PAC ad, it’s based on a proposal from El-Sayed’s failed 2018 campaign to be Michigan’s governor.

In a section on “Criminal Justice Reform,” the 2018 plan (on page 26) proposed repealing the state’s law that requires convicted felons to serve their entire minimum sentence before becoming eligible for parole. Repealing the law “would allow for more flexibility in sentence length based on the rehabilitation that occurs in prison,” it said.

“Additionally,” the plan said, “within the first term, the El-Sayed Administration would review the sentences of all prisoners sentenced before age 18 (nearly 4,000 as of March 2013) with the aim of commuting sentences for all prisoners deemed low risk, with credit for time served.” (A commutation doesn’t automatically mean an immediate release from prison. It could be a reduced sentence.)

However, El-Sayed is not campaigning on that now.

In a Sept. 19 town hall, El-Sayed said that his 2018 plan was making the point that for a minor convicted of a petty crime instead of a violent crime, “that crime shouldn’t follow them the rest of their lives. That’s it.” Then he said, “The problem that we often have is that we police petty crime, but we don’t actually take on violent crime. And I’m just saying that if you put your hands on somebody else, if you violate their body, then you deserve to be held accountable for what you’ve done.”

Furthermore, the overwhelming majority of U.S. inmates are in jails or prisons run by state and local governments. While the federal government, including the Senate, can influence state and local policy, it has no direct control over state and local facilities, as the nonprofit Prison Policy Initiative noted in a 2025 report.

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In congressional races around the country, Democrats find themselves under attack in political ads for allegedly opposing the popular tax cuts for tips, overtime and older Americans that were part of Republicans’ One Big Beautiful Bill Act.

While the ads warn that the Democratic candidates opposed or would do away with those tax cuts, many of the candidates themselves say they support those particular provisions.

Not a single Democrat in either the House or Senate voted in favor of the OBBBA, which was signed into law by President Donald Trump on July 4, 2025. And the law did cut — though didn’t completely eliminate — taxes on tips, overtime pay and Social Security through 2028.

Those provisions enjoy bipartisan public support. 

But many of the candidates facing these attacks say they voted against the OBBBA for other reasons — chiefly that overall tax cuts were skewed to the wealthy, and that it cut funding to Medicaid and reduced spending on federal food benefits. Many Democrats say they aren’t opposed to the bill’s tax cuts for tips, overtime and older Americans. Some have even said they would work to make them permanent.

Even before the OBBBA was being considered, then Vice President Kamala Harris said in August 2024 that she supported the elimination of taxes on tips for hospitality and service workers.

The No Tax on Tips legislation that was ultimately folded into the OBBBA enjoyed bipartisan support, and was passed by the Senate 100-0. When introducing another bill to clarify that no tax on tips would also apply to automatic gratuities, such as those added by restaurants when serving large parties, Democratic Sen. Ruben Gallego called the no tax on tips provision in the OBBBA “shamefully short term.”

And Democrats have proposed legislation — the You Earned It, You Keep It Act — that would permanently eliminate federal taxes on Social Security, and pay for it by expanding the Social Security payroll tax to earnings above $250,000 a year.

In other words, opposition to the OBBBA doesn’t necessarily translate to an opposition to the bill’s tax cuts related to tips, overtime pay or Social Security.

These provisions — which all expire after 2028 — provide tax deductions up to certain limits; a deduction reduces the total income subject to taxes. The overtime measure applies to the extra 50% income earned on time-and-a-half overtime, up to a limit. The Tax Policy Center estimated that “3 percent of taxpayers benefit from the tips deduction, with an average tax reduction of about $1,480 among those who benefit, and that 10 percent of taxpayers benefit from the overtime deduction, with an average tax reduction of about $1,200.”

The provision aimed at Social Security is a tax deduction, too — $6,000 for those age 65 and older, whether they get Social Security benefits or not, and it phases out for those earning $75,000 or $150,000 for couples filing jointly. The Tax Policy Center found that the deduction “would benefit fewer than half of older adults,” with seniors earning $80,000 to $130,000 benefiting the most. They get an average tax cut of about $1,100, TPC said, in 2025.

Texas Senate Race

One example of this midterm messaging is an ad in Texas from the campaign of Republican Ken Paxton that claims his Democratic opponent, James Talarico, “backs higher taxes on working families, $3,000 a year. Taxes on your tips, your overtime, even Social Security.” Talarico, a state legislator, was not in Congress when the One Big Beautiful Bill Act passed in July 2025. But he opposed it — saying its tax cuts disproportionately benefited billionaires.

Regarding the claim that Talarico “backs higher taxes on working families, $3,000 a year,” that’s a reference — according to the ad’s footnotes — to a Tax Foundation estimate in February that taxpayers would see a nearly $2,300 average tax cut due to the OBBBA in 2026, while business tax cuts would save $1,541 on average.

The lion’s share of the tax cuts in the OBBBA were the result of permanently extending individual tax cuts first passed in the 2017 Trump-backed Tax Cuts and Jobs Act. Those provisions were set to expire at the end of 2025.

But the ad assumes Talarico opposes all of the tax cuts in the OBBBA. He does not.

In a campaign event in Arlington in August, Talarico said, “It’s time to repeal the big ugly bill’s tax breaks for the top 1% and give that $1 trillion to the middle class in the form of a cost of living tax cut.” He often frames the OBBBA as a boon for billionaires.

That’s in line with the mainstream Democratic position. As a presidential candidate in 2024, Harris proposed an economic plan that focused on cutting costs and “cutting taxes for more than 100 million working and middle-class Americans.” Specifically, Harris promised that “no one earning less than $400,000 a year will pay more in taxes,” which would have required her to extend the Trump tax cuts to at least that level.

As we’ve written, each party has misleadingly emphasized only certain aspects of the law, and Talarico’s emphasis on its benefits to billionaires ignores that the OBBBA benefited all income groups on average. According to the Tax Foundation, the extension avoided a tax hike on an estimated 62% of tax filers in 2026.

But it’s also true that the biggest tax gains went to the top earners.

Estimates from the Tax Policy Center last year showed that the average tax cuts by income group in 2026 ranged from $150 for households earning less than about $35,000 to $21,000 for households earning nearly $500,000 to a little more than $1 million.

Factoring in the bill’s spending cuts lowers the benefits for low-income households. In a July 8, 2025, report on the “total value of the legislation,” the Penn Wharton Budget Model found that the OBBBA largely benefits wealthy taxpayers. 

“On a conventional basis, households in the first income quintile lose about $885 in 2030, reflecting net reductions in taxes and transfers, including cuts to Medicaid and SNAP,” the report said, referring to the Supplemental Nutrition Assistance Program, which was formerly known as food stamps.

“As spending cuts deepen over time, lower income households come out worse off,” the Penn Wharton Budget Model report said. We wrote more about that report in fact-checking an ad that attacked Georgia Sen. Jon Ossoff over his vote against the OBBBA.

As for the ad’s claim that Talarico supports higher taxes on “tips, your overtime, even Social Security,” Talarico’s campaign said he specifically supports provisions of the OBBBA that cut taxes for the middle class, including taxes on tips, overtime pay and Social Security.

Of the estimated $3,813 overall average tax savings in 2026, about $450 is attributed to the “no tax on” tips, overtime and Social Security provisions, Garrett Watson, vice president of federal tax policy at the Tax Foundation, told us. 

“This ad is a lie,” Talarico campaign spokesperson JT Ennis told us via email. “James was proud to vote for the largest property tax cut in Texas history and has consistently voted to cut taxes for working Texans.”

North Carolina Senate Race

In North Carolina, an ad from No Going Pack PAC Inc. says, “North Carolina seniors earned their Social Security and Medicare, but Roy Cooper supported higher taxes on Social Security, hitting seniors earning under $75,000.” If Cooper is elected, the ad says, “he’ll tax your Social Security.”

