The Congressional Budget Office now projects Medicare’s Hospital Insurance trust fund will run dry in 2040 — a dozen years sooner than scorekeepers estimated just last March. The shortfall did not come from demographics. It came from a president, a bill, and a set of priorities so detached from working America that they amount to a constitutional warning.
For sixty years, Medicare has been the single firmest promise the federal government makes to working Americans: pay into the system across a lifetime of labor, and the country will be there when you grow old and need a hospital bed. That promise was just shortened by twelve years. On February 23, the Congressional Budget Office published a revised projection showing that the Hospital Insurance Trust Fund — the account that pays for Medicare Part A’s inpatient, skilled-nursing, home-health, and hospice benefits — will exhaust its balance in 2040. In March 2025, the CBO had projected the fund would last until 2052. In less than a year, the agency took an axe to its own forecast.
The reason is not a mystery. The CBO names it. The agency attributes the collapse primarily to revenue losses it did not anticipate a year ago — chief among them the tax provisions of the reconciliation law that President Trump signed in July 2025 and branded the “One Big Beautiful Bill.” That law lowered tax rates, created a temporary deduction for taxpayers age 65 and over, and as Healthcare Dive reported, in doing so it sheared a decade-plus off the solvency of the program those same seniors depend on. The CBO also points to lower projected payroll-tax revenue and shrinking interest income on a shrinking fund balance. Strip away the technicalities and the trade is plain: the wealthy got a tax cut now, the elderly got a benefit cliff later.
1. The Numbers the President Does Not Want You to See
The case against the administration’s priorities does not require interpretation. It is in the official ledger, and the ledger is brutal.
The Cliff
Automatic Cuts Triggered
Benefit Reductions if Nothing Changes
Added to the National Debt
Those four numbers tell a single story. The country was on a path toward Medicare solvency that, while always tight, gave Congress a reasonable runway. The administration’s signature legislative achievement obliterated that runway — and it did so deliberately, with the CBO’s warnings on the table months in advance.
“No Republican who voted for this bill can credibly say that they want to protect Medicare.”
— Sen. Sheldon Whitehouse (D-R.I.), Ranking Member, Senate Finance Committee
2. A Promise Made, A Promise Liquidated
The cruelty here is sharpened by what the president told voters he would never do. As PolitiFact documented, candidate Trump pledged across the 2024 campaign that not a single penny would be cut from Medicare or Social Security. The 2024 Republican Party platform formalized that commitment in plain language: protect the programs, no cuts, no raised eligibility age. Seniors were a centerpiece of his coalition. They were told, repeatedly, that the program would be safe.
It was not safe. The reconciliation law accomplished what the campaign promised would never happen, only through indirection. Rather than legislating an explicit benefit cut — which would have been politically suicidal — the administration engineered a fiscal architecture in which the cut becomes automatic and the trust fund hollows out on its own. As an analysis at MSNBC put it, the promise not to touch Medicare was simply broken. The mechanism is the PAYGO sequester, the result is half a trillion dollars in Medicare reductions over a decade, and the architect signed his name to it on July 4, 2025.
The political class noticed. Sen. Ron Wyden, ranking member of the Senate Finance Committee, accused the administration of having actively misled the public, saying in a joint statement with Senate Democrats that Americans were not told the bill would punch a hole in far more than Medicaid. Rep. Brendan Boyle, ranking member of the House Budget Committee, was blunter still: Republicans, he said in an August fact sheet, knew exactly what their tax breaks would force, and they did it anyway. House Minority Leader Hakeem Jeffries, during what PBS NewsHour called the longest speech in House history, framed the bill as ripping health care from Americans.
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3. The Hospitals Are Already Closing
The 2040 cliff is the long-term horror. The short-term horror is unfolding now, in towns and counties across the country, while the president holds ballroom events. CNN reported in early March that hospitals across the country are already cutting staff, closing wards, and shuttering clinics in direct response to the reconciliation law’s pressure. The pattern is identifiable on a map.
This is not a debate about projections in a vacuum. These are working hospitals in working communities — rural counties where the nearest delivery room is now an hour’s drive, retirees who will not be able to use a Medicare card in 2040 the way they could in 2024, and clinicians like retired Dr. Peter Reiter, who, as CNN reported, said the Ottumwa closures are not the way that is best for patients. The damage is in motion. The 2040 cliff is the destination, not the journey.
