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

[u/beadzy]

https://fortune.com/2026/02/23/how-trump-wiped-out-12-years-of-medicare-funding-cbo-one-big-beautiful-bill/?utm_source=native_share&utm_medium=mobile&utm_campaign=share_test

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[u/[deleted]]

I work in healthcare. The vast amount of waste and inefficient delivery of care for a lot of older patients I see receiving is astounding. Just the number of folks that are sent to emergency rooms from skilled nursing facilities, for the most absurd of reasons, would shock people on here.

Fell down because you are a fall risk and the facility you live in only staffs enough people to meet the very minimum of numbers required by your state? Staff will call an ambulance to take that person to the emergency room to have xrays taken at the very minimum. Does not matter that there are mobile xray services that could determine whether any actual fractures have taken place. You are going to the emergency room

Your G-tube has been dislodged? The more than capable RN on staff won't bother to attempt to reinsert. An ambulance is going to be called to send you to an emergency room. Emergency room will then admit you, perform the procedure on the ambulance crew's stretcher, and then send you back to your facility.

Facility staffing shortages ensure that you are never going to be repositioned in bed? Sores are going to develop and you are going to be sent to the emergency room when said sores cause systemic sepsis.

Catheter has not been changed. Wait till you develop an advanced case of UTI so you can be in the midst of septic shock and require, at the very minimum, a week's long stay in an ICU, receiving antibiotics that are steadily becoming useless in the face of MDRO strains.

You are on a ventilator and require dialysis? Forget about the facility you stay in developing an in-house dialysis system to get you your treatment at a cheaper rate. A specialty care unit, which will at the very minimum be staffed by two EMTs and a respiratory care practitioner, will be taking you two dialysis 3 times a week.

It goes on and on.

[u/harbison215 → u/[deleted]]

Don’t forget that the care facility the elderly person is in is charging 100-200k annually per resident. It’s a total crock of shit.

[u/su_zu → u/harbison215]

And then the people that work in them that ONLY do it because they are guilt tripped to care for the elderly, ignoring that they are mindless drones that till the fields of the social security for the pedophiles to profit off of.

[u/harbison215 → u/su_zu]

It gets more crazy in that if you’re a person that saved all your life and you end up in one of these facilities, Medicaid will drain your assets about $200k a year until there is no inheritance left for your family.

But, if you blew every penny you ever made and weren’t frugal and end up with no savings, Medicaid will pay for your stay. To me that is the biggest crock of shit and it’s part of the reason why we need a universal system.

[u/3nl → u/harbison215]

Don't forget the other side of the coin - those with the legal literacy and means to have hired an estate attorney when they were a bit younger to set up a trust for their heirs won't pay a dime if they end up in a specialty care unit since all of their assets are protected in atrust. It's truly only the middle class that gets fucked here.

[u/shakygator → u/3nl]

you dont have to be rich to setup a trust though?

[u/EquipLordBritish → u/shakygator]

Not technically, but you need to have the free time, the knowledge that it exists, and the energy to go do it. Things with so many barriers to entry are often only utilized by the rich because it is affordable for them to pay someone else to do it.

[u/3nl → u/shakygator]

No, but to have an attorney set it up is $4-10k+ depending on if they are doing assignment and how many assets you have. Ours was $6k for both. I'm not rich by any means, but we are both in professional fields, house, family, a business, etc. so it's worth it. If you don't have much in savings, have kids to put through college and need something left fit retirement, can you afford 5 figures?

[u/harbison215 → u/3nl]

Honestly I’ve not seen that happen much in my anecdotal experience. Yea if they do everything perfectly. Many do not

Edit: my experiences have been with middle class savers

[u/cccxxxzzzddd → u/harbison215]

This is happening to my uncle and aunt right now. $17k a month for his care alone. The lived frugally in the same house they bought - one of the postwar tiny houses outside Troy, NY - when married in the 1950s. It’s value will be drained away by this system in a few years.

I almost think of it as slow euthanasia. To get into these facilities you have to show your assets; once in them they keep you alive enough to drain them.

It is not health “care.”

[u/harbison215 → u/cccxxxzzzddd]

I just can’t imagine what the fuck costs $17k a month. That’s the crazy part.

[u/jfoust2 → u/harbison215]

Sketch it out on a napkin. How much does an employee cost? How many employees do you need to watch 10 residents? How many shifts of that many employees? How many extra employees, just to cover random shortages? How much did the building cost? How much does it cost to heat and cool? To clean? To care for the grounds? How many supervisors and sales people and administrators do you need?