No Going Back PAC is a newly formed super PAC with ties to another super PAC, MAGA Inc., which is affiliated with President Donald Trump. Cooper, the former Democratic governor of North Carolina, faces former Republican National Committee chair Michael Whatley in a race to fill the Senate seat occupied by outgoing Republican Sen. Thom Tillis.

An ad from the Whatley campaign — being run on streaming services — similarly claims that “Cooper backs higher taxes on tips and overtime, and even higher taxes on Social Security.”

Although the No Going Back PAC ad specifically warns a repeal of the Social Security tax cuts in the OBBBA would specifically hurt “seniors earning under $75,000,” as we’ve written before, many seniors below that income level already do not pay federal income taxes.

According to the White House’s Council of Economic Advisers, 64% of seniors age 65 and over who receive Social Security income already receive exemptions and deductions that exceed their taxable Social Security income. As the Bipartisan Policy Center noted in an article last year, “The increased standard deduction in OBBB means that many older Americans with low income will not receive any benefit from the additional deduction.”

Cooper never served in Congress, so he didn’t vote on the OBBBA. But he has said he opposed it. “It is amazing to me that people like my opponent, Michael Whatley, cheer on this One Big Beautiful Bill when what it did was to take away people’s healthcare in order to fund tax breaks for billionaires,” Cooper said at a press conference on Oct. 5.

But importantly, he has repeatedly said he doesn’t oppose the provision aimed to cut Social Security taxes.

“These attacks are false,” a spokesperson for the Cooper campaign told us via email. “Roy Cooper supports eliminating taxes on Social Security, voted to protect the Social Security tax exemption in North Carolina and cut taxes for working families and seniors.”

According to his campaign, Cooper also supports eliminating taxes on tips and overtime pay.

New Hampshire Senate Race

In New Hampshire, another ad from No Going Back PAC attacks Democratic Rep. Chris Pappas — who is now vying for a Senate seat — as a tax-raiser, saying, “Pappas voted against cutting taxes on tips, overtime, and Social Security. $4,600 in higher taxes on New Hampshire families.”

Pappas voted against the OBBBA in the House. He said he voted against the legislation because the cuts to the Supplemental Nutrition Assistance Program and Medicaid were too extreme and risked causing the closure of health centers.

At the time, Pappas told Fox News, “I support targeted tax cuts for working people, for our small businesses and to make sure we are targeting that relief to the people that need it, not to billionaires, to the biggest corporations.”

Pappas’ campaign said he supports cutting taxes on tips, overtime and Social Security. Indeed, he co-sponsored bipartisan legislation that sought to permanently cut most taxes on tips. As we said, the tax cuts on tips in the OBBBA are set to expire in about two years.

Pennsylvania’s 7th House District

Numerous Democratic candidates for the House are facing the same type of attack ads. For example, in Pennsylvania, an ad from Safety and Affordability PAC claims Democrat Bob Brooks “wants to keep higher taxes on overtime pay and Social Security benefits. Families, firefighters, nurses, and seniors would see their taxes go up.”

Brooks, president of the Pennsylvania Professional Fire Fighters Association, is running in Pennsylvania’s 7th Congressional District against Republican incumbent Rep. Ryan Mackenzie.

Brooks’ campaign pointed us to a Fox News story in June in which a spokesperson for his campaign said the Democrat “ran into burning buildings for 20 years [and] knows what hard work is, and he knows that first responders deserve to keep more of their hard-earned money.”

That Fox News story cites a May interview in which Brooks claimed that most firefighters didn’t benefit from the overtime tax cut. In that story, a Brooks campaign spokesperson said Brooks supports “no tax on overtime” and “no tax on tips.”

Brooks hasn’t served in Congress, so he couldn’t vote on the OBBBA.

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President Donald Trump’s remarks about the possibility that Iran could “take out” Los Angeles and San Diego have sparked a firestorm of criticism, with Democrats claiming the president was either calling for a foreign adversary to attack the U.S. or portraying the destruction of two major cities as acceptable collateral damage. 

But given the full context — as well as Trump’s numerous past comments on this issue and the White House’s later clarification — that’s not our reading of the president’s comments. While his wording is confusing, a more plausible interpretation is that he meant the war would prevent Iran from posing a threat to U.S. cities, and higher gas prices are a small sacrifice to make. He’s made versions of those points before, using similar language.

Trump’s remarks came during an Oct. 5 rally in Nebraska. 

“Remember, with the war, it’s just artificial. It’s a little bit high,” he said, apparently referencing gas prices. “It’s a small price to pay for keeping the world safe, keeping our country safe. They could take out a city. Let them take — let it — let them take out Los Angeles. Let them take out San Diego. 

“That’s — this is a very small price to pay, and it’s going to be over with very soon,” he continued. “It’s essentially almost over with.”

The speech quickly drew outraged responses from Democrats in California and nationally. 

“After sending the National Guard and Marines to occupy California, Donald Trump is now saying our foreign enemies should ‘take out’ Los Angeles and San Diego,” California Gov. Gavin Newsom wrote on X. “He is deranged and dangerous.”

Newsom’s press office subsequently posted, “Let’s be clear: The President is advocating for an attack on 10+ million U.S. residents in two of America’s largest cities.”

Newsom posted again the following day, calling Trump’s remarks “dangerous — if not treasonous” and saying that he was directing the state “to actively monitor the situation in the event that foreign actors interpret the President’s remarks as an invitation to target California.”

“The President says the Iran war will end ‘very soon,’” Democratic Sen. Adam Schiff of California posted. “How many times have we heard that promise? And if it means attacks on two major American cities in the process, he is not troubled by the cost.”

“I can’t believe we have to say this, but the annihilation of two major American cities — more than 5 million people — is not a ‘small price to pay’ for Trump’s illegal war,” Sen. Bernie Sanders of Vermont, an independent who caucuses with Democrats, wrote on X.

Trump’s remarks were admittedly confusing, in keeping with his characteristically roundabout style of speaking. His speeches at rallies frequently veer off on tangents before circling back to an earlier point. It doesn’t help that some in the crowd in Nebraska began cheering as he said, “Let them take out Los Angeles. Let them take out San Diego,” though Trump himself didn’t seem to react to or encourage the crowd’s response.

But taken in context, his remarks don’t appear to be “advocating” an attack on U.S. cities or suggesting their destruction would be an acceptable cost. 

Trump first referenced the war in Iran a few minutes into his Nebraska speech. “We’re saving the world from what could be one of the worst tragedies ever,” he said, adding that the war would end soon and, when it does, the price of oil “will come tumbling down.” 

After riffing on other topics, he eventually came back to the subject of the war, which is when he made his controversial comments about Los Angeles and San Diego. What immediately preceded those statements, however, suggests that Trump wasn’t calling for the destruction of those cities, but rather saying that protecting them is worth paying a bit more at the pump: “It’s a little bit high. It’s a small price to pay for keeping the world safe, keeping our country safe. They could take out a city.” 

He was likely making the same point about paying more for gasoline when, after referencing the California cities, he said, “This is a very small price to pay, and it’s going to be over with very soon.” 

Trump has used similar language before to argue that higher gas prices are worth it if the war prevents Iran from posing a threat to the U.S. 

“The one thing already has happened is, Iran will never have a nuclear weapon,” he said in the Oval Office on Sept. 28. “That’s a very big thing, because if you want to see turmoil and a travesty, let them take out a city with a nuclear weapon. I’m not only talking about Israel and big parts of the Middle East, but let them hit us with a nuclear weapon.” 

