Many federal programs, including Medicare and Social Security are funded through trust funds and other dedicated funds. Medicare is funded through the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. The Government Accountability Office (GAO) was asked to review issues related to federal trust funds. In its report the GAO found that several major federal trust fund programs – including Social Security and Medicare – are on an unsustainable course.

The GAO found that trust funds are projected to start decreasing in Fiscal Year 2022. If no action is taken, these trust funds are projected to be unable to fully support paying their projected obligations in future years. The GAO notes that to change the long-term fiscal path, policymakers will likely need to consider policy changes to the entire range of federal activities, both revenue and spending. Because Medicare and other programs funded through these trust funds are entitlement programs, legislative changes would be necessary.