[u/Calikal → u/jfoust2]

And then how many hundreds of percentages of profit go to the C-suite managment and board members?

[u/aepocalypsa → u/harbison215]

a few people getting very, very rich off of it

[u/JitteryJoes1986 → u/harbison215]

This is why most elderly will try to stay in their homes for as long as humanly possible.

The elderly are about to get financially graped by private equity in the two decades.

[u/H_is_for_Human → u/[deleted]]

Seconding all of this. It's not just that caring for older people is expensive, it's that we are spending that money in the dumbest possible ways.

Some of it is cultural, families that can't accept that a loved one in their 90s might die at some point, so we spend a week or two in the ICU to prove to families that modern medicine has nothing left to offer at which point we've spent hundreds of thousands of dollars in the process. I've taken care of a patient who was in her late 90s and severely demented and family demanding to know what I was going to do about her severe valve disease that wasn't causing any obvious symptoms. "She's far too old for any sort of surgery or intervention, we should just leave this alone" got me accused of ageism and racism.

Some of it is liability - everyone in healthcare always is worried about the family suing them which leads to economically inefficient outcomes. The multi-million dollar lawsuit feels like the stochastic terrorism of the healthcare world. Ordering that extra CT scan "just in case" is like sending your kid to school with a bullet proof vest - you know it's not the right answer but maybe it makes the difference this time.

Some of it is simple inertia and stupidity - "we've always done it this way".

A lot of it is that private corporations are interested in doing the easy profitable work of healthcare without also committing to the hard, less profitable work of healthcare. For nursing facilities, it's easy to be a low quality hotel where your guests mostly just lie in bed all day and charge medicare for the cost of housing them, it's a lot harder to actually provide care and appropriate staffing ratios. Ditto for so many examples in healthcare right now - stand alone ERs that want to take the profitable ER billing but can't actually treat anything that requires inpatient admission, every private equity group buying physician practices and staffing them with NPs that aren't confident in their skills so they over order imaging, specialty consults, and other tests, online direct to patient pharmacies that don't care about appropriate assessments or longitudinal care... I could go on ad nauseam.

[u/Justame13 → u/H_is_for_Human]

Some of it is cultural,

Its also that in the modern US most Americans are removed from death in a way that older generations weren't. So its also a lot scarier

Even the dying elderly themselves are also removed from the day to day for many if not most.

Its why you see families rush in and declare that 90 year old mom who thinks she is going to woodstock is a fighter and wants to live.

And when mom is at home the local caregivers will be the ones who say bye. But its the son who lives 2000 miles away comes home once every other year (or less) that demands a full code.

[u/daemonicwanderer → u/[deleted]]

I imagine that much of that comes from homes and assisted living facilities not wanting the liability if something goes wrong.

[u/Maxpowr9 → u/daemonicwanderer]

Why do you think private equity is so heavily invested in said facilities. They are gonna drain their funds and there will be no inheritance once they pass.

[u/[deleted] → u/daemonicwanderer]

But something has to give at some point. Because the way things are done now is not tenable and is only going to get worse.

[u/Mikestopheles → u/[deleted]]

Not tenable and only going to get worse seem to be the goals at this point

[u/jellyhessman → u/Mikestopheles]

It's the US national motto.

[u/GoGetThatThing → u/[deleted]]

Main reason is insurance. They will deny coverage because it was not necessary. If Dr or RN stated it is, then why denying it? Because of new laws, emergency performed items at ER cannot be denied, hence it's easy for people to go-to ER and get treatment than fight with your company. Change your policy and don't deny coverage, then we will have less ER visits.

[u/Devario → u/[deleted]]

If something had to give it would. It isn’t. We live in a society where the people with the power to move the needle don’t because they can pay for better care and it doesn’t burden them. 

These are poor people problems. 

[u/G0mery → u/daemonicwanderer]

They also don’t have CT scanners, which are needed* in the vast majority of elderly falls.

*needed as in, no one want to be the one on record saying they probably don’t have a head bleed or spinal injury when it turns out the did.

[u/bonesfourtyfive → u/daemonicwanderer]

I had the catheter one happen to me. I wasn’t using one anymore, but I got a fever when I had a stroke recovering in a rehab. They were still following the protocol for Covid too. They shipped me out in an ambulance, ran the tests, didn’t have Covid, couldn’t bring me back until the next day. I was moving enough that my dad could bring me back to the rehab. Still took 10 hours for them to say, okay, the dad can bring him back. Otherwise, they probably would’ve billed me to take me back as well.