Speaking to reporters in the Oval Office in March, he said rising oil prices were “a very small thing compared to allowing them to have — you want to see the stock market go down? Start letting them hit you with nukes, OK? I said it this morning, I think it’s a very small price to pay.”

“We’re going to get [the cost of fuel] down,” he told a Nebraska news network on the day of his rally there. “But it’s all going to come pouring down as soon as the war’s over, which will be very soon. And we will not have Iran having a nuclear weapon. And that’s going to be — and I say it and I say it proudly — a relatively small price to pay for keeping nuclear weapons out of the hands of a lunatic nation.”

Reached for comment, a White House spokesperson directed us to an X post from Communications Director Steven Cheung.

“The media freakout over President Trump’s comments is not rooted in reality,” Cheung said. “He was clearly stating U.S. cities would have been threatened if a nuclear Iran hadn’t been stopped.”

In his Feb. 24 State of the Union address, days before the U.S. and Israel launched airstrikes on Iran, Trump said Iran was “working to build missiles that will soon reach the United States of America.” But experts told us the threat of Iran developing an intercontinental ballistic missile capable of reaching the mainland of the United States was not particularly imminent.

Update, Oct. 8: Asked by reporters on Oct. 6 to clarify his remarks, Trump waved away the question without answering. But he brought up Los Angeles and San Diego again during a rally the following night in San Antonio, making the point that he launched the war with Iran to prevent attacks on such cities.

“Just as I promised, I am ensuring that Iran will never have a nuclear weapon,” Trump said, before saying that oil prices are “a little” high but will come down as soon as the war ends.

“But you want to see trauma, you want to see problems, and I said it the other day, let them hit a missile into San Diego or Los Angeles on the way,” he said. “Let them hit — you want to see a horror show? You want to see problems? Let them hit San Diego. Let them hit Los Angeles, and you want to see some bad things happen, you want to see a country that would be in freefall. We’re not going to let that happen. We protect our cities. We protect our country. We’re not letting that happen.”

He made similar comments when interviewed by News 4 San Antonio the same day.

“I had to do Iran because they would’ve had a nuclear weapon, and then you would’ve found out what problem,” he said. “I say it all the time. Let’s see what would happen if they ever did something like to Los Angeles or San Diego. Those seem to be the most prominent because of location, and I’m talking about through missiles. That would be terrible if a thing like that happened.”

As we’ve written, Trump’s repeated claims about the imminence of Iran’s nuclear weapon capabilities have been disputed. In June, he claimed that if he hadn’t launched airstrikes in June 2025, Iran would “right now have a nuclear weapon.” That’s contradicted by reports from the International Atomic Energy Agency and the U.S. Intelligence Community, which said in March 2025 that “Iran is not building a nuclear weapon.” Both entities have expressed concerns about Iran’s nuclear ambitions, however.

Arms control experts told us the 2025 bombing set back Iran’s nuclear program and there wasn’t evidence Iran was rebuilding it. But in an April prime-time address a month after the U.S.-Israeli war on Iran began, Trump said that Iran was “right at the doorstep” of “a nuclear bomb.” Experts told us it would likely take months for Iran to enrich uranium to bomb-grade level and then much longer before it could be made into a weapon, if it chose to do so.

Correction, Oct. 7: We misidentified the location where Trump made remarks on Sept. 28. They were made from the Oval Office.

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Political leanings: Republican/Conservative

2024 total spending: $456.8 million

Make America Great Again Inc. is one of many political action committees affiliated with President Donald Trump. The super PAC was established six weeks before the 2022 midterm elections to provide a final push for Trump-backed candidates.

As a super PAC, officially known as an independent expenditure-only committee, MAGA Inc. advocates the election or defeat of federal candidates without coordinating with candidates, campaigns or political parties. It can accept unlimited contributions, but it must disclose its donors.

In the 2024 election cycle, MAGA Inc. raised about $410.5 million and spent more than $456.8 million, including nearly $376.9 million on independent expenditures, which are ads and other forms of communication. Its spending on the presidential race supported Trump and opposed Democratic candidates Joe Biden and Kamala Harris. During the Republican primary, the super PAC also spent against Florida Gov. Ron DeSantis and former South Carolina Gov. Nikki Haley.

As of Aug. 31, MAGA Inc. spent about $32.4 million, including more than $2.5 million in independent expenditures, leaving it with about $415.8 million in cash, according to its latest monthly filing with the Federal Election Commission. Large donors to the super PAC in 2026 include Cameron and Tyler Winklevoss, co-founders of the cryptocurrency company Gemini; Diane Hendricks, co-founder of the wholesale company ABC Supply; and Dr. Miriam Adelson, a physician and businesswoman with multiple casino investments.

The super PAC’s independent expenditures this cycle have supported Republican candidates in several House and Senate races. During the 2026 primary elections, it backed Rep. Matt Van Epps, who won Tennessee’s 7th Congressional District special election; Rep. Clay Fuller, who won the special runoff election in Georgia’s 14th Congressional District; and Sen. Darline Graham, the late Sen. Lindsey Graham’s sister, who won the Republican nomination in South Carolina’s Senate race.

More recently, MAGA Inc. became involved in the Texas Senate race, spending millions of dollars supporting Texas Attorney General Ken Paxton against Democratic state Rep. James Talarico.

On Sept. 4, Trump said he expected MAGA Inc. to allocate roughly $400 million to $500 million to help Republicans in the midterms, while also saying he expected to retain some money for the 2028 cycle. The super PAC is also reportedly helping to finance a separate super PAC, No Going Back PAC Inc., which was registered with the FEC on Sept. 1, and has since spent or reserved more than $125 million in advertising, according to the ad-tracking service AdImpact.

In addition, Trump said in an Oct. 5 social media post that MAGA Inc. will fund a series of ads that are “a positive promotion for our Great U.S.A.” Earlier ads featuring Trump, which the White House called “public service announcements,” had previously been paid for using taxpayer-funds, drawing criticism from Democratic lawmakers, ethics experts and even some congressional Republicans.

FactCheck.org Undergraduate Fellow Angela Lin contributed to this article. 

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Political leanings: Democratic

2024 total spending: $30 million by its hybrid PAC

VoteVets is a political group that supports veterans, and promotes Democratic policies and candidates. It operates two political committees: the VoteVets PAC and the VoteVets Action Fund.

VoteVets, the PAC, is a Carey committee, a hybrid organization that functions as both a PAC and a super PAC. Like a traditional PAC, the committee can give money directly to a campaign. However, like a super PAC, it can also raise and spend unlimited amounts of money for independent expenditures, which are funds spent on advertisements or other communications in order to elect or defeat specific candidates. For years, the PAC’s goal has been to elect veterans to office.

VoteVets Action Fund is a 501(c)(4) nonprofit, a “social welfare organization” that must spend less than 50% of its funds for political purposes. It does not need to disclose its donors, but it must report its independent expenditures to the Federal Election Commission.

The co-founder of VoteVets is Jon Soltz, an Iraq War veteran. VoteVet’s treasurer is Rick Hegdahl, who also is its national veteran organizer. 

As of Aug. 31, the VoteVets PAC reported raising about $26 million for the 2026 election cycle while spending about $31 million, according to its latest FEC disclosure. Major donors include Deborah Simon, daughter of the late property developer Melvin Simon; Lisa Mennet, a child psychologist and founder of the philanthropic Perigee Fund; and the Democrat-aligned super PACs AB PAC and Project 218. 

“Overall, VoteVets plans this year to spend $60 million on 331 Democratic candidates nationwide — 20 House and Senate candidates and 311 down-ballot races — the most since it was founded,” the New York Times reported in late September. “That makes it one of the most substantial single-issue advocacy groups operating in the midterm cycle, and one of the main groups spending the most to support Democratic candidates.”

