Democratic ads in multiple congressional races are accusing Republican candidates of “gutting Medicare,” voting for “huge cuts to Medicare” and “cheering on Trump’s attack on Medicare.” Several ads cite President Donald Trump’s major domestic policy law, the One Big Beautiful Bill Act. But the law’s changes to Medicare are narrow in scope and affect relatively few beneficiaries.
The law could have triggered much larger cuts to Medicare, under a 2010 law that requires automatic spending reductions whenever Congress passes legislation that results in higher deficits. But Congress subsequently waived those cuts — as lawmakers of both parties have done regularly in the past.
Recent Democratic attack ads, however, misleadingly frame the OBBBA or Republican policies as a major assault on Medicare.
Rep. Derrick Van Orden, a Wisconsin Republican, was “the deciding vote to gut Medicare,” claims an ad from House Majority PAC, a group working to elect Democrats to Congress. An ad aired by his Democratic challenger, Rebecca Cooke, and the Democratic Congressional Campaign Committee similarly says he “voted to make huge cuts to Medicare and Medicaid.”
Rep. Marcy Kaptur, a Democrat running for reelection in northwestern Ohio, is airing an ad that claims her Republican challenger, Derek Merrin, will “cut your Medicare.”
The Wisconsin and Ohio ads both cite the OBBBA.
In New York’s 3rd Congressional District, which covers part of Long Island, an ad from Democratic Rep. Tom Suozzi’s campaign describes his Republican challenger, Mike LiPetri, as “ready to do Trump’s bidding, gutting Medicare.” In the same race, an ad from a Democratic-aligned outside group called Article One PAC criticizes LiPetri for “cheering on Trump’s attack on Medicare.”
The New York ads don’t include any citations for those claims. But it’s unclear what else, other than the OBBBA, they could be referencing.
The Cook Political Report rates the House races in Wisconsin and Ohio as toss ups. The New York district is rated as likely Democratic, though some news outlets continue to describe it as competitive or a race to watch, and both parties are putting millions of dollars into ads there in the closing stretch, according to the ad-tracking service AdImpact.
Medicare, which covers older adults and people with disabilities, is popular with large majorities of the public — and common fodder for often-misleading campaign ads that accuse one candidate or another of wanting to slash seniors’ benefits.
The OBBBA did include large cuts to federal healthcare spending. But the bulk of those cuts involved Medicaid, the public insurance program for people with low incomes. The law’s changes to Medicare are much narrower, and will not affect benefits or eligibility for the vast majority of enrollees.
“These are important policies,” said Jack Hoadley, a research professor emeritus at the McCourt School of Public Policy at Georgetown. “But next to something like the Medicaid changes, they’re pretty marginal.”
We reached out to the Cooke, Kaptur and Suozzi campaigns, as well as House Majority PAC and Article One PAC, about the basis for their claims and haven’t received a response.
As we said, some of the ads cite the OBBBA. It’s possible these claims are also referring to the automatic cuts the law could have triggered indirectly under pay-as-you-go rules. Democratic groups airing other midterm ads in Maine and Colorado, which don’t explicitly cast the cuts to Medicare as “huge,” have cited the PAYGO rules, in part, as backup. But as we’ll explain, Congress routinely votes to ignore those rules, and similar attacks could be made against Democrats for legislation they’ve enacted in the past.
“Derek Merrin will fight to protect Medicare and Social Security benefits for the seniors who depend on them — including his own mother,” Michael Stwarka, a campaign spokesman, told us in a statement, accusing Kaptur of “fearmongering.” “Suggesting Derek would cut Medicare simply because he supports lower taxes is a desperate stretch designed to scare voters.”
The Van Orden and LiPetri campaigns did not respond to our requests for comment.
Democrats aren’t the only ones invoking the OBBBA to attack their opponents over Medicare.
In the New Hampshire Senate race, an ad from a Trump-aligned super PAC makes the contorted claim that the Democratic candidate, Rep. Chris Pappas, voted for “devastating cuts to Medicare” — because he opposed the legislation that waived the automatic cuts that Republicans’ own law could have triggered. But Pappas opposed that legislation for other reasons, and he voted against the OBBBA in the first place.
We’ll explain what the OBBBA actually did when it comes to Medicare, and the context surrounding the pay-as-you-go cuts it could have triggered.
OBBBA’s Changes to Medicare Are Small in Scope
Medicare covers around 70 million people, at an annual cost of about $1 trillion. The OBBBA includes a few provisions that could impact costs or eligibility for certain beneficiaries, though they make up a small subset of total enrollment.
One provision ends Medicare eligibility for certain lawfully present immigrants who previously qualified for coverage, including refugees, asylees and people with Temporary Protected Status, though they would still be required to pay into the program through payroll taxes. (Immigrants without legal status are already barred from Medicare and other federally funded health programs.) Lawful permanent residents, Cuban and Haitian entrants, and citizens of certain Pacific Island nations are still eligible for Medicare under the law.
The nonpartisan Congressional Budget Office projects that will result in 100,000 fewer people having health insurance, and reduce Medicare spending by $5.1 billion over 10 years.
Another provision blocks the implementation of a Biden-era rule that aimed to make it easier for low-income Medicare beneficiaries to access financial assistance through Medicaid, by streamlining enrollment in so-called Medicare Savings Programs. Those programs allow Medicare beneficiaries with low enough incomes to have their premiums and, often, out-of-pocket costs covered by Medicaid.
