- Senator Patty Murray raised the alarm over impending cuts to Medicare, which provides healthcare for seniors.
- The PAYGO (Pay-As-You-Go Act of 2010) requires Congress to offset increases in the federal debt by either cutting spending or raising revenue.
- The House Republicans’ proposed budget will explode the federal debt and trigger PAYGO..
- Medicare cuts from PAYGO will automatically kick in if Congress doesn’t vote for a waiver
“Republicans are claiming they won’t cut Medicare, but their bill would do exactly that. They’re hoping the public doesn’t understand what PAYGO means. But let me be clear. Seniors will suffer if these cuts go through.”
— Senator Patty Murray, X (May 2025)
Medicare Cuts Without A Congressional Vote
The federal Medicare program is expected to face up to $45 billion in automatic spending cuts in 2026 as a result of the Pay-As-You-Go Act (PAYGO) unless Congress acts to waive the rule before the end of the year.
Medicare cuts from PAYGO would not affect direct Medicare benefits, but it would lower reimbursement rates for healthcare providers serving Medicare beneficiaries. The impact would be felt most acutely in areas of the country with large numbers of seniors and with hospitals, often in rural areas, that rely heavily on Medicare reimbursements, such as those in large parts of Western New York and the Southern Tier.
PAYGO cuts to Medicare would affect large swaths of Langworthy’s NY23rd district and Tenney’s NY24th district. Their constituents would suffer from PAYGO cuts, similar to the massive cuts House Republicans have proposed for Medicaid and food assistance cuts (SNAP).
PAYGO and How It Works
The Pay-As-You-Go Act, also known as PAYGO, was enacted in 2010 under President Barack Obama, to promote fiscal discipline. It requires new federal spending to be offset by either raising revenue or reducing spending.
However, here’s the problem: If there’s no offset – no increase in revenue or decrease in spending – PAYGO automatically goes into effect and cuts specific otherwise mandatory spending programs.
Medicare is one of the programs that is cut if the deficit brakes kick in. Social Security and Medicaid are exempt from PAYGO (although Medicaid is already being gutted in the House Budget bill).
According to the Congressional Budget Office, PAYGO would reduce Medicare spending by $45 billion in 2026, with the potential for up to $500 billion in cuts over the next decade.
If a PAYGO waiver is not passed, despite such waivers having been frequently passed by Congress in the past, Medicare cuts would take effect on January 1, 2026.
This would also add another nail to the coffin of Republican re-election hopes in the 2026 midterm elections.
How Western New York Representatives Voted on PAYGO
In 2010 when PAYGO became law, both Western New York’s Democratic House members – Rep. Brian Higgins and Rep. Louise Slaughter – voted in favor of the legislation. At the time, PAYGO was viewed as a “good thing” – a way to ensure that new federal spending did not add to the national debt.
Western New York Republicans at the time, Reps. Chris Lee and Tom Reed (who later resigned following allegations of sexual abuse) both voted against the measure.
Medicaid Is Also On The Chopping Block
In addition to the automatic Medicare cuts under PAYGO, the House Republican budget includes massive reductions to Medicaid. These proposed changes shift Medicaid costs to the states. Most, if not all, states will be unable to absorb the massive Medicaid cuts.
The House Republicans’ cuts to Medicaid include:
Requiring states to contribute at least 5% of the cost of Medicaid benefits, beginning in 2028, conveniently after Trump’s term ends..
Increasing the state share of administrative costs from 50% to 75%.
Implementing stricter eligibility verification and new work requirements (although most Medicaid recipients already work or can’t work). The more stringent verification requirements are a backdoor way of disenrolling people from Medicaid. That is, the reporting requirements are so onerous that many current recipients will not be able to meet the verification requirements.
If the House Republican proposals are enacted, the states will be pressured to fill the federal healthcare void. That’s the intent of House Republicans – to force states to make a Hobson’s choice (an illusion that options are available).
If a state fills the federal healthcare void by expanding state support for healthcare, Republicans will accuse Democrats of raising taxes, being business-unfriendly, and paying for undocumented immigrant healthcare. If a state chooses not to fill the federal healthcare void, then Republicans will blame Democrats, particularly in blue but not red states, for cutting healthcare.
What Medicare Cuts Mean for Local Healthcare Providers
Western New York has a higher-than-average population of residents aged 65 and older, most of whom rely on Medicare and some on Medicaid for their healthcare. Healthcare providers in the region, particularly those in rural and community-based clinics, depend on stable reimbursement rates to operate.
Potential impacts of the PAYGO-mandated cuts to Medicare and the Republican House budget cuts to Medicaid include:
Fewer healthcare providers – doctors, NP’s, PA’s – will be able to accept Medicare and Medicaid reimbursement. The new, lower reimbursement rates mean healthcare providers and facilities will lose money every time they see a patient. That is not a sustainable economic model.
There will be long delays in services such as home healthcare and rehabilitation from the remaining providers.
Jobs will be cut at hospitals and long-term care facilities.
There will be financial strain on safety-net hospitals and rural providers. Some, such as the one in Westfield, will likely close.
Response times will increase, and people will die for lack of timely care.
Western New York's Congressmen
Morelle (D-NY25), who represents Rochester, and Kennedy (D-NY26), who represents Buffalo, both support waiving PAYGO to protect Medicare.
Langworthy (R-NY23), who represents Western New York and the Southern Tier, and Tenney (R-NY24), who represents the counties surrounding Lake Ontario, voted for the 2025 House budget bill that cuts Medicaid and triggers PAYGO Medicare reductions. Neither Langworthy nor Tenney has endorsed a PAYGO waiver to preserve Medicare.
If you think Congress is wrong about cutting Medicare, then reach out to your representative and express your concerns. If congressmen don’t receive pushback from their constituents on these proposals, they’ll move ahead with their plans to gut healthcare.
It’s easy to do. You can click on the link below for your congressman and share your thoughts with them.
Rep. Nick Langworthy (NY-23) – Republican
Clarence Office: 8201 Main St, Suite 13, Williamsville, NY 14221
Jamestown Office: 2-6 E Second St, Room 208, Jamestown, NY
Rep. Claudia Tenney (NY-24) – Republican
Lockport Office: 20 Pine Street, Lockport, NY 14094
Auburn Office: 71 Genesee Street, Auburn, NY 13021
Rep. Joe Morelle (NY-25) – Democrat
Rochester Office: 3120 Federal Building, 100 State Street, Rochester, NY 14614
Rep. Tim Kennedy (NY-26) – Democrat
Buffalo Office: Larkin at Exchange Building, 726 Exchange Street, Suite 610, Buffalo, NY 14210