Through the end of August, the VoteVets PAC had spent more than $18.3 million on independent expenditures supporting candidates. About half of that was spent backing Democratic state Rep. Josh Turek in the Iowa Senate race against Republican Rep. Ashley Hinson. Turek, who won Paralympic medals for the U.S. in wheelchair basketball, was born with spina bifida due to his father being exposed to Agent Orange during the Vietnam War. He’s one of the VoteVets-backed candidates who aren’t veterans but whose lives have been influenced by a family member’s military service. 

The PAC also spent more than $1 million helping Luke Bronin defeat Rep. John B. Larson in the Democratic primary for Larson’s seat in Connecticut’s 1st Congressional District. “We have no issue with Larson,” Soltz told the Times. “It’s about the fact that we can get a veteran into Congress for the next 30 years, to be the chairman of the House Veterans Committee or Foreign Affairs. That’s our interest.”

During the 2024 election cycle, VoteVets raised over $31 million and spent roughly $30 million, with more than $13.6 million going to independent expenditures, including about $2.9 million to support Ruben Gallego, a former Marine and an Iraq War veteran, who won the Senate race in Arizona.

FactCheck.org Undergraduate Fellow Justine Weng contributed to this article. 

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Political leanings: Republican/Conservative

2024 total spending: $89.8 million

Club for Growth Action, the super PAC of the conservative Club for Growth organization, was launched in August 2010. It has taken credit for helping to elect conservatives such as Sens. Ted Cruz of Texas, Rand Paul of Kentucky and Tim Scott of South Carolina.

On its website, the Club for Growth, which also has a traditional political action committee, declares its mission is to “take on any Member of Congress on policy who fails to uphold basic economic conservative principles … regardless of party.” The group says it even opposes some Republican incumbents in primary elections in order to replace them with “free-market, limited government conservatives.”

Club for Growth President David McIntosh told Fox News in March that the organization’s goal was to raise and spend $175 million in the 2026 election cycle. “The club plans to spend $75 million on Senate races, $55 million on House showdowns, $20 million in ballot box battles for governors, and $20 million — mostly already spent — on issue advocacy in support of Trump’s tax cuts, school choice efforts and the push for congressional redistricting,” Fox News reported.

As of Aug. 31, the super PAC alone had raised more than $50 million, according to Federal Election Commission records. Its independent expenditures — spending for or against named candidates, without coordination with candidates or parties — totaled almost $5 million at that point.

So far, most of the super PAC’s spending has been on ads supporting Republican candidates in congressional races, including Jackson Lahmeyer, who has since dropped out of the contest for Oklahoma’s 1st Congressional District; Rep. Clay Fuller, who’s running for reelection in Georgia’s 14th District; and Alexandra Mealer, who is running in Texas’ 9th District. The money spent opposing candidates has mostly been against Casey Askar, a Republican candidate for Florida’s 22nd Congressional District, and Aftyn Behn, a Democrat who lost the special election in Tennessee’s 7th District in December.

In addition, the super PAC contributed more than $4.5 million to Win It Back PAC, an affiliated super PAC.

As for its donors, much of the Club for Growth Action’s money thus far in the 2026 cycle has come from one person: Jeff Yass, the co-founder of the financial firm Susquehanna International Group.

In the 2024 presidential cycle, the super PAC spent about $89.8 million, including more than $18 million in independent expenditures and roughly $58 million in contributions to other committees. That total was slightly higher than the $89.3 million it spent during the last midterm cycle in 2022.

FactCheck.org Undergraduate Fellow Christine Sung contributed to this article. 

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President Donald Trump and other federal officials are claiming that deals the administration has struck with pharmaceutical companies are “rescuing state budgets” or helping to “save Medicaid” by saving the program tens of billions of dollars on prescription drugs over a decade.

But experts say there are many unanswered questions about the scope of those deals that could limit the potential savings, including how many drugs they actually cover.

It’s also an exaggeration to suggest this program will single-handedly save state budgets, even under the rosiest of scenarios. According to the White House’s projections, the savings to states would initially come to less than 2% of what they spend on Medicaid annually, and diminish over time.

Trump has talked regularly about his efforts to lower prescription drug costs, arguing it’s unfair that the U.S. pays much higher prices for brand-name drugs than other wealthy countries. 

Over the past 13 months, his administration has announced agreements with more than two dozen drug manufacturers — from large corporations like Pfizer and Johnson & Johnson to midsize biotech firms — to bring certain prices in line with those in other countries. The administration calls this approach “most favored nation” or MFN pricing.

Among other things, companies have agreed to sell certain drugs to state Medicaid programs at MFN prices. Trump and other administration officials touted the potential savings that could generate at a Sept. 18 White House event.

“The Council of Economic Advisers estimates that the most favored nations deals that we’re extending to states today will save Medicaid over $64 billion, and that’s over a relatively short period of time,” Trump said. “And others project the savings are going to be actually much more than that. I think they’re going to be much higher than that. Could be $100 billion.”

Those savings, Trump continued, “will help us save Medicaid and protect it for future generations.” 

“We are rescuing state budgets with this program,” Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, added. Medicaid prescription-drug spending, he said, “is crowding out schools and roads and long-term care and rural care.”

“It’s going to save the state budget,” Health and Human Services Secretary Robert F. Kennedy Jr. said, adding that states previously “had to choose between medicine and nutrition, lifestyle, prevention.”

The $64 billion number comes from a report released in May by the White House Council of Economic Advisers, which projected that MFN pricing could save Medicaid about that much over 10 years, split between the federal government and the states.

But experts told us it’s unclear how realistic that estimate is. The details of Trump’s agreements with drugmakers are largely confidential and key questions remain unanswered, including which drugs will be offered to Medicaid at MFN prices, the degree to which states will participate and how long those arrangements will last.

“It is unclear what assumptions were made to develop the administration’s estimates, and there are a number of factors that make it difficult to assess the overall impact the new model will have on Medicaid drug costs,” Robin Rudowitz, a senior vice president and director of the Program on Medicaid and the Uninsured at the nonprofit health policy research organization KFF, told us in an email.

Because Medicaid already gets substantial discounts on prescription drugs, the amount of savings will depend heavily on which drugs are included and whether the prices actually give states a better deal, said Edwin Park, a research professor at Georgetown University’s Center for Children and Families. 

He said the administration initially made it seem like participating companies would offer all their drugs to Medicaid at MFN pricing, which the CEA report describes as the second-lowest prices among a small set of countries — the G-7 nations, plus Switzerland and Denmark. But a number of companies have since indicated that the agreements cover only some products.

“There’s just sort of a cone of silence around all these agreements,” Park said. “So, you know, I think a healthy dose of skepticism is warranted in this case.”

A White House official said the CEA analysis “is based on manufacturer and state participation” and the administration expects the actual savings to be in line with its estimates.

A spokesperson for the Centers for Medicare & Medicaid Services told us the Medicaid program, called GENEROUS, includes “hundreds” of drugs used to treat cancer, asthma, Parkinson’s and various other “costly and chronic diseases.”

“CMS estimated total [MFN] rebates flowing through GENEROUS could reach $5.2 billion annually, depending on which drugs, of those included in GENEROUS, states choose to access through the model each year,” the spokesperson said. “This figure represents a significant portion of annual net drug spend in Medicaid.”

We’ve previously written about other aspects of Trump’s drug-pricing deals, including his exaggerated claims about the savings available through the government’s direct-to-consumer TrumpRx platform and the administration’s questionable projections that his MFN policies will save hundreds of billions of dollars overall. 

Here’s a closer look at the Medicaid drug-pricing initiative, what we know about it and the administration’s claims about potential savings.

