Center for Medicare Advocacy: Issue Brief

Medicare and Revenue – Looking Back, Looking Forward

By Marilyn Moon, Center for Medicare Advocacy Visiting Scholar

We are pleased to present a new Issue Brief by Marilyn Moon – “Ensuring Medicare’s Financial Health” – reviewing the fiscal solvency of Medicare and the Part A Trust Fund. Highlights are provided here. The full Brief is available at

When Medicare was originally passed, a schedule of tax rate increases was put in place, with the expectation that more would be needed in the future. The original schedule went from 0.35% to 0.8% to begin in 1987. Just two years later, that schedule was increased to reach 0.9% in 1987 and after.

The rate of 0.9% was actually achieved by 1974.  Since then it has been raised five times to 1.45% in 1986. There have been no further rate increases since 1986.

In 1986, when the last rate increase occurred, Part A spending totaled $50.4 billion, or 1.1 percent of GDP. There were 28.3 million beneficiaries enrolled in the program at that time, about 11.4 percent of the population. By 2019, the total number of enrollees had reached 60.9 million, 18.6 percent of the population and spending was $328.3 billion, 1.52 percent of GDP.

Other changes have helped keep the Part A Trust Fund solvent.  The most important of these lifted the cap on the level of payroll subject to tax. That change occurred in 1994. In 2019, revenues to the Part A trust fund were about a third higher than if the cap were set at the same level as for Social Security.

Since Medicare was introduced, the role of payroll taxes has been declining. In 1970, payroll taxes accounted for 61.8 percent of Medicare spending but by 2019 had fallen to 36.4 percent. This is largely because there has been a major shift of spending from Part A, which is largely financed by payroll taxes, to Part B which is financed by general revenues (75 percent) and premiums (25 percent). In 1970, Part B was just 28 percent of the total program. In 2019, it amounted to 53 percent of combined A and B spending. And if Part D spending is included, the payroll tax share declines even further since it is also financed in the same way as Part B.

When Medicare was passed in 1965, the payroll tax applied to a greater share of GDP than it does today. After being stable for many years, the share of our economy that goes to labor has declined substantially since 2000, as interest and dividends have grown. This is important in terms of how well the payroll tax base represents growth in the economy. (Medicare is actually in better shape in this area than is Social Security since the cap on wages subject to the Medicare payroll tax was eliminated in 1994. For Social Security, the payroll tax cap is still in effect, at $100,000, thus the share of wages subject to the tax has also declined because wages for those with higher incomes have grown faster than wages below the cap.)

If payroll is a declining share, then the tax base is not keeping up with economic growth and consequently it may become less adequate over time as compared to broader based (e.g. income) taxes. This may be relevant in deciding whether to continue to rely on the payroll tax to fund the Medicare Trust Fund.

Read the full Issue Brief at: