The Congressional Budget Office said Friday that President Donald Trump’s recently enacted tax-and-spending package will increase federal deficits by an estimated $3.4 trillion over the next decade, large enough to activate automatic spending reductions required under the Statutory Pay-As-You-Go Act of 2010. Because Medicare is subject to the PAYGO sequester, the non-partisan scorekeeper projects the health-care program could lose roughly $45 billion in fiscal 2026 and as much as $491 billion cumulatively from 2027 through 2034 unless Congress passes legislation to waive or offset the cuts. Lawmakers have repeatedly voted to avert similar sequesters in the past, but doing so would again require bipartisan agreement. The findings challenge Republican assurances that the legislation would spare Medicare. Democrats said the projected reductions would threaten access to care for the program’s 66 million beneficiaries, while supporters of the bill argue that economic growth and subsequent congressional action can prevent the cuts.