Lack of Details Make It Hard to Assess Savings

Medicaid, which provides health coverage to more than 65 million people with low incomes or disabilities, already pays some of the lowest prices in the U.S. for prescription drugs. By law, manufacturers have to agree to certain rebates for their drugs to be covered by Medicaid. On top of that, most states negotiate “supplemental rebates” that further reduce the cost of branded drugs.

Those discounts reduce Medicaid’s drug costs by more than half. In fiscal year 2024, Medicaid’s gross spending on prescription drugs topped $106 billion, but net spending was only $48 billion after rebates, according to the Medicaid and CHIP Payment and Access Commission, a governmental body that advises Congress on Medicaid policy.

Nearly all of those costs are split between states and the federal government. Medicaid beneficiaries pay, at most, a nominal copay for their prescriptions, so they’re not directly impacted by Medicaid drug prices going up or down. 

While prescription drugs account for a small share of overall Medicaid spending — around 6% in 2024 — rising drug costs can be a concern for state budgets. Pharmaceutical companies’ deals with the Trump administration include participation in GENEROUS, through which they’ll offer state Medicaid programs access to certain drugs at MFN prices. The five-year pilot program launched in January, and participation for states and drug manufacturers is voluntary.

The Council of Economic Advisers report estimated that the GENEROUS model would initially reduce Medicaid’s drug costs by $18 billion per year, though because it assumes the changes would also increase prescription drug utilization, it put the net savings at $14.4 billion.

The report said those savings would likely diminish over time as existing products lose patent exclusivity, though it says Medicaid would continue to benefit from other provisions of the president’s MFN deals that cover new product launches. (We’ve previously written about the shaky assumptions behind the administration’s claims of massive savings from those provisions.) Experts have also pointed out that companies could raise prices in other countries, so that they wouldn’t have to discount their drugs as much in the U.S.

Taking those diminishing effects into account, the report put the total savings over 10 years at $64.3 billion.

Outside researchers have come up with somewhat lower estimates. An analysis published in the journal JAMA in July estimated the potential one-year savings at $8.6 billion. 

“The CEA estimates are basically sort of a back-of-the-envelope calculation,” said the study’s lead author, Dr. Thomas Hwang, director of the Cancer Innovation and Regulation Initiative at Harvard Medical School and Brigham and Women’s Hospital. 

The CEA calculated its savings by assuming that current Medicaid prices are 2.5 times higher on average than MFN prices would be, but doesn’t go into detail about how it arrived at that figure. Hwang said it’s also unclear if CEA accounts for other supplemental rebates, which states would have to forego to access MFN prices.

Hwang’s study, which is based on drug- and state-specific data, looked at a somewhat smaller cohort of drugs than CEA’s, but he said that would only account for part of the difference between estimates.

The bigger issue, he said, is that it’s not yet clear which drugs will actually be included in GENEROUS.

The CEA report said its estimate is based on “implementation of Medicaid MFN across all single source branded drugs and biologics.” Hwang and colleagues made the same assumption in their study. He said that’s how federal officials initially described the program, including in a request for applications directed at states.

But “what we’ve seen in the past month or so is a lot of backsliding on that commitment,” Hwang said. Multiple companies have said in Securities and Exchange Commission filings or other public statements that MFN pricing for Medicaid applies only to “certain” or “select” products. 

Because Medicaid requires additional rebates if a drug’s price rises faster than inflation, older drugs tend to be discounted more steeply, so the savings from MFN pricing could depend heavily on which specific drugs are included, he said.

“One of the concerns with this is, obviously, companies have every financial inventive to cherry-pick which drugs they offer MFN pricing for, in ways that will reduce their MFN liability,” Hwang said. 

Jeromie Ballreich, an associate research professor at Johns Hopkins University who studies pharmaceutical policy, similarly said savings will vary widely from drug to drug. 

In a forthcoming study, he and several co-authors looked at how GENEROUS could affect prices for 86 branded drugs accounting for more than half of Medicaid gross drug spending in 2024. For more than a third of those products, they found, there wouldn’t be any savings. For the others, savings ranged from 1.3% to 87.5%.

“Some drugs are going to provide a lot of savings,” he said. But “there’s going to be other branded drugs out there that will provide essentially no savings because of the way the inflation rebates affect Medicaid pricing. There are branded drugs in the Medicaid program that are [already] essentially free for Medicaid.”

The paper estimated the GENEROUS model could save Medicaid $3.1 billion over a year, but Ballreich said that’s going to be “highly dependent” on which drugs are actually included and how international reference prices are calculated.

“So there are still a number of question marks,” he said. 

“The GENEROUS model includes hundreds of single source and innovator multiple source covered outpatient drugs from the portfolios of participating manufacturers,” the CMS spokesperson told us.

“The included drugs span most major drug classes, including those acutely important to Medicaid beneficiaries like oncology, diabetes care, and asthma. Some of these drugs are used to treat numerous costly and chronic diseases, including hemophilia, Parkinson’s disease, macular degeneration, glaucoma, liver disease, skin conditions, and various forms of cancer.”

State Uptake Remains to Be Seen

Another open question is the degree to which states choose to participate. Under the GENEROUS model, states can pick and choose which specific drugs they want. Whether the MFN price offers them a better deal will depend on what kind of rebates they’ve already negotiated with the manufacturer. 

States will also have to agree to a standard set of coverage criteria for each MFN-priced drug, which could change guidelines for when certain drugs need prior authorization. Those changes could offset some of the savings if the criteria result in more people being prescribed those drugs.

“The key question for states is, how does [the MFN rebate] compare to their existing rebates, and then how expansive are the coverage terms,” said Park, the Georgetown professor.

Trump announced on Sept. 18 that all 50 states had joined the GENEROUS model, though the Centers for Medicare & Medicaid Services clarified later the same day that while every state had applied, 40 had actually signed agreements to participate. The health news site STAT reported on Sept. 24 that some states were still on the fence about doing so.

At least some of the remaining states did sign agreements with CMS before the Sept. 30 deadline, spokespeople for their health departments told us. However, those departments also told us they’re still evaluating whether to accept any MFN offers from manufacturers. Several of them said that signing participation agreements was the only way to access pricing information and determine whether there would be a benefit.

“Applying and signing a participation agreement does not commit the state to actually participate in the GENEROUS model in terms of entering into rebate agreements with manufacturers,” Anthony Cava, a spokesperson for the California Department of Health Care Services, told us in an email. 

“Rather, signing a participation agreement will enable DHCS to obtain drug pricing information, evaluate whether the MFN prices offered under the model would meaningfully benefit Medi-Cal [California’s Medicaid program], and decide whether entering into supplemental rebate agreements with manufacturers would be advantageous.”

One state, South Dakota, announced last month that it “has currently identified three drugs that would benefit from these lower prices, saving the state approximately $750,000 a year.” South Dakota’s Medicaid program spent $167.2 million on prescription drugs in fiscal year 2024, with the costs split between the state and federal governments.

Multiple state health departments have told us or other news outlets that they can’t share specifics due to confidentiality agreements. CMS told us that its projections of potential savings will depend “on which drugs, of those included in GENEROUS, states choose to access through the model each year.”

There’s also uncertainty about how long these agreements will be in place. Some companies have indicated their deals with the administration run for three years. Pfizer’s ends on the last day of Trump’s term, according to a redacted copy released to the liberal watchdog group Public Citizen through a Freedom of Information Act request.

“Participating manufacturers voluntarily chose to sign participation agreements to take part in GENEROUS and we do not currently plan to renegotiate the GENEROUS model during its five-year performance period,” the CMS spokesperson told us.

The White House official said the CEA projections assume the MFN arrangements will continue under future administrations. 

“Those who assume it won’t last a decade would be making an assumption that a future administration would not want MFN pricing and the hundreds of billions in savings associated with it,” the official said. 

