WASHINGTON (AP) — Automatic cuts to Medicare could be triggered due to budget deficits arising from President Donald Trump’s tax and spending legislation, unless Congress intervenes, according to a report released Friday by the nonpartisan Congressional Budget Office (CBO).

The CBO projects that Medicare, which provides health insurance to Americans over 65, could experience up to $491 billion in cuts between 2027 and 2034. This is a consequence of a 2010 law enforcing automatic reductions to federal programs when laws increase the federal deficit. These findings highlight the strain Trump’s tax and spending law places on cornerstone federal programs forming part of America’s social safety net.

Despite assurances from Trump and fellow Republicans that Medicare would remain untouchable, the legislation’s addition of $3.4 trillion to the federal deficit over ten years implies that Medicare programs might still face reductions. Historically, Congress has intervened to alleviate cuts to Medicare and similar programs, necessitating bipartisan efforts to achieve this once again.

Democrats, who requested the analysis from CBO, jumped on the potential cuts.

“Republicans were aware their tax concessions for billionaires would lead to over $500 billion in Medicare reductions — yet proceeded regardless,” stated Rep. Brendan F. Boyle, the senior Democrat on the House Budget Committee. “American families cannot sustain Donald Trump’s onslaughts on Medicare, Medicaid, and the Affordable Care Act.”

Rural hospitals are already struggling with Medicaid cuts—which serves low-income individuals—and further Medicare reductions could worsen these financial challenges.

As Republicans advance the bill through Congress and present it to constituents, they have been sharply critical of the CBO’s analysis. They argue that the tax cuts will stimulate economic growth and highlight the $50 billion allocated for rural hospitals included in the legislation.

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