4. Whose Priorities Are These?
To understand how detached the administration has become from the lives of ordinary Americans, look at who benefits from the trade. The Center for Medicare Advocacy, in its comprehensive analysis of the bill, calculates that the legislation cut more than $1 trillion from federal health programs — the largest rollback of federal health-care support in American history — to extend tax cuts originally passed in 2017 and to fund administration priorities such as border enforcement and detention. Roughly 10 million Americans are projected to lose health insurance.
Rep. Kelly Morrison, a physician of more than two decades, did not mince words in a September statement: she called the policy unconscionable and said the providers she has met across the country are terrified. The Federation of American Hospitals — not a left-leaning advocacy group but the trade association representing more than 1,000 hospitals — issued a public statement saying the bill failed the test of protecting beneficiaries that the president himself had set.
This is the priorities question, and it answers itself. A president who is in touch with the country he governs does not respond to a CBO warning by accelerating the policy that triggered it. He does not preside over hospital closures while staging gilt-edged spectacles at the White House. He does not promise seniors their benefits are sacred and then sign a law whose explicit fiscal consequence — flagged in advance by the nonpartisan scorekeeper — is to drain the very fund that pays those benefits.
“Republicans knew their tax breaks for billionaires would force over half a trillion dollars in Medicare cuts — and they did it anyway.”
— Rep. Brendan F. Boyle (D-Pa.), Ranking Member, House Budget Committee
5. The Constitutional Question
It is no longer adequate to call this bad policy. A president who breaks his most solemn campaign promise to seniors, who signs legislation his own scorekeepers warn will shorten Medicare’s life by more than a decade, and who responds to the closure of hospitals in the states that voted for him with indifference is not merely failing politically. He is failing the duties of his office. And the Constitution provides a framework — rarely invoked, but explicit — for exactly that failure.
The 25th Amendment and the Duty of Fitness
Section 4 of the Twenty-Fifth Amendment, ratified in 1967, provides that the Vice President, together with a majority of the Cabinet (or “such other body as Congress may by law provide”), may declare in writing that the President is unable to discharge the powers and duties of the office. Upon that declaration, the Vice President immediately assumes those powers as Acting President. The amendment is designed for moments when the country requires a functioning chief executive and does not have one — whether for medical, cognitive, or judgment-based reasons.
The clause “unable to discharge the powers and duties” has historically been read narrowly to mean physical or cognitive incapacity. But the constitutional scholars and lawmakers now invoking the amendment argue — correctly, in our view — that a sustained pattern of decisions detached from documented fact, expert warning, and the basic welfare of the governed is itself evidence of unfitness. A president who is told by the CBO that his signature law will hollow out Medicare and signs it anyway is not exercising the considered judgment the office requires.
Who Is Calling for It
The 25th Amendment conversation is no longer fringe. Rep. Jamie Raskin, ranking member of the House Judiciary Committee, has formally demanded a cognitive evaluation of the president by the White House physician, and on April 14, 2026, he introduced legislation establishing an independent Commission on Presidential Capacity — precisely the “other body” the amendment contemplates. The bill carries 50 co-sponsors. Rep. Alexandria Ocasio-Cortez, Rep. Melanie Stansbury of New Mexico, and others have publicly called for the amendment’s invocation, citing both the president’s rhetoric on Iran and his pattern of catastrophic decision-making at home. Notably, several longtime Republican allies have joined the call.
The Constitutional Argument as Applied to Medicare
The argument is not that any single policy failure justifies removal. The argument is that a coherent pattern — domestic policy that contradicts the president’s own campaign commitments and harms the constituents he pledged to protect, foreign-policy rhetoric that allies and adversaries alike find unhinged, a refusal to absorb expert warnings before signing irreversible legislation — describes a chief executive who can no longer be trusted to discharge his duties. The Medicare collapse is not an isolated misstep. It is a data point in a portrait. The CBO told him what would happen. He did it. The hospitals are closing. The trust fund is bleeding twelve years of solvency. This is the office failing.
