If Congress does not waive PAYGO, the following cuts are expected:
- Up to 4% reduction in Medicare provider payments:
- This affects payments to hospitals, doctors, nursing homes, and Medicare Advantage plans
- It does not reduce Medicare benefits, eligibility, or coverage for beneficiaries
- Estimated financial impact:
- $45 billion in cuts for fiscal year 2026
- $490–$500 billion in total cuts from 2027 to 2034, depending on the final deficit increase
- Potential ripple effects:
- Lower reimbursement may strain rural and underfunded facilities
- Some providers might become reluctant to accept new Medicare patients
Historical Context
Congress has always waived PAYGO for Medicare in the past:
- 2013: Taxpayer Relief Act — waived
- 2017: Tax Cuts and Jobs Act — waived
- 2021: American Rescue Plan — waived
- 2023: Inflation Reduction Act — waived
But this time, with the One Big Beautiful Bill (OBBBA) adding an estimated $3.4 trillion to the deficit over 10 years, the pressure is mounting. If Congress doesn’t act, the cuts will be automatic.
NY Representatives Who Voted Not to Waive PAYGO (via H.R. 1)
- Rep. Mike Lawler (NY-17)
- Rep. Nick LaLota (NY-1)
- Rep. Anthony D’Esposito (NY-4)
- Rep. Andrew Garbarino (NY-2)
- Rep. Brandon Williams (NY-22)
- Rep. Elise Stefanik (NY-21)
- Rep. Claudia Tenney (NY-24)
- Rep. Nicole Malliotakis (NY-11)
These votes aligned with the broader Republican support for H.R. 1, which passed without the PAYGO waiver, setting the stage for a 4% cut in Medicare provider payments starting in 2026.