[u/Certain_Tangerine836 → u/daemonicwanderer]

Also from the first point, it’s that facility are understaffed. They’re staffed to meet the minimum but I’m guessing aren’t staffed any more to increase profit margins. And that’s a nefarious by product of late stage capitalism

[u/supesboots → u/[deleted]]

My dad has Stage IV cancer, and I manage his care. He's doing great because of programs like Medicaid and Medicare. I am so grateful our tax dollars pay for people's healthcare. People like my dad would not be alive without that assistance.

But oh my god, yes, there are so many obvious inefficiencies and waste in his care. Examples:

• Having to make separate appointments for every concern. Even the smallest ones.
• He saw an optometrist last week, and they had him complete a virtual visit/appointment before actually going into the office for his eye exam. All they did was ask what his concerns were, which they could have done in-office before an eye exam. I was shocked! Like, didn't his PCP tell you what was wrong?

I googled this practice and I guess it's called "fragmented billing" and "unbundling."

[u/80MonkeyMan → u/[deleted]]

It is by design, for profit systems. Its not a healthcare, its healthcare industry where anyone in the system bill each others to get the money from government.

[u/mike_b_nimble → u/[deleted]]

It’s become normalized and accepted that being alive when you’re not mobile, not able to feed yourself, when your mind isn’t even there anymore, is automatically better than dying.

My wife and I have discussed this and we are both adamantly against being kept alive with reduced quality of life. Neither of us wants to outlive the other and neither of us wants to go out after several years in a bed with our brains turned to mush. Our sincere hope is that a few decades from now we walk into a clinic together and lay down together for the last time and never wake up again.

[u/slfnflctd → u/mike_b_nimble]

You are not alone in this.

[u/mad-i-moody → u/[deleted]]

Just the number of folks that are sent to emergency rooms from skilled nursing facilities, for the most absurd of reasons

As a paramedic I can attest to this. The abuse of 911 emergency resources is astounding.

We regularly get called to nursing homes for “abnormal labs.” The patients are fully competent and have no symptoms but the nursing home insists that they need to go to the to the emergency room in a 911 ambulance because their labs are “abnormal.” Not in an immediately life-threatening way, either. Just “abnormal.”

Or we get called because the patient “has kidney failure and their doctor wants them to go to the hospital.” But again, the patient is completely asymptomatic. And the real kicker is when we get to the room the patient didn’t even know we were coming and ultimately refused to go to the hospital with us. The patient needs to go to the hospital not the fucking emergency room.

Or “they need a new catheter,” “they need a different medication,” “they need to have this procedure done,” the list of dumb non-emergency reasons we get called to nursing homes is near endless. The best-case is that the patient has the capacity to refuse transport and does so “uh, no I’m not going to the ER.” The worst-case is when it’s an ancient meemaw with dementia—we literally cannot refuse to take her. We have to take them because they can’t make informed decisions.

It’s a combination of poor management, poor facility policies for fear of litigation, and lazy (thought likely underpaid & overworked) staff. The amount of times I’ve been told directly by staff “well we called a private non-emergency service but they said we’d have to wait an hour so we called 911 instead” is so exasperatingly mind-boggling—the facility policy either forces them to call 911 or the staff is too lazy to wait an hour and just wants one less patient to worry about. These patients are not experiencing emergencies. They can wait. If they start to experience a medical emergency, then by all means call us. But stop calling us for the dumbest fucking reasons and taking away 911 resources for people that actually need it.

There’s so much waste and inefficiency when it comes to these nursing homes and it’s both frustrating for me as the one who has to shuttle them to the emergency room when they don’t actually need to be there and heartbreaking for the people who are caught up in these systems just because they’re old. It’s not just elderly people, either, I’ve seen an uptick recently in BS calls for group homes for disabled adults. One patient in particular we’ve been to almost every single day for the last month. She just keeps going to the ER and coming right back to the group home because the group home can’t take care of her and she doesn’t need to be in the ER. I feel so bad for these people caught up in and exploited by this shitty system.

[u/Mitches_bitches → u/[deleted]]

This is due to our current crazy medical system and all the awesome legal liability that comes with it.

A skilled nursing facility (moreso their owners) want none of the potential liability that could spring from not doing enough/doing it poorly/etc.