The Practical Barriers, Honestly Stated
We will not pretend the path is easy. Section 4 requires the Vice President’s initiation and a majority of the Cabinet — officials the president himself selected. The Raskin commission bill faces a Republican-controlled House and a near-certain veto. As even Fox News conceded, the measure is a long shot in the current Congress. None of these obstacles, however, negates the constitutional case. The framers wrote the amendment precisely for moments when the political will is hard to muster and the need is urgent. To say “it cannot pass” is a description of the politics. It is not a refutation of the principle. And it is not an excuse for elected representatives to sit silently while a president breaks the program that 67 million Americans depend on.
6. What the Country Is Owed
An honest accounting of this moment requires naming three things. First, the CBO’s revised projection is not an act of God. It is the direct, predictable, and documented consequence of a specific law signed by a specific president after specific warnings. Second, the people who will pay the price are not the donors who funded the campaign. They are seniors in Lavonia and Ottumwa and rural New Hampshire — and they are everyone who one day intends to be a senior. Third, the legal mechanisms for accountability exist. They are inscribed in the Constitution. Whether the political class has the courage to use them is a separate question, but it is not a question that has been answered yet.
The pattern is now too consistent to ignore: a president who promised to protect Medicare has, on the documented record of his own scorekeepers, done more damage to its solvency in eleven months than any predecessor did in a full term. And he did it to fund tax cuts for the people who least needed them. That is not policy. That is a category of leadership failure the Constitution names by its proper word.
Editorial Conclusion
Medicare did not erode by twelve years on its own. A president signed a law that did it, against the warnings of the nonpartisan scorekeeper, in service of donors who do not need the help, at the expense of seniors who were told their benefits were sacred.
This is not a budget argument. It is a question of whether the man holding the office is still capable of governing in the interest of the governed. Every member of Congress, every Cabinet secretary, and every American who one day intends to grow old in this country has a stake in the answer. The Constitution provides the framework. The Twenty-Fifth Amendment is not a partisan weapon — it is a safeguard. It exists for moments exactly like this one. The duty now is to use it, or to be honest about why we will not.
Sources & References
- CBOCBO’s Updated Projections of the Hospital Insurance Trust Fund’s Finances (Feb. 23, 2026)
- FortuneIn less than a year, Trump erased 12 years of solvency for the trust fund that pays for Medicare Part A
- Healthcare DiveGOP’s ‘Big Beautiful Bill’ erases 12 years of solvency for Medicare trust fund: CBO
- McKnight’sMedicare could run out of funds in 2040, new CBO projection predicts
- Becker’sMedicare’s hospital trust fund drained by 2040: CBO
- Fierce HealthcareCBO estimates Medicare Trust Fund will run out in 2040
- CRFBCBO Projects High Federal Health Program Costs
- Sen. WhitehouseCBO Confirms Big, Beautiful-for-Billionaires Law Triggers $536 Billion Medicare Cut
- House Budget DemsTrump’s Big Ugly Law Triggers $536 Billion in Medicare Cuts (Boyle Fact Sheet)
- Senate FinanceWyden, Senate Democrats Introduce Legislation to Reverse Health Care Cuts
- Rep. MorrisonRep. Kelly Morrison Introduces Bill to Reverse Trump’s Medicaid Cuts
- Ctr. for Medicare AdvocacyImpact of the “Big Bill” on Medicare
- CNNHospitals are making cuts after ‘big beautiful bill,’ fueling Democrats’ midterm attacks
- PBS NewsHour60 years after Medicaid was signed into law, Trump’s ‘One Big, Beautiful Bill’ is chiseling it back
- KFF Health NewsMedicare Cuts Resulting From One Big Beautiful Bill Are Spared — For Now
- MSNBCTrump made a promise not to touch Medicare. His megabill just broke it.
- PolitiFactPolitiFact: Trump’s 2024 campaign Medicare pledges
- House Judiciary DemsRanking Member Raskin Demands Cognitive Evaluation, Calls to Invoke 25th Amendment
- Deseret NewsDemocrats want a medical check on Trump’s fitness for office
- TIMEWhat to Know About the 25th Amendment as Lawmakers Call for Trump’s Removal
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