Public Source Registry

Social Security will pay only 78% of benefits starting in 2032.

Source

2026 OASDI Trustees Report — Summary (Social Security Administration)

Table IV.A1. Scheduled benefits payable at 78% from 2032 onward under intermediate assumptions.

Social Security is projected to be underfunded by $477 billion per year starting in 2032.

Source Derived

2026 OASDI Trustees Report — Table IV.A1 (Social Security Administration)

Derived: 22% benefit cut × $2,166.3B scheduled annual benefits = $476.6B ≈ $477B.

More than 71 million Social Security beneficiaries.

Source

2026 OASDI Trustees Report — Table V.C4 (Social Security Administration)

In 2033, Medicare will pay only 89% of projected benefits.

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2026 Medicare Trustees Report — Summary (Centers for Medicare & Medicaid Services)

HI Trust Fund (Part A) depletion projected 2033; 89 cents on the dollar payable thereafter from incoming revenues.

Medicare shortfall estimated at least $85 billion in 2033.

Source

2026 Medicare Trustees Report — Table III.B4 (Centers for Medicare & Medicaid Services)

Nearly 79 million Medicare beneficiaries.

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2026 Medicare Trustees Report — Table V.B3 (Centers for Medicare & Medicaid Services)

Congress has been officially warned by law for the last nine years that Medicare is underfunded.

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Summary of the 2026 Annual Reports — Medicare Funding Warning (Social Security Administration)

Nine consecutive Medicare Funding Warnings issued under the Medicare Modernization Act, requiring presidential action. Congress has not acted.

Combined Social Security + Medicare annual shortfall of approximately $562 billion.

Source Derived

2026 OASDI and Medicare Trustees Reports (Social Security Administration / CMS)

$477B (Social Security) + $85B (Medicare HI) = $562B. Conservative; excludes SMI (Parts B & D), which are automatically funded by general Treasury revenues.

U.S. national debt already at 99% of GDP at the end of FY2025, projected to reach 175% of GDP by 2056.

Source

CBO — The Long-Term Budget Outlook, 2026 to 2056 (via Peterson Foundation, March 20, 2026)

CBO projects federal debt held by the public at 99% of GDP at the end of FY2025, rising to 175% of GDP by 2056. CBO's long-term projections have historically undershot actual outcomes (see GAO, BPC, and CRFB retrospectives on the 2008 financial crisis, COVID-19, and extensions of "temporary" tax provisions); treat 175% by 2056 as a floor, not a ceiling.

Congress has long enabled drug companies to charge roughly four times what peer nations pay for the same brand-name drugs.

Source

RAND Corporation — International Drug Price Comparison (RRA788-3, 2024)

RAND RRA788-3 documents U.S. brand-name drug prices at 422% of peer-nation averages (gross); net-adjusted differential used in $7T derivation.

$7 trillion taken from the American public over 25 years in excessive drug pricing.

Source Derived

CMS National Health Expenditure Data + RAND RRA788-3 (2024) (1998–2022)

CMS NHE retail prescription drug spending 1998–2022 in 2022 dollars: $8.36T. Scaled to full U.S. drug market via IQVIA-to-NHE ratio (1.52×, per RAND). Share-weighted using RAND's net-adjusted brand differential (308%), with generic savings credited. Yield: $6.97T ≈ $7T. Conservative by construction.

43 percent of adults report not taking medications as prescribed because of cost.

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KFF Health Tracking Poll — Prescription Drug Costs (Kaiser Family Foundation)

More than 100 million Americans are uninsured, underinsured, or carrying medical debt.

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Commonwealth Fund — Underinsured Report; U.S. Census Bureau — Health Insurance Coverage

$220 billion in medical debt.

Source

JAMA — Medical Debt in the United States (Himmelstein et al.)

The system overcharged Americans $40 trillion over 25 years.

Source Derived

Peterson Foundation — Per-Person Health Spending Data vs. 13-nation peer average

U.S. per-person health cost ($14,885, 2024) vs. 13-nation peer average ($7,371, 2024: Australia, Belgium, Canada, France, Germany, Ireland, Italy, Japan, Korea, Netherlands, Sweden, Switzerland, U.K.) = $7,514 per-person overpayment, scaled to 340M U.S. population = $2.5T per year, applied 1999–2024 (25 years, 2022 dollars) = $43T actual calculation, cited conservatively as $40T.

U.S. ranks dead last among peer nations in access and quality.

Source

Commonwealth Fund — Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System

$193.6 trillion of unfunded obligations for generations X, Y, Z, and Alpha, measured over the infinite horizon.

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U.S. Treasury — Fiscal Year 2025 Financial Report of the United States Government

Open-group infinite horizon unfunded obligation for Social Security (OASDI) and Medicare (HI and SMI) combined, government-wide basis. The Trustees' standard 75-year measure for the same three programs combined is $88.2 trillion; the infinite-horizon figure is larger because the 75-year window counts the payroll taxes of the next several generations of workers without counting the full lifetime benefits owed to them. Excludes national debt to avoid double-counting.

The Medicare Modernization Act (2003), effective January 1, 2006, included a non-interference clause barring Medicare from negotiating drug prices with manufacturers.

Source

CMS.gov — CMS' Program History: Medicare Part D Prescription Drug Benefit

The 2022 Inflation Reduction Act gave Medicare limited ability to negotiate prices on ten high-cost drugs; Medicare overpaid an estimated $183.75 billion to $193.75 billion for these ten drugs, launch year through 2022, compared to eleven peer nations, while still charging beneficiaries an estimated $15.80 billion in copays over the same span.

Source Derived

Imperative Foundation analysis, derived from CMS Medicare Part D Drug Spending Dashboard (2013–2022) and KFF/Peterson-KFF Health System Tracker international price data (2024)

Aggregate overpayment and beneficiary copay totals across the ten first-cycle Medicare-negotiated drugs, launch year through 2022.

Average Medicare Part D spending per claim for Eliquis rose from $314 (2013) to $802 (2022), a 155 percent increase.

Source

CMS, Medicare Part D Drug Spending Dashboard, calendar years 2013–2022 (Eliquis)

Eliquis's WAC-based list price for a 30-day supply was $521 in 2023 and $606 in 2025.

Source

CMS Medicare Drug Price Negotiation Program documents; Bristol Myers Squibb / Pfizer official ELIQUIS pricing data

Average Medicare beneficiary copay for Eliquis rose from about $37 per claim (2013) to about $82 per claim (2022), a 120 percent increase.

Source Derived

Imperative Foundation estimate, derived from CMS Medicare Part D Drug Spending Dashboard (2013–2022) and HHS/ASPE Inflation Reduction Act Research Series out-of-pocket fact sheets (2018, 2022 anchor years, interpolated)

Reflects an average across all Medicare beneficiaries taking Eliquis, not the median beneficiary.

The IRA's negotiated prices did not take effect until 2026, giving manufacturers four additional years at the old price. For Eliquis alone, that delay cost Medicare an estimated $24.2 billion in 2022–2023 combined, and an estimated $54.9 billion across 2022 through 2025; beneficiaries paid roughly $7.5 billion in copays for Eliquis over that same four-