Tax Reconciliation Bill Could Trigger $500 Billion in Mandatory Medicare Cuts
The deficits caused by the tax bill would trigger the Statutory Pay-As-You-Go Act of 2010 and force billions in cuts to Medicare, unless Congress takes action.


President Trump's new tax bill, passed in the House and now headed to the Senate, could yield billions in mandatory cuts to Medicare. That's because projected deficits in the tax bill could trigger the Statutory Pay-As-You-Go Act of 2010 (PAYGO), unless Congress acts to intervene.
The pending House reconciliation bill could lead to over $500 billion in Medicare cuts from 2026 to 2034, as projected by the Congressional Budget Office (CBO).
The CBO estimates that the bill would increase the deficit by at least $2.3 trillion compared to current law. If enacted, this deficit increase would trigger mandatory sequestration cuts under PAYGO. Notably, unlike Social Security and low-income programs, Medicare is not exempt from these potential cuts.
From just $107.88 $24.99 for Kiplinger Personal Finance
Be a smarter, better informed investor.

Sign up for Kiplinger’s Free Newsletters
Profit and prosper with the best of expert advice on investing, taxes, retirement, personal finance and more - straight to your e-mail.
Profit and prosper with the best of expert advice - straight to your e-mail.
The PAYGO Act
The PAYGO Act mandates sequestration if Congressional legislation is projected by the Office of Management and Budget (OMB) to increase the deficit on average over either a five- or ten-year period, within a session. Despite being triggered multiple times, Statutory PAYGO sequestration has been consistently waived by Congress and has therefore never been implemented.
Certain programs and types of spending are exempt from sequestration, with most of the exemptions related to mandatory spending. Exempt health programs include: Medicaid, CHIP, ACA tax credits, Medicare Part D low-income subsidies and reinsurance, and veterans' medical care. Social Security is also exempt from sequestration.
Most Medicare spending is subject to sequestration, but special rules cap the reduction percentage for Medicare and certain other programs. The Budget Control Act (BCA) limits cuts to Medicare benefits spending, encompassing payments to providers under Part A and Part B, and to plans under Part C (Medicare Advantage) and Part D, to 2%. This is less than the standard percentage reduction applied to other nonexempt mandatory spending. Under a Statutory PAYGO sequester, these Medicare benefit payment reductions are capped at 4%.
If a PAYGO sequester were to be triggered, neither the Statutory PAYGO Act nor the BCA includes any explicit directions as to how the two sequesters would be implemented alongside each other.
Congress can stop the cuts
The aim of Statutory PAYGO is to enforce budget discipline, but the automatic spending cuts have never taken effect. Congress has consistently prevented these cuts by either excluding their impact during the initial legislation or by later delaying or eliminating them.
For instance, the Tax Cuts and Jobs Act of 2017 and the American Rescue Plan of 2021 both significantly increased the federal deficit, $1.9 and $2.1 trillion respectively, without triggering automatic cuts under PAYGO because of congressional action.
Time will tell
Congress could act later this year to prevent these cuts, similar to previous years when the PAYGO cuts were triggered. However, unlike the reconciliation bill, removing the impact of legislation from the PAYGO scorecard in the Senate requires 60 votes instead of a simple majority, making it more challenging for the administration due to slim majorities in both chambers.
Related Content
Profit and prosper with the best of Kiplinger's advice on investing, taxes, retirement, personal finance and much more. Delivered daily. Enter your email in the box and click Sign Me Up.

Donna joined Kiplinger as a personal finance writer in 2023. She spent more than a decade as the contributing editor of J.K.Lasser's Your Income Tax Guide and edited state specific legal treatises at ALM Media. She has shared her expertise as a guest on Bloomberg, CNN, Fox, NPR, CNBC and many other media outlets around the nation. She is a graduate of Brooklyn Law School and the University at Buffalo.
-
The Five Best Cruise Lines for Retirees
Retirement is an ideal time for cruising. Check out the five best cruise lines for comfort, ease, and unforgettable experiences.
-
My First $1 Million: Oil and Gas Retiree, 67, Round Rock, Texas
Ever wonder how someone who's made a million dollars or more did it? Kiplinger's My First $1 Million series uncovers the answers.
-
The Five Best Cruise Lines for Retirees
Retirement is an ideal time for cruising. Check out the five best cruise lines for comfort, ease, and unforgettable experiences.
-
I'm a Retirement Coach: Eight Surprising Signs You're Ready to Retire
You've met your savings goal, your friends are having fun without you, your boss is mean to you, and your kids are grown and gone. What are you waiting for?
-
'Work Forever' Is Not a Retirement Plan: What Needs to Change for Gen Z, From a Financial Pro
Saving for retirement isn't what it used to be. The deck is stacked against Gen Z in some crucial ways. The system is broken, and we need to fix it.
-
I'm a Financial Planner: These Three Things Are Missing From Almost Every Financial 'Plan' I See
A financial plan should be a detailed road map to a worry-free retirement. Watch out: If your plan has these common holes, you could be headed for a dead end.
-
Is the One Big Beautiful Bill Really All That Great for Your Retirement?
While tax cuts sound attractive, it's still wise to plan ahead for retirement by considering strategies like Roth conversions to offset potential tax increases in the future and stealth taxes that could surprise you.
-
Average Spending by Age for Those 55 and Up: Are You Thrifty?
Everybody has their own number for how much they’ll spend in retirement. See if your's is in line with the averages.
-
I’m Not Worried About Saving for Retirement; I’ll Just Work Forever. What Can Go Wrong?
Here's why that approach to saving for retirement doesn't always work out.
-
Your State Wants to Help You Save for Retirement. Here's How
Maximize your side hustle by saving for retirement through a state auto-IRA. You may even get matching funds from a federal program in 2027.