Ballreich said trying to make projections about the pharmaceutical market 10 years out is inherently difficult because of the number of variables. He said the administration’s estimate of $64 billion over 10 years is “probably a little high,” though not outside the realm of possibility.

But again, he said, it’s “hard to model out without knowing the details.”

Ballreich also noted that by agreeing to offer some discounts to Medicaid, drug companies appear to have negotiated exemptions from the administration’s implementation of mandatory MFN pricing in Medicare. 

“For pharmaceutical companies, Medicare is where they make their money,” he said. “Medicaid is often kind of this afterthought.”

The MFN pricing initiative in Medicare has two components. One of those programs, called GLOBE, covers drugs administered in doctors’ offices. CMS recently released a final rule estimating it will save $440 million over seven years — a 96% decrease from the initial estimate of $11.9 billion in savings. According to the rule, the program will apply to just four manufacturers, as other companies have exemptions because they are participating in the Medicaid pilot. (The other one, GUARD, applies to prescription drugs and is still in the works.)

“The narrative that I’m understanding from industry, or at least how industry has been interpreting the approach by the administration, is that ‘We will participate in GENEROUS,’” Ballreich said. “‘In return, we’re going to be a lot more selective on what drugs are going to be in GLOBE and GUARD.’”  

Questionable Claims of ‘Rescuing’ State Budgets

Whether or not the White House’s projections are realized, experts told us MFN pricing could create real savings for states and the federal government. But claims of “rescuing” state budgets are overblown.

We asked CMS what exactly Oz meant by that and didn’t get a direct answer. But even taking the White House estimates at face value, the savings represent a fraction of what states spend on Medicaid — not to mention all services — every year.

While prescription drugs are a small part of total Medicaid spending, a recent policy brief from KFF noted that rising drug prices and the “emergence of new, high-cost drugs can put pressure on state budgets.” More than a third of states cited rising pharmacy costs as one of the factors driving higher Medicaid spending overall in KFF’s most recent survey of state Medicaid directors.

Because states and the federal government split the cost of Medicaid, not all of the projected $64 billion in savings would go to states. The CEA report projects that states collectively would save $6.2 billion per year at first and $27.6 billion over a decade, or about $2.8 billion per year on average. 

By comparison, in fiscal year 2024, states spent around $325 billion of their own money on Medicaid, according to KFF. The projected savings in the first year would amount to about 2% of that, falling to less than 1% in later years as MFN discounts diminish over time. The savings make up an even smaller share of total state expenditures, which came to around $2 trillion in fiscal year 2024, not counting costs reimbursed by the federal government, according to the National Association of State Budget Officers. 

Of course, that’s not to say states wouldn’t welcome those savings.

Park said states are justifiably concerned about rising medication costs, especially as new, expensive blockbuster drugs come out.

“That being said, prescription drugs is only a very small share of Medicaid spending, well under 10%,” he said. “The big drivers are things one would expect, like hospital costs.”

Park also noted that the domestic policy law Trump signed last year, the One Big Beautiful Bill Act, includes cuts to Medicaid funding that could outweigh the potential savings from lower prescription drug prices. 

Some of those changes, such as work requirements and more frequent eligibility checks, will reduce both state and federal Medicaid spending by limiting enrollment. But other provisions cut federal funding to states without reducing the size of the Medicaid program, meaning states will have to make cuts or use general funds to make up the difference. 

On balance, a recent study from the nonpartisan research organization RAND estimated those changes could cost state general funds more than $80 billion through 2034, though the effects vary by state.

“You can see how there’s going to be some savings if these agreements go into effect,” Park said. “But it’s not a way for states to offset the historically large Medicaid cuts that were included in the budget reconciliation law, and that includes the significant cost shifts to states.”

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In the Maine Senate race, ads from a Democratic super PAC misleadingly claim Republican Sen. Susan Collins cast a vote to “cover up the Epstein files” and received “$3 million to her super PAC” from “Jeffrey Epstein’s business partner.”

Collins supported an Epstein-files disclosure bill in November that required the Department of Justice to publicly release records related to the convicted sex offender. She had voted two months earlier against an amendment that called for the release of the files and was attached to a defense spending bill. Collins said she opposed adding the amendment to an unrelated bill.

Furthermore, the ad stretches the facts in claiming that “Epstein’s business partner” gave money to Collins. A political action committee supporting Collins received millions of dollars in contributions from a man who was reportedly a “founding member” of a private New York City club along with Epstein and many other wealthy people.

A spokesperson for the man told us he had no relationship with Epstein. 

This is the third time this election cycle that we have written about Democratic ads misleadingly citing Republican senators’ votes to block the amendment and not mentioning that the full Senate later supported releasing the Epstein files. The ads also try to connect the Republican senators who blocked the amendment to people linked in some way to Epstein.

The ads against Collins were sponsored by WinSenate, a super PAC that works to elect Democrats to the Senate. Collins is facing Democrat Troy Jackson, a former Maine state Senate president, in a close race for her seat.

WinSenate released the first attack ad on Sept. 24. In it, a woman, identified as a retired teacher, says she is “horrified” and claims: “Susan Collins voted to cover up the Epstein files. She knew 14-year-old girls were raped. Turns out that Jeffrey Epstein’s business partner funneled $3 million to her super PAC. Susan Collins took the money and protected child predators.”

The second ad, which started airing Sept. 29, features the same woman saying Collins “voted with Trump to cover up the Epstein files” — but the ad leaves out the claim about donations from an alleged Epstein business partner.

For the Epstein files claim, the ad cites Senate roll call vote 512 on Sept. 10, 2025. That’s when Collins — and nearly all Republican senators — voted to table an amendment Senate Democratic Leader Chuck Schumer tried to include in the annual bill that sets the budget and policies for the Defense Department. Schumer’s amendment called for the U.S. attorney general to release all unclassified material pertaining to Epstein, including documents about federal investigations of Epstein and his associates, as well as information about Epstein’s 2019 death that was ruled a suicide. At the time of his death, Epstein, a wealthy financier, was in jail and facing federal charges of sex trafficking minors.

According to the New York Times, Collins said of the failed amendment: “It does not belong on the Department of Defense policy bill.” The newspaper also reported that Collins “said she opposed Mr. Schumer’s measure because a similar amendment had been adopted on a spending bill that would fund the Justice Department.” 

But the amendment that Collins supported in the July 2025 markup session by the Senate Appropriations Committee did not require the same level of disclosure. It required the attorney general to “retain, preserve, and compile” Epstein-related records or evidence and submit a report to Congress. While that DOJ spending bill had not yet passed in the Senate, “Ms. Collins said it was a more appropriate vehicle for a measure on the Epstein files,” the Times wrote.

In addition, when the Epstein Files Transparency Act — a standalone bill to release the Epstein documents — came up for consideration in the Senate in November, it passed by unanimous consent, which means the bill was not opposed by Collins or any other senator.

“I support the release of the Epstein files,” Collins said in a statement about the bill passing. “This is an important step for the survivors of these heinous crimes.”

As we have explained before, President Donald Trump initially opposed Congress’ attempts to release the files, but relented days before the Senate passed the bill in November.

The ‘Business Partner’ Claim

The first WinSenate ad that aired suggested Collins voted against Schumer’s amendment because of millions of dollars in donations from an Epstein associate.

Although the ad does not mention the alleged Epstein “business partner” by name, it does cite donations to a pro-Collins super PAC on June 27, 2025, and June 26, 2026. Federal Election Commission records show on those dates, Stephen Schwarzman, the co-founder, chairman and CEO of the Blackstone investment management firm, made contributions totaling $3 million to Pine Tree Results PAC, a group supporting Collins in the 2026 midterms. (Maine is known as the Pine Tree State.)

