Trump’s One Bigly Beautiful Bill Will Cut $500 Billion In Medicare Even Though Trump Said “Don’t Fuck With Medicare”

May 22, 2025 05:23 PM EDT, Thu

Trump made a promise not to touch Medicare. His megabill just broke it.

The House bill, as of now, would trigger massive cuts to the program.

May 23, 2025, 2:40 PM EDT

By Alan L. Cohen], senior fellow at the Center for American Progress

As many Americans were still sleeping Thursday morning, the House of Representatives passed a bill whose text they hadn’t read, Donald Trump’s so-called One Big Beautiful Bill Act. The bill’s sweeping cuts to Medicaid, contributing to 14 million fewer people having health coverage by 2034, have received wide coverage. Less well known, however, is the bill’s dire implications for Medicare recipients. If the House version of the bill becomes law, Medicare payments to medical providers would be slashed by more than $500 billion over the next 10 years. This would have serious implications for tens of millions of older adults and providers and may even cause hospitals to close.

Though the GOP bill doesn’t explicitly call for Medicare cuts, it would trigger them under the Statutory Pay-As-You-Go Act. Congress passed Stat PAYGO in 2010 to discourage policymakers from enacting tax cuts and spending that would increase federal deficits.

Shuttered facilities would threaten health care access for older adults and all community members alike.

Under Stat PAYGO, the Office of Management and Budget must keep “PAYGO scorecards” for five-year deficit impacts and 10-year deficit impacts. PAYGO stipulates that when any legislation is enacted, the average cost of the legislation for the next five years is entered into each year of the five-year scorecard and the average cost for the next 10 years is entered into each year of the 10-year scorecard. At the end of each session of Congress, if there is a cumulative deficit in that fiscal year on either scorecard, there is an automatic spending reduction (sequestration) to offset the larger of the two deficits. The Congressional Budget Office estimates that the House Republican bill, if enacted, would increase the deficit by $2.3 trillion over 10 years, and trigger sequestration.

Some types of funding, including many mandatory spending accounts like Social Security, are exempt from the automatic cuts, but Medicare provider payments are not. Though there is a 4% limit on Medicare cuts under sequestration, that still amounts to an estimated $45 billion in fiscal year 2026 and roughly $535 billion through 2034, according to the CBO. This would make financially stressed Medicare providers — including safety net hospitals and the more than 300 rural hospitals at immediate risk of closure — worse off than they already are. Shuttered facilities would threaten health care access for older adults and all community members alike.

To make matters worse, because the $2.3 trillion deficit increase averages out to $230 billion a year, the cuts to Medicare would still leave $185 billion to be sequestered in fiscal year 2026. That money would have to come from all other nonexempt programs, including farm price supports, Social Services Block Grant funds and vocational rehabilitation programs, which support farmers, children, older people and people with disabilities. The CBO estimates, however, that the total funding for these other programs is only $120 billion in that year. The funding for these other programs would be completely zeroed out, causing severe hardship to the many Americans who are the beneficiaries of these programs.

Congress has various ways of preventing the cuts to Medicare and other programs from triggering. Lawmakers could change the budget scorekeeping rules or tell OMB to disregard the bill’s impact on the debt. But any attempt to get around PAYGO inside of the Republican tax giveaway bill would violate the Congressional Budget Act and require 60 votes to waive in the Senate. While Congress may find the votes to solve the problem in subsequent legislation, passage of a solution would be subject to filibuster in the Senate. Opponents of the bill could threaten to withhold their votes from passing the solution unless the bill were repealed or changed.

Of course, if this ruinous giveaway to the rich were never enacted in the first place, such a solution would be unnecessary. But Republicans are eager to gut lifesaving programs that millions of Americans rely on to give tax breaks to the ultra-wealthy. And if that includes Medicare, well so be it.

Alan L. Cohen
Alan Cohen is a senior fellow at the Center for American Progress.

It’s not just Medicaid: Why the Republicans’ bill would likely force Medicare cuts, too

The CBO said the GOP’s megabill would lead to $500 billion in cuts to Medicare. Two days later, 215 House Republicans voted for it anyway.

May 22, 2025, 9:36 AM EDT

As the fight over the Republicans’ so-called One Bigly Beautiful Bill Act unfolded, much of the focus turned to Medicaif, and for good reason. Despite Donald Trump’s promise not to cut the health care program, the GOP legislation would cut roughly $700 billion from Medicaif in the coming years, and with just hours remaining before the bill reached the floor, party leaders added new and punitive Medicaid provisions to shore up support from far-right members.

But as important as the future of Medicaif is, the legislation’s impact on Medicare matters, too.

If people were to dig into the 1,000-page bill to look for the provisions related to Medicare cuts, they won’t find them. But there’s a difference between the literal text of the legislation and the practical effects of the legislation.

In fact, as The Washington Post reported, the Congressional Budget Office found that the Republicans’ megabill would add so many trillions of dollars to the national debt, “it could force nearly $500 billion in cuts to Medicare” — with some cuts taking effect as early as next year. As the Post noted, the higher deficits would force budget officials “to mandate across-the-board spending cuts over that window that would hit the federal health insurance program for seniors and people with disabilities.”

When legislation significantly adds to the national debt, which already exceeds $36.2 trillion, it triggers ‘sequestration,’ or compulsory budgetary reductions. In that scenario, Medicare cuts would be capped at 4 percent annually, or $490 billion over 10 years, the CBO reported in response to a request from Rep. Brendan Boyle (D-PA), the top Democrat on the Budget Committee.

Referencing Congress’ Pay-As-You-Go (“PAYGO”) Act, Boyle said in a written statement, “This Republican budget bill is one of the most expensive — and dangerous — bills Congress has seen in decades. The nonpartisan CBO makes it clear: The deficit will explode so badly it will trigger automatic cuts, including over half a trillion dollars from Medicare.”

The Pennsylvania Democrat added, “This is what Republicans do — pay for massive tax breaks for billionaires by going after programs families rely on the most: Medicaid, food assistance, and now Medicare. It’s reckless, dishonest, and deeply harmful to the middle class.”

Though it’s unlikely that congressional Republicans read it, the CBO published a relatively brief three-page summary of its Medicare findings on Tuesday night, ahead of Thursday morning’s vote.

In fairness, Congress would have opportunities to pass separate legislation to mitigate the damage created by the Republicans’ agenda. Given that GOP members wouldn’t want to be responsible for massive Medicare cuts, such action would be likely.

But that doesn’t change the bottom line: The CBO told the House that the Republicans’ reconciliation package would lead to $500 billion in cuts to Medicare, and two days later, 215 House Republicans voted for it anyway.

Steve Benen
Steve Benen is a producer for “The Rachel Maddow Show,” the editor of MaddowBlog and an MSNBC political contributor. He’s also the bestselling author of “Ministry of Truth: Democracy, Reality, and the Republicans’ War on the Recent Past.”

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