Written by David Mills — Fact checked by Jill Seladi-Schulman, Ph.D.
There isn’t any direct mention of Medicare cuts in the Trump bill, but there are measures that could impact people who are enrolled in the program.
Under a 2010 budget mechanism law known as PAYGO, which is tied to the national debt, the Congressional Budget Office estimates the Trump bill could trigger $500 billion in Medicare cuts between 2026 and 2034.
Those cuts would be in provider reimbursements, which are payments made by Medicare to doctors, hospitals, and other healthcare providers.
The Health Foundation for Western & Central New York states that these reimbursement reductions could cause healthcare providers, especially specialists and rural facilities, to stop accepting new Medicare patients or even discontinue Medicare altogether.
In addition, the Center for Medicare Advocacy reports the bill will also reduce the number of people eligible to receive Medicare. They say some non-citizens who meet Medicare eligibility requirements through work history or residency length will no longer be covered.
“This represents a major policy shift. While undocumented immigrants have never been eligible for Medicare, lawfully present individuals who worked and paid into the system have historically been able to qualify for Medicare benefits,” the center states.
The new eligibility requirements are scheduled to take effect on Jan. 1, 2027.
The Kaiser Family Foundation reports that the $793 million in cuts to Medicaid services could affect 22 million people aged 50 and older who now use the low-income health program.
Kanwar Kelley, MD, a specialist in otolaryngology, head and neck surgery as well as obesity medicine and lifestyle medicine and the co-founder and chief executive officer of Side Health, says these reductions put older adults in a predicament.
“This bill boasts savings, but at the expense of decreasing access to care, especially in a population that is closest to retirement,” Kelley told Medical News Today. “The cuts in funding will restrict their access to care and cause changes in planning for retirement, due to budget constraints or the need to continue working to continue coverage into later life.”
The Inflation Reduction Act of 2022 gave Medicare officials the power to negotiate prices for certain high-cost medications, with the first negotiated prices taking effect in 2026.
The Wall Street Journal reports that the bill could help reduce the prices of some drugs. However, it states that the bill also delays Medicare price negotiations for other drugs, including the cancer-fighting medication Keytruda. Other drugs, such as the myeloma treatment Darzalex, will be excluded entirely from Medicare negotiations.
The Center for Medical Advocacy reports that the bill also carves out “orphan drugs” (medications for rare diseases) from this negotiation process, limiting Medicare’s ability to control costs for some of the most expensive medications.
Gerard Anderson, PhD, a professor in health policy and management at the Bloomberg School of Public Health at Johns Hopkins University, notes that older adults could be impacted.
“About 40 percent of Medicare beneficiaries receive low-income subsidies, a cost-sharing program within Medicare Part D that makes prescription drugs more affordable,” Anderson said in a news release from the university. “This law reduces the amount of the premium support these beneficiaries receive. This means [low-income subsidy] recipients will pay more for prescriptions.”
Experts say the bill will reduce the number of people enrolled in Affordable Care Act (ACA) health insurance programs as well as increase premiums on those who kept their plans.
The Kaiser Family Foundation estimates that more than 5 million people ages 55 to 64 are now receiving health insurance through the ACA, also known as Obamacare.
The foundation says the bill’s changes to shorten the enrollment period, impose new documentation requirements, and eliminate automatic re-enrollment will make it more difficult for older adults to sign up for ACA programs.
They also note that the bill does not extend enhanced ACA premium tax credits that are set to expire at the end of this year. That means enrollees with incomes more than four times the official poverty level would lose subsidy eligibility. Those with incomes between 100% and 400% of the poverty level will receive a smaller tax credit.
The foundation estimates that more than half of Obamacare enrollees with incomes above four times the poverty threshold are between the ages of 50 and 64. They note that premiums are generally higher for this age group because they need more medical attention.
The Kaiser Family Foundation states that the new law will reduce federal funds for nursing care facilities and will likely lead to reductions in spending for other long-term care services.
The bill also prohibits the implementation of a Biden Administration rule on nursing facility staffing. The rule aims to help address long-standing concerns about inadequate staffing and the quality of care.
The bill also reduces Medicaid funds available to nursing facilities through a moratorium on provider taxes (in place for nursing facilities in 46 states) and new limits on some payments to nursing facilities (known as state-directed payments).
The foundation also states that substantial cuts to federal Medicaid spending could lead to reduced spending for home care, which includes long-term care provided in people’s homes and the community.
“Restricting or removing access to this care will be difficult with a growing aging population,” Kelley said. “The bill also delays staffing requirements, which will worsen gaps in care for the same aging population.”
Miller Morris, MA, MPH, a women’s health researcher and founder of the menstrual health Comma, a service focusing on menstrual health, said the bill’s provisions might be particularly harsh on older women.
“Women’s unique healthcare needs do not end at menopause. Cancer screening, menopause care, and blood pressure and chronic condition monitoring are all crucial services for women over the age of 50,” Morris told Medical News Today.
She noted that many of these health services are provided by Planned Parenthood, an organization she says is under attack in the bill.
Miller added that women tend to live longer than men and therefore comprise a majority of nursing home residents.
“The bill blocks national minimum staffing requirements for nursing homes, thus threatening the safety and health of women this standard is meant to protect,” Morris said.
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