The date at which a key trust fund underpinning Medicare’s hospital benefit is expected to go broke is inching up, largely due to the GOP’s “Big Beautiful Bill” passed last summer, according to new government projections.
The Hospital Insurance (HI) trust fund is set to run dry in the second quarter of 2033, one quarter earlier than previously expected, after the sweeping reconciliation legislation permanently cut taxes that had flowed into Medicare’s coffers, according a report released Tuesday by the Medicare trustees.
“There’s not a lot of movement in the HI depletion date,” CMS Chief Actuary Paul Spitalnic said during a briefing from the American Enterprise Institute on the trustees’ report Wednesday. But “lower taxation means ... there’s a little less income coming in.”
Republicans have cheered tax cuts in the “Big Beautiful Bill,” which was jammed through a closely divided Congress despite unified opposition from Democrats last year. The legislation lowered taxes and created a temporary deduction for Americans aged 65 or older, shrinking Medicare revenues that come from taxing Social Security benefits.
That’s hastening Medicare’s insolvency — a towering deadline that’s dogged the program for years, and one with major implications for the 70 million elderly and disabled Americans who receive health insurance in the program and would see their benefits reduced if the fund expires.
The “Big Beautiful Bill” is shrinking the HI’s revenues as a tsunami of forces coalesce to add more stress on the embattled trust fund, which pays hospitals and providers of post-acute services and also covers some of the cost of private Medicare Advantage plans.
More and more Americans are aging into Medicare, while at the same time the number of workers paying into its trust fund is dropping — a trend accelerated by the Trump administration’s ouster of immigrants, experts say.
More seniors are also selecting privatized Medicare Advantage plans, which cover seniors at a higher cost than traditional Medicare, according to the trustees. Currently, about 51% of Medicare beneficiaries are in MA, but the trustees expect that share to rise to 56% by 2035.
Meanwhile, spending on certain provider services is expected to grow at a rapid clip in the coming years. The trustees forecast substantial increases in costs for hospital services, skilled nursing facilities, home care and hospice.
These stressors are slightly offset by lower Medicare spending than expected in 2025, leaving the HI trust fund with stronger reserves. Reserves should increase further this year, as income brought in from taxes exceeds costs, the trustees said.
But the fund will likely return to operating at a deficit in 2027 — a pattern that will continue until the fund’s resources are eventually depleted in 2033.
It’s worth nothing that there’s a large degree of uncertainty in the trustees’ projections, which vary based on macroeconomic forces in a given year. That can result in big changes in the insolvency date.
For example, in 2020 during the early days of COVID-19, the board predicted the hospital trust fund would run out by 2026. That deadline was pushed back to 2028 and then 2031 in subsequent years, as more care shifted to cheaper outpatient settings and America enjoyed a broader economic rebound.
The Medicare trustees’ HI exhaustion date of 2033 is also significantly more dire than the results of a similar analysis run by the Congressional Budget Office. The nonpartisan watchdog thinks the fund will last until 2040.
Though, the CBO moved up that deadline a monumental 12 years because of tax cuts in the “Big Beautiful Bill,” while the trustees are only nudging theirs forward by a quarter.
However, the trustees’ report relies on more recent data than the CBO’s, according to Spitalnic. In addition, the forces shaping Medicare’s revenue and spending have stabilized since COVID-19, suggesting 2033 may be a more reliable estimate than predictions in past trustees’ reports.
The HI depletion date has “bounced around somewhat” but “over the last two years has been relatively stable,” the chief actuary said. “It is important to note, though, that 2033 is only seven years away.”
If the trustees’ latest projections are accurate, the HI trust fund will become insolvent when today’s 58-year-olds first become eligible for Medicare. At that point, the hospital trust fund will have inadequate income to fund those benefits.
Medicare payments would immediately be cut by 11% under current law. Those cuts would grow over time, disrupting services for seniors and reimbursement for providers.
Costs to another fund that pays Parts B and D, called the Supplemental Medical Insurance trust fund, are also climbing, increasing pressure on beneficiary budgets and the federal budget.
The Supplemental Medical Insurance trust fund is largely funded by premiums and general revenue that resets each year and doesn’t face the same solvency concerns as the HI fund. But it’s still illustrative of Medicare’s growing drain on the nation’s resources, experts say.
In particular, Spitalnic called out significantly higher projected spending on Medicare’s Part D prescription drug benefit, in part due to increasing utilization of GLP-1 drugs, which are in demand for weight loss and other benefits. More Americans are also getting access to expensive specialty drugs due to pharmaceutical companies expanding patient assistance programs, he said.
Those forces are putting notable upward pressure on Part D spending, despite price negotiations curbing Medicare’s drug costs in the near term, according to Spitalnic.
Still, “SMI never faces depletion” so it’s always less of a focus — “even if it’s growing more than we can afford,” said Jim Capretta, a senior fellow and the Milton Friedman Chair at the American Enterprise Institute.
Trustees have been ringing warning bells about insufficient Medicare funding for years. The HI trust fund hasn’t been adequately financed since 2003, and this year’s report triggers an official Medicare funding warning for the ninth consecutive year.
“Much of that has been ignored,” Capretta said. “That doesnt mean, however, the problem is going away.”
To date, Congress has not allowed Medicare to go under. But legislators’ lack of action despite years of warnings has caused heartburn for Medicare advocates, physician lobbies and budget hawks.
The easiest fixes — raising taxes or cutting benefits — are politically unappetizing. Still, experts have urged lawmakers to respond sooner rather than later, given many reforms to stabilize Medicare could take some time to go into effect.
“The projections in this report show that change is needed to address Medicare’s financial challenges,” the trustees wrote. “The sooner solutions are enacted, the more flexible and gradual they can be. Introducing reforms early would give affected individuals and organizations — including health care providers, beneficiaries, and taxpayers— more time to adjust their expectations and behavior.”
Top Democrats said that the report “demonstrates the urgent need for Congress to act” in a statement following its release.
Still, it’s unlikely the findings will spur a deadlocked Congress into action, especially as November’s midterm elections eat up much of the political conversation.
Other reforms that could curb Medicare spending, like implementing site-neutral payments or reducing overpayments in MA, have bipartisan support but aren’t a policy priority on the Hill, especially as the Republican-led Congress focuses on funding immigration enforement agencies and avoiding another government shutdown weeks before the midterms.
