We're going to need a big education push on this bill

But now Republicans have created another problem. They didn’t just cut Medicaid; they also have forced nearly half a trillion dollars in cuts to Medicare, the health program for the elderly.

Because of a statutory requirement to automatically impose budget cuts when legislation increases the deficit, the Big Beautiful Bill would require automatic sequestration cuts across the board, something that has been confirmed by the Congressional Budget Office (CBO) but has been largely absent from the debate over the bill. Medicare is one of the programs that will face the axe, and the damage sums to $490 billion over the next ten years, starting in the next fiscal year that begins in October. While many of the safety-net cuts in the bill are delayed to help Republicans with their re-election campaigns, the Medicare cuts must begin next year.

The Statutory Pay-As-You-Go (PAYGO) Act of 2010 requires the Office of Management and Budget to keep scorecards that track the cumulative effects of legislation on the budget deficit, based on estimates from the CBO. The Senate version of the Big Beautiful Bill adds roughly $3.3 trillion in debt over the next ten years. That will have to be made up through automatic sequestration cuts.

As CBO confirmed in a letter to the top Democrat on the House Budget Committee, Rep. Brendan Boyle (D-PA), OMB’s calculation is mandatory, and unless Republicans manage to also pass massive deficit-reducing legislation within this fiscal year, something that is incredibly unlikely to happen, the cuts would follow.

Republicans could have waived the inclusion of the Big Beautiful Bill on the PAYGO scorecard, averting the sequestration cuts, but they did not do so. Future legislation could waive the cuts as well, but that has yet to be discussed.

Therefore, OMB would be required to issue an order reducing spending by $330 billion by January 2026. Many accounts are exempted from sequestration, including Social Security and several programs affecting low-income Americans. But Medicare is not.