This article demonstrates how government files are objects imbued with affects that reflect the electoral tensions which Delhi’s bureaucrats navigate. With files as its key instrument, affect becomes a central technology of governmentality that supports a state logic which is more often concerned with electoral outcomes than with clinical ones. This article traces two ethnographic cases. First, I outline the pathway of my own research permissions file within Delhi’s health bureaucracy to demonstrate the affective load of files. Second, I draw comparisons to other types of files within Delhi’s health bureaucracy to show how the lack of signatures on files has systemic effects on Delhi’s healthcare system. Delays in the movement of files lead to delays in patients accessing healthcare services and limits healthcare availability. This article contributes to studies of medical anthropology and the state by conceptualising the affect of electoral politics as a technology of biopolitics.