Schwarzman’s first donation, which was $2 million, was made more than two months before the vote on Schumer’s amendment. But the second donation, which was $1 million, was made more than six months after the full Senate supported disclosing the files.

The “business partner” label was based on reporting that Schwarzman and Epstein were among the very first people who paid to join Core Club, a private club in New York City that was founded by Jennie Enterprise in 2005.

“Susan Collins blocked the release of the Epstein files and then her PAC accepted millions from a business associate of Epstein’s, an individual who belonged to the same exclusive business club,” Lauren French, a spokesperson for WinSenate, said in a statement to us. “As [has] been publicly reported, they ‘were founders and members of an exclusive social club for billionaires.'”

The “founders” language does appear in a July 21 MeidasTouch News story with the headline: “More Donations from Epstein Contacts to Susan Collins Uncovered.” The story from the left-leaning outlet went on to mention Schwarzman’s donations to Pine Tree Results PAC and said, “Schwarzman and Epstein were founders and members of an exclusive social club for billionaires in New York called the Core Club.”

But to call them “business partners” is a stretch.

We reached out to the Core Club’s press office for comment, but have not received a response.

The Real Deal, a real estate news publication, reported in February that Epstein “paid $100,000 as a founding member, alongside 150 other investors, according to a spokesperson for Core.” Its story said, “Epstein’s fellow founding members included Aby Rosen of RFR, Steven Roth of Vornado Realty Trust and Stephen Schwarzman of Blackstone Group.”

In 2011, the New York Times also referred to Schwarzman as among the “founding members” of the club, “who anted up an initial investment of $100,000 when the club was conceived.”

“Being founders of the same exclusive club inherently makes individuals partners in business,” French said in an earlier statement provided to PolitiFact and Quick Check, an election feature of the Bangor Daily News.

But other than paying money to join and get the club started, it’s not clear that Schwarzman and Epstein ever did business together as “partners,” which implies a close working relationship.

The men had no relationship, a spokesperson for Schwarzman told us.

“It would be categorically false and reckless to claim or imply that Steve had any relationship with this despicable individual,” the spokesperson said in an email.

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The White House has defended three taxpayer-funded advertisements featuring President Donald Trump by comparing them to ads that were paid for by past presidential administrations. But some legal experts have said the Trump White House commercials are political messages intended to influence the 2026 midterms and may violate U.S. laws, including a prohibition against using federal funds for propaganda.

The White House described its ads as “public service announcements” in a Sept. 25 press release pushing back on criticism. It said, “The announcements are very clearly not campaign ads; President Trump is not on the ballot and there is no call to action. Instead, the announcements are a reminder for Americans to love their country and know why it’s worth defending — at home, at the border, and abroad.”

The release went on to say that “[a]dministrations of both parties have used public service announcements to explain policy and make the case for the nation’s direction,” citing examples of ads from the George W. Bush, Obama and Biden administrations, among others.

A legal expert we consulted did not see a correlation. 

“I just think you’re not going to find any comparison at all,” Richard Painter, a corporate law professor and former White House ethics lawyer for George W. Bush, told us in an interview. Painter said the Trump White House ads are “so clearly propaganda,” which generally refers to government communications intended to manipulate or influence public opinion. 

John G. Geer, a professor of political science at Vanderbilt University and author of “In Defense of Negativity: Attack Ads in Presidential Campaigns,” also told us, “I just think that the ads are different enough so that I personally don’t buy the argument” that the ads from the Trump administration and recent presidents are all the same. He said his perception is that the Trump White House ads are more political. “We’ll see what the courts say,” he said — if a lawsuit brings the matter to the judiciary.

Later, we’ll go over the cited examples of federally funded ads that were run under Presidents Bush, Barack Obama and Joe Biden.

The first Trump White House message to air includes images of Trump as he says, “Together we will defeat communism, socialism, and Marxism in America. America will never be a communist country.” Viewers repeatedly hear the words “love me,” which are lyrics from a JMSN song of the same name. Near the end of that 30-second spot, Dana White, the UFC CEO, compliments Trump and talks about him “fighting so hard for the country he loves.”

The third ad, in black and white, shows Trump walking and staring into the camera as he says in a voiceover, “we will demolish the deep state,” “expel the warmongers from our government,” “drive out the globalists,” and “cast out the communists, Marxists and fascists.” The ad ends with: “We will rout the fake news media, and we will liberate America from these villains once and for all.” The video is almost identical to an ad from Trump’s 2024 presidential campaign.

The second ad, a minute long, features video and audio from Trump’s July 3 speech from a site near Mount Rushmore, as the president says, “We are the freest people on Earth, and by the grace of God, the United States of America is the most successful, most accomplished, most exceptional nation ever to exist in human history.” The ad ends with him saying, “This is only the beginning of the golden age of America.”

All three ads were released on or after Sept. 23 and include a “Paid for by the U.S. Government” disclaimer. The ads have aired on broadcast and/or streaming platforms, including during Sunday political talk shows and college and NFL football games.

“Our tax dollars are hard at work. And, we believe, probably illegally so,” Painter and three other ethics experts wrote in a Sept. 28 piece in the online publication the Contrarian. For the post, Painter was joined in criticizing the Trump White House ads by Norman L. Eisen, former White House special counsel to Obama; Virginia R. Canter, former White House associate counsel to Obama and President Bill Clinton; and Christopher J. Swartz, who worked for the Office of Government Ethics across multiple administrations and was briefly acting chief of the Ethics Law and Policy Branch in 2025, during Trump’s second term.

“These videos are not ‘public service announcements’ as the White House claims,” the authors wrote. “They are clear attempts to boost Republicans’ chances in the impending midterm elections given their sagging poll numbers. The timing, content, and format of the videos all suggest they are covert attempts directed at the success of the Republican party.”

The White House said “Trump is not on the ballot” this November, but the president has told wavering Republican voters to pretend he is. The legal experts also noted in their piece that two of the White House ads highlighting Trump include references to defeating communism or communists, which is what Trump regularly calls democratic socialists running for Congress. (We’ve written that democratic socialists and communists do not have the same political or economic ideology, and democratic socialists make up a small minority of congressional candidates.)

“Even during the height of the McCarthy era and the Cold War, the United States government never came anywhere close to making an ad like this,” the experts said, adding that under the Hatch Act, a federal employee other than the president or vice president “may not use his official authority or influence for the purpose of interfering with or affecting the result of an election.” The statute would apply to other federal employees who participated in making or disseminating the ads, the experts said.

Also, annual appropriations bills passed by Congress have long included language prohibiting taxpayer funds from being used for “publicity or propaganda purposes within the United States.”

A few Republicans have spoken out against the Trump White House ads as well. “I like the message, but it shouldn’t be paid for with taxpayer dollars,” Senate Majority Leader John Thune told reporters about the ads on Sept. 28. The day prior, on CBS’ “Face the Nation,” Sen. John Kennedy of Louisiana said, “I don’t think any public official, including President Trump … should spend public money on private ads for themselves.”

A federal worker who violates the Hatch Act could face penalties such as “removal from federal service, reduction in grade, debarment from federal employment for a period not to exceed 5 years, suspension, reprimand, or a civil penalty not to exceed $1,000,” according to the U.S. Office of General Counsel.

In addition, Citizens for Responsibility and Ethics in Washington has written that the Government Accountability Office previously found that using federal funds for unauthorized publicity or propaganda violates the Antideficiency Act, which, “in severe cases,” could lead to administrative penalties, or a fine of up to $5,000 or up to 2 years in prison.

Painter told us that Congress could also ask to be reimbursed for an improper use of taxpayer funds. The ads combined have cost at least $2.5 million, according to the ad-tracking service AdImpact.