CBO estimates that OBBBA’s suspension of the rule will lead to 800,000 fewer Medicare beneficiaries receiving those extra subsidies, saving the government $66 billion over 10 years. Most of those savings will accrue to Medicaid, but the change is expected to reduce Medicare spending as well, because higher out-of-pocket costs will likely lead those beneficiaries to seek less care. The Biden administration, in announcing the now-suspended rule in 2023, estimated it could increase Medicare spending by $7.6 billion over five years.
The OBBBA also broadens the category of drugs that are exempt from price negotiations under Medicare. While not technically a cut — it’s expected to increase Medicare spending by $4.9 billion over a decade — beneficiaries who need certain high-cost drugs could pay higher prices than they would otherwise have as a result.
Restricting immigrant eligibility “certainly is a cut, because people are now not getting coverage from a program where they were otherwise going to,” said Jeannie Fuglesten Biniek, deputy director for the Program on Medicare Policy at KFF, a health policy research organization.
She noted this is “the first time that there has been a change to Medicare eligibility that actually took Medicare benefits away from somebody.”
Suspending the Medicare Savings Program rule is “a little trickier,” she said. “It is likely to reduce use of Medicare services, so it does reduce Medicare spending. I think people may have different views on whether that is a cut.”
Fuglesten Biniek said those changes could have a significant impact on the people they affect. Immigrants who lose Medicare will have few other options for coverage unless they’re still working, and low-income beneficiaries may delay or forego care without financial assistance.
But she said the changes are relatively small in scope, especially compared with the bill’s changes to Medicaid. Those provisions, which include work requirements and more frequent eligibility checks, are expected to cut more than $900 billion in federal Medicaid spending over 10 years and lead to 7.5 million more people becoming uninsured, according to CBO.
“The changes to Medicaid are unprecedented. They’re enormous. I think there’s no way to deny that,” she said. “The changes to Medicare are more on the margins — but they are, I think, concentrated among particularly vulnerable beneficiaries.”
Indirect Effects of PAYGO Rules
After the OBBBA’s passage last year, some Democrats pointed to its potential indirect effects on Medicare.
Under a 2010 law called the Statutory Pay-As-You-Go (or PAYGO) Act, legislation passed by Congress is supposed to be budget-neutral. If Congress ends a year having passed legislation that, on net, will increase the deficit over five or 10 years, it’s supposed to trigger across-the-board cuts in federal spending. Some programs, including Social Security, are exempt, though Medicare is not.
Because the OBBBA is projected to add $3.4 trillion to the deficit over 10 years, CBO estimated last year that it would trigger automatic cuts to Medicare totaling $45 billion in 2026 and more than $500 billion over a decade. Those cuts would take the form of a 4% reduction in payments to healthcare providers serving Medicare patients.
However, Congress has never allowed Statutory PAYGO cuts to actually go into effect, despite passing numerous laws that have added to the deficit since 2010, as the Congressional Research Service said in a September report. In every case, Congress either included a PAYGO exemption in the law itself, or passed subsequent legislation preventing the cuts from taking effect.
That’s what Republicans in Congress did with the OBBBA. The November 2025 law that reopened the government after a six-week shutdown also wiped out any PAYGO effects from the OBBBA. (Van Orden, the Wisconsin representative, voted for it; Merrin and LiPetri were not in Congress.)
Democratic ads may be referring to this when they tag Republicans with supporting “huge” Medicare cuts or “gutting” Medicare. But it’s something both parties have done.
In 2021, for example, a Democratic Congress passed a COVID-19 relief package, the American Rescue Plan Act, that would have triggered $36 billion in automatic Medicare cuts in 2022 and billions more in future years.
“Everybody seems to not worry about it,” Rep. John Yarmuth, a Kentucky Democrat then serving as House Budget Chair, told Politico at the time, referring to the strategy of passing such a bill and then counting on future legislation to avert the steep cuts it would trigger. “I don’t know, I’ve been told it’s pretty much perfunctory that we’ll get it done.”
Congress subsequently passed legislation deferring those cuts, and they never went into effect.
GOP Ad Twists the Facts in Attacking Pappas
Democrats aren’t the only ones claiming their opponents support large Medicare cuts.
An ad from No Going Back PAC Inc. — a group linked to Trump’s main super PAC, MAGA Inc. — uses the PAYGO cuts that could have been triggered by the OBBBA as the basis for an attack on Rep. Chris Pappas, the Democrat running for an open Senate seat in New Hampshire against Republican former Sen. John E. Sununu.
“Pappas went after seniors’ healthcare too, voting to cut Medicare by $500 billion,” the ad’s narrator says. No Going Back PAC has spent more than $1.8 million on the ad since it began airing on TV and streaming platforms Oct. 7.
The claim here is convoluted, and misleading. The ad cites Pappas’ vote against the November 2025 bill that ended the government shutdown, which Democrats had brought about in an unsuccessful effort to force Republicans to extend expiring health insurance subsidies.
As we explained above, that bill also included a provision that negated any PAYGO cuts that would have been triggered by the OBBBA’s impact on the deficit.
But Pappas voted against the November bill for unrelated reasons, as New Hampshire Public Radio reported at the time — namely, that it did not guarantee the extension of more generous subsidies for Affordable Care Act plans.
“Chris Pappas voted against this bill because it didn’t extend the ACA enhanced premium tax credits,” a campaign spokesperson told us.
And, of course, Pappas voted against the OBBBA, which is what created the risk of those cuts to Medicare in the first place. In effect, Republicans are attacking Pappas for the potential consequences of their own bill.
We reached out to the person listed in Federal Election Commission paperwork as No Going Back PAC’s treasurer, as well as to MAGA Inc., and have not received a response.
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