Surprise! GOP Medicaid Massacre bill is also a Medicare Massacre bill!

Pennsylvania Democratic Representative Brendon Boyle, on MSNBC last night:

Rep. Boyle: The one thing I would point out, though, is this bill is actually significantly worse [than the GOP's ACA repeal attempt in 2017], because this piece of legislation will throw 13.5 million, almost 14 million Americans off their healthcare.

First, you're cutting people off Medicaid. But second, this does include very deep cuts to Obamacare as well. And finally, I have breaking news for you tonight, that literally just came out in the last few minutes as I've been sitting here: The nonpartisan Congressional Budget Office, the official authority on these figures, has now confirmed that this bill, in addition to Medicaid cuts, in addition to Obamacare cuts, includes $500 BILLION WORTH OF CUTS TO MEDICARE that is now in this bill as well.

Lawrence O'Donnell: That is breaking news...$500 billion in cuts to Medicare. That's the biggest cut to Medicare ever contemplated by the Congress. There have been, over the years, trims to Medicare for budget reasons, but nothing on this order has ever been done to Medicare. What happened? Talk more about that, about that breaking news piece that the CBO has projected in here. Is that because of interactions that Medicare has with the Medicaid program?

Rep. Boyle: Yeah, and forgive me this...given your great experience on the Senate Finance Committee, you'll understand this, but it does get a bit wonky for normal folks. Basically it's because of those interactions and specifically because of a provision called "Paygo" that will force a certain amount of Medicare sequestration, again, to the tune--and these aren't my figures, these are the Congressional Budget Office official figures--$500 billion.

So they take the biggest cuts to Medicaid in American history. They take massive cuts to Obamacare. And then, add on top of that, the impact of all their policies mean a result of the biggest cuts to Medicare in American history on top of all of it.

Sure enough, here's the actual letter to Rep. Boyle from the Congressional Budget Office:

Re: Potential Statutory Pay-As-You-Go Effects of a Bill to Provide Reconciliation Pursuant to H. Con. Res. 14, the One Big Beautiful Bill Act

Dear Ranking Member Boyle:

Today the Congressional Budget Office transmitted an estimate of the budgetary effects of the 2025 reconciliation bill, as ordered reported by the House Committee on the Budget on May 18, 2025. 1 CBO has not yet completed estimates of the effects of interactions among the titles of the legislation.

This letter responds to your questions concerning the sequestration (the cancellation of budgetary resources) in accordance with the Statutory Pay‑As‑You‑Go Act of 2010 (S-PAYGO) that would occur if an enacted bill raised deficits by $2.3 trillion over 10 years.

Under S-PAYGO, the Office of Management and Budget (OMB) is required to maintain 5- and 10-year scorecards that it updates with the estimated cumulative changes in revenues and outlays generated by newly enacted legislation.

If either scorecard indicates a net increase in the deficit, OMB is required to order a sequestration to eliminate the overage. The balance used to determine the amount of a sequestration is not the projected increase in the deficit for that particular year. Rather, OMB’s 5- and 10-year scorecards identify the average annual effects of a piece of legislation over those periods and assign the average to each year in the period. Before an average is calculated, any current-year effects are combined with those for the budget year.

Would Enactment of Legislation That Increases Deficits by $2.3 Trillion Over the 2025–2034 Period Trigger Sequestration?

Yes, in accordance with S-PAYGO, OMB would record the average increases in deficits over the period, in this case $230 billion each year, on the PAYGO scorecard. Without enactment of subsequent legislation that would offset the deficit increase, waive the recordation of the bill’s effects on the scorecard, or otherwise mitigate or eliminate the statutory requirements, OMB would be required to issue a sequestration order not more than 14 days after the end of the current session of Congress (excluding weekends and holidays) to reduce spending by $230 billion in fiscal year 2026 (or by a larger amount if the 5‑year average increase in deficits was greater than the 10-year average).

How Would Sequestration Affect Medicare and Other Programs, Assuming That Funding Subject to Sequestration Remained Equal to the Amounts in CBO’s January 2025 Baseline Projections?

Under S-PAYGO, reductions in Medicare spending are limited to 4 percent— or an estimated $45 billion for fiscal year 2026. That would leave $185 billion to be sequestered from the federal budget’s remaining direct spending accounts in that year.

S-PAYGO exempts many large accounts, including those that provide funding for Social Security and low-income programs. Therefore, in CBO’s estimation, OMB would have roughly $120 billion in budgetary resources available for cancellation in 2026—less than the remaining amount that would be required to be sequestered.

How Would Medicare Be Affected After 2026?

The 4 percent maximum reduction in Medicare spending would apply to sequestration orders for years after 2026. If OMB ordered a sequestration of $230 billion for each year through 2034, the ordered reductions in Medicare spending would increase to about $75 billion in 2034 and would total roughly $490 billion over the 2027–2034 period.

How Would All Other Programs That Are Subject to Sequestration Be Affected?

After accounting for the reduction in Medicare spending, the required reduction in spending for other programs would exceed the estimated amount of resources available to those programs in each year over the 2027–2034 period. If OMB sequestered all of the funding for those programs, the total amounts would be less than the reductions required by S-PAYGO.

I hope this information is useful to you. Please contact me if you have further questions.

So, if I understand this, the net total in Medicare cuts would amount to around $45 billion in 2026 plus another $490 billion from 2027 - 2034, or $535 billion total...plus another $185 billion from other programs even though there's apparently only $120 billion available to cut, which Rep. Boyle didn't even get into.