In less than a year, Trump erased 12 years of solvency for the trust fund that pays for Medicare Part A | Fortune

This rapid deterioration of Medicare’s financial solvency represents a stark drop from the CBO’s previous estimate, which was published just last year, in March 2025. The dramatically shortened timeline means future retirees could face significant cuts to vital health care services far sooner than previously anticipated. As required by the Deficit Control Act, CBO Director Phillip Swagel noted the projections reflect the assumption benefits would be paid as scheduled even after the HI trust fund was exhausted. 

The primary culprit for this accelerated depletion is a sharp reduction in the fund’s projected income, heavily driven by legislation passed over the last year. Specifically, the 2025 reconciliation act (Public Law 119-21, more commonly known as the One Big Beautiful Bill Act) significantly reduced the revenues the trust fund normally receives from taxing Social Security benefits. This legislation lowered tax rates and established a temporary deduction for taxpayers age 65 or older. Consequently, this major policy shift enacted during the Trump administration has directly contributed to starving the Medicare safety net of critical future funding.

What is the HI trust fund?

The HI trust fund is the financial backbone for Medicare Part A, which covers essential services including inpatient hospital care, stays in skilled nursing facilities, home health care, and hospice care. Over the next 30 years, the fund is expected to rely on the Medicare payroll tax for about three-quarters of its annual income, with another roughly one-eighth derived from income taxes on Social Security benefits.

However, the recent tax cuts are not the only factor draining the fund. The CBO also cited decreased projections for payroll tax revenues, warning it had to adjust their models to account for lower expected worker earnings. Furthermore, because the trust fund will have smaller balances going forward, it will generate less interest income, creating a compounding negative effect on its overall finances.

On the other side of the ledger, Medicare spending is rising faster than anticipated. The CBO noted per-enrollee spending in Medicare Part A’s fee-for-service program in 2025, along with 2026 bids by Medicare Advantage plan providers, both came in higher than expected.

The consequences of the fund’s exhaustion in 2040 would be severe for both seniors and health care providers. By law, if the trust fund runs dry and spending continues to exceed income, Medicare would be legally restricted to paying out only what it takes in. To make up the shortfall, total benefits would need to be slashed. The CBO estimates these benefit reductions would start at 8% in 2040 and steadily climb to a 10% cut by 2056. It currently remains unclear exactly how the Centers for Medicare & Medicaid Services would manage the program under such dire financial constraints.

Addressing this looming crisis will require significant legislative action. The fund currently faces a 25-year actuarial deficit of 0.30% of taxable payroll—a figure representing the total amount of earnings subject to the payroll tax. This deficit is 0.17 percentage points worse than last year’s projection. To eliminate this deficit and restore the 12 years of solvency lost over the last 11 months, lawmakers will be forced to increase taxes, reduce health care payments, transfer money into the trust fund, or implement a combination of these politically fraught approaches.

Notably, these already grim baseline projections remain highly uncertain and do not yet account for the potential economic or budgetary fallout from the recent Supreme Court ruling on tariffs (Learning Res., Inc. v. Trump, issued on February 20, 2026).