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Medicare and Medicaid’s 60th Anniversary Overshadowed by Deficit-Driven Cuts

With automatic PAYGO rules set to slash $45 billion from Medicare next year, 80-hour monthly work requirements begin shifting Medicaid costs to states

FILE - President Lyndon B. Johnson uses the last of many pens to complete the signing of the Medicare Bill into law at the Truman Library in Independence, Missouri, July 30, 1965, with former President Harry S. Truman at his side. At rear are Lady Bird Johnson, Vice President Hubert Humphrey, and former first lady Bess Truman. (AP Photo, File)
WASHINGTON, DC - JUNE 23: Care workers with the Service Employees International Union (SEIU) participate in a living cemetery protest at the US Capitol June 23, 2025 in Washington, DC.
In this image taken from video, Amanda Hinton speaks about work requirements for Medicaid and the Supplemental Nutrition Assistance Program during an interview, Tuesday, July 1, 2025, at the Samaritan Center food pantry in Jefferson City, Mo. (AP Photo/David A. Lieb)
FILE - President Donald Trump signs his signature bill of tax breaks and spending cuts at the White House, July 4, 2025, in Washington, surrounded by members of Congress. (AP Photo/Julia Demaree Nikhinson)

Overview

  • Signed by President Donald Trump on July 4, the One Big Beautiful Bill Act imposes over $1 trillion in Medicaid cuts over the next decade
  • The law mandates that many Medicaid recipients, including parents of teenagers and older adults up to age 64, must complete 80 hours of work or community service each month to retain benefits
  • Statutory PAYGO rules will trigger sequestration that cuts Medicare spending by 4 percent—about $45 billion—in fiscal year 2026, on top of existing provider payment reductions
  • The Congressional Budget Office projects nearly 17 million more uninsured Americans by 2034 due to the Medicaid changes, and a UNC Sheps Center analysis warns that 338 rural hospitals could close beginning in 2026
  • Advocates and health-care providers are urging Congress to waive PAYGO requirements as it has in 2015 and 2017 to avert the coming cuts to Medicare and other federal programs