Obama Administration Ads/Outreach

One of the examples the White House cited under Obama sparked controversy, and the Government Accountability Office determined the public outreach campaign had violated federal laws. The other example is similar to ads run under Trump, promoting the open enrollment period for Affordable Care Act insurance plans.

Under Obama, the Environmental Protection Agency in 2014 and 2015 used a public outreach campaign through social media to encourage support for its proposed rule on clean drinking water. The New York Times called it “a campaign that tests the limits of federal lobbying law.” The effort was aimed at ginning up support during a public comment period on the proposed rule, which concerned EPA regulation of water sources.

The EPA argued that it wasn’t violating the Anti-Lobbying Law because its outreach didn’t tell the public to contact or lobby Congress.

But in December 2015, the GAO concluded that the EPA had violated federal laws prohibiting the agency from spending federal dollars for “publicity or propaganda purposes” and prohibiting the use of federal appropriations for “indirect or grassroots lobbying in support of or opposition to pending legislation.”

In particular, the GAO faulted the EPA for using a social media tool that resulted in some messages not identifying the EPA as the source of the information. Instead, to some members of the public, “it appeared that their friend independently shared a message of his or her support for EPA and clean water,” GAO said, calling this “covert propaganda.” (The messages shared through people’s social media accounts said, “Clean water is important to me. I support EPA’s efforts to protect it for my health, my family and my community.”)

GAO said that the violation of grassroots lobbying occurred when the EPA’s blog posts linked to outside groups, whose pages included prompts to contact Congress in support of EPA’s proposed rule.

The Trump White House also pointed to the Obama administration running TV ads about HealthCare.gov, the website people use to sign up for Affordable Care Act health plans, during the open enrollment periods in 2015 and 2016. The ads didn’t feature the president, but rather everyday people talking about how they had signed up for low-cost insurance.

In one spot, run in November 2015, a woman who’s going for a run says that her premium was $22 a month and that signing up was “very easy.” A guy who appears to be going to a university says he got “exactly the kind of coverage I wanted at the price I wanted,” with the words “$57/month” on screen. A woman and her child are shown with the words “$405/month family of 4.” The ad then says that “most people who sign up on HealthCare.gov qualify for financial help to make coverage more affordable.” It ends by encouraging people to “sign up by Dec. 15.” The ad says at the bottom that it is “sponsored by the U.S. Department of Health & Human Services.”

Another example from 2015 similarly says that most people can get financial help with their premiums.

The Obama administration also ran ads in the run up to the 2016 open enrollment period, which began Nov. 1 — meaning that those ads ran shortly before and after that year’s presidential election. One example from November 2016 is similar to the 2015 ads, showing various people and saying that most people signing up “can find plans for $50-$100/mo. with financial help.”

One could argue that Obama, who signed the Affordable Care Act into law in 2010, had a vested political interest in getting people to sign up and having the program succeed. But the Trump administration also has run ads to inform the public about the open enrollment periods. Like the Obama-era ads, these three examples from late 2025 featured people talking about how they easily enrolled in an insurance plan, and the ads said that “4 out of 5 customers can find a health plan for $21 or less per month with financial help.”

Biden Administration Ads

As the Trump administration pointed out, the Biden administration also used taxpayer dollars for an ad campaign using television, digital, radio and print spots to encourage people in early 2021 during the COVID-19 pandemic to get vaccinated.

The Trump press release said the Biden administration “poured hundreds of millions of dollars” into an ad campaign “to drive a nationwide public health message.”

But as the Washington Post story the press release links to explains, the campaign used a $250 million contract that the Trump administration signed with consultancy Fors Marsh the previous year. According to the article, “Officials have said they held the campaign until vaccines were widely available to maximize its impact.”

Ironically, numerous Democrats expressed concern in September 2020 after the Trump administration hired Fors Marsh for a campaign from HHS that sought to “defeat despair, inspire hope and achieve national recovery” amid the pandemic.

In a Sept. 11, 2020, letter to HHS, Democratic Rep. Frank Pallone, then chair of the Energy and Commerce Committee, wrote, “Among other things, the Committee is concerned that HHS may use more than a quarter-billion dollars in taxpayer funds on private communications consultants charged with distorting the facts and misleading the public about the Trump Administration’s failed response to the COVID-19 pandemic.”

A letter from three other Democratic leaders in the Senate similarly stated, “We have grave concerns that, rather than focus on planning and executing a national strategy to contain the coronavirus, the Trump Administration is using a quarter of a billion dollars in taxpayer money to fund what appears to be a political propaganda campaign just two months before a presidential election.”

Under Biden, the “We Can Do This” campaign directed by Fors Marsh sought to appeal to “a group known as the ‘movable middle’ — people who were hesitant but not necessarily opposed to getting vaccinated — with highly customized, science-based communications and messages of empowerment,” according to the consultancy.

The ads featured images of Americans and encouraged people to visit the Centers for Disease Control and Prevention’s website or vaccines.gov for more information.

At the time, Trump was also encouraging people to get vaccinated. At the Conservative Political Action Conference on Feb. 28, 2021, Trump boasted that his administration had helped deliver the vaccine in “record time” and later said, “So, everybody go get your shot.”

“I encourage them to take it,” Trump told Fox News’ Sean Hannity in April 2021.

George W. Bush Administration Ads

The Trump administration also pointed to a controversial $9.5 million ad campaign produced by the George W. Bush administration in 2004 touting the prescription drug benefits in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

The TV ad and flyers claimed the law, which passed largely along partisan lines, provided the same Medicare with “more benefits.”

At the time, Democratic Sen. Frank Lautenberg criticized the ad as “a propaganda effort with taxpayer dollars.”

At least one network, CBS, pulled the ad while the General Accounting Office (later renamed the Government Accountability Office) — at the request of Lautenberg and other Democrats — investigated whether it violated prohibitions on federal funds being used for “publicity or propaganda” purposes. Democrats argued the ad was inaccurate and was intended to promote the reelection of Bush that year.

The GAO concluded that while the TV ad and accompanying flyers contained “notable omissions and other weaknesses,” they were “not so partisan as to be unlawful.”

By way of omissions, Anthony H. Gamboa, general counsel of the GAO, said that the ad failed to note that people might be charged $30 for the new drug discount cards “and that savings may vary across covered drugs.” He further criticized the flyer’s indication that beneficiaries would pay a premium of “about $35 a month” for the prescription drug benefit, when in fact that was an estimated average.

“The omissions notwithstanding, we do not find the content of the flyer and its cover letter or the advertisements to be purely partisan in violation of the publicity or propaganda prohibition,” Gamboa wrote.

“This is not to say that the content is totally free of political tone,” he added. “Without a doubt, the future of the Medicare program is the subject of ongoing and highly spirited discussion and debate at the national level. In this context, the references in the flyer and print and television advertisements to ‘Same Medicare. More Benefits’ and ‘preserve and strengthen’ may appear to some as an attempt to persuade the public to the Administration’s point of view regarding the newly enacted benefit.”

Nonetheless, he wrote, the “publicity or propaganda prohibition, however, does not bar materials that may have some political content or express support for a particular view. … The content of these publications does not constitute a purely partisan message.”

Two months later, however, GAO said during the course of its investigation, “we learned that the Centers for Medicare & Medicaid Services … had prepared as part of this campaign video news releases or VNRs, including a news story for television broadcast, to provide information to the television medium.” Because the prepackaged stories did not note they had been prepared by CMS, the GAO concluded their use ”violated the restriction on using appropriated funds for publicity or propaganda purposes.”

The White House further noted that in 2002, the Bush administration paid more than $3 million for two Super Bowl ads that said buying illegal drugs could help support terrorists; it also created anti-drug YouTube ads in 2006.

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