The U.S. Congressional Budget Office said Friday that President Donald Trump’s recently enacted tax and spending package could force automatic reductions in Medicare spending unless lawmakers intervene. Under the 2010 PAYGO law, legislation that expands the federal deficit must be offset or mandatory programs face across-the-board cuts. CBO projects the measure will add about $3.4 trillion to the deficit over the next decade, large enough to trigger as much as $491 billion in Medicare cuts between 2027 and 2034. House Democrats, who requested the analysis, cited the estimate to warn that seniors’ health coverage is at risk. Rep. Brendan Boyle, the top Democrat on the House Budget Committee, said Republicans knew the fiscal impact yet advanced the bill. Congress has routinely voted to waive PAYGO requirements in the past, and Republican supporters of the package argue that its tax incentives will spur growth and that lawmakers can again shield Medicare. The report nonetheless intensifies pressure on Congress to craft a bipartisan fix before the automatic reductions come due.