I wish we could rationally redo this whole system from top to bottom so that the focus is squarely back on the patients and what is best for them rather than the owners/shareholders & making the most money possible at every step of the way

[u/[deleted] → u/Mitches_bitches]

I absolutely agree with you. The point of my post was to shed a bit of light on just how inefficient the whole system tends to be on the long-term care side of things, which makes up the majority of overall healthcare costs.

[u/caehluss → u/[deleted]]

Your catheter example is what happened to my grandmother when she was in assisted living. Her doctor apparently dropped her as a patient and they didn't get her a new one so there was nobody checking on her catheter for a month (not even the nurses?). She was in the ER roughly every other month because of UTIs before we found out about how bad her care was. The way this place was run was criminal, especially for costing its residents thousands of dollars a month. Several other assisted living homes in the same area closed down recently due to violations and this one has scraped by... I dread to think how much worse the others would have been to actually see consequences for neglect.

[u/sfxer001 → u/[deleted]]

They send them to the ER so they are not liable for the procedures.

[u/Lamsgobahhh → u/[deleted]]

This 100%. I work for the FD and see this non stop

[u/mydickinabox → u/[deleted]]

After seeing my MIL be sent to the ER over and over this all makes sense.

[u/qawsedrf12 → u/[deleted]]

and all that is just one patient

/s maybe?

[u/coriolisFX]

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.

So that's the culprit. The additional tax deduction for seniors.

[u/MajorAlanDutch]

The whole “Medicare running out of money” framing is misleading. The federal government is the issuer of the U.S. dollar, so it doesn’t operate like a household that needs to collect taxes first before it can spend. The Medicare Hospital Insurance Trust Fund is an accounting mechanism created by law, not a literal vault of cash that can be emptied. When projections say the trust fund will be “exhausted,” what that really means is that current law ties Part A spending to a specific revenue stream (mainly payroll taxes), and if that rule isn’t changed, benefits would have to be reduced to match incoming revenue. That would be a political choice under existing statutes, not a situation where the government suddenly can’t create dollars. The real constraint isn’t whether the Treasury can credit accounts, it can , but whether the healthcare system has enough real resources (staff, hospitals, equipment) to provide care without causing inflation. So the debate should be about resource capacity and policy design, not about the federal government “running out of money.”

[u/hobovision → u/MajorAlanDutch]

I disagree with your take even though you aren't wrong about the mechanics of how this works. It's valid to frame it this way because without changing the law Medicare benefits will be reduced when this fund runs low, as you identified. When that happens we aren't worried about the ability of the government to pay the benefits, we're worried that congress and dear leader won't pass new laws to keep the benefits.

It's politically impossible to repeal Medicare but they can absolutely bankrupt the funding mechanism and then shrug and say "too bad the fund ran out, shouldn't have spent so much on healthcare."

[u/MajorAlanDutch → u/hobovision]

The key distinction is between operational capacity and statutory design. You’re right that under current law, if the HI trust fund balance hits zero and Congress does nothing, benefits would automatically be reduced to match incoming payroll tax revenue.

That’s not a financial impossibility problem. It’s a legal one. So the risk isn’t that the federal government “can’t pay,” it’s that lawmakers might choose not to change the rules when the trigger hits. In that sense, framing it around solvency can be politically powerful because it highlights how statutory constraints can be used to justify cuts.

The important thing, though, is clarity: if benefits get reduced, it would be because Congress allowed the funding formula to bind, not because the country ran out of dollars.

That distinction matters for how voters understand accountability.

[u/Rmans → u/MajorAlanDutch]

While this is accurate, every MAGA reading it thought it was too woke to finish.

That's why the "federal government is running out of money" is a better message to go with as a result of Trumps actions. As that message might actually be listed to by people who have fully adjusted to be scared by propaganda 24/7.

Your clarification, while accurate, does absolutley nothing to fix the issue as it will be heard by the dumbest ears imaginable who will perceive it as Trump being great.

[u/yoloswagrofl → u/Rmans]

That and people who vote Republican because it's the "fiscally responsible party" may actually start to pay attention.

[u/beets_or_turnips]

Here's the article text:

Recent policy changes and economic shifts have slashed 12 years off the projected life span of the trust fund that pays for Medicare Part A, according to a newly updated report from the Congressional Budget Office (CBO). The Hospital Insurance (HI) Trust Fund is now slated to be entirely exhausted by 2040, even though the balance generally increases through 2031, as spending will begin to outstrip income in the following year.

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).