The nonpartisan Congressional Budget Office said in an Aug. 20 report that President Donald Trump’s recently enacted tax-and-spending package will raise federal deficits by about $3.4 trillion over the next decade. Because the 2010 PAYGO statute mandates across-the-board spending reductions when legislation enlarges the deficit, Medicare could face up to $491 billion in payment cuts between 2027 and 2034 unless Congress waives the requirement. Democratic lawmakers condemned the projections, branding the measure the “Big, Ugly Bill” and warning that the automatic sequestration would jeopardize health care for seniors, low-income families and veterans. Party leaders said they will seek legislation to protect Medicare, Medicaid and Veterans Affairs programs from any reductions. Republican supporters argue the law’s tax cuts will stimulate economic growth and note that it includes $50 billion for rural hospitals. Congress has historically acted to defer PAYGO cuts, and it would need bipartisan agreement to do so again before the first round of reductions is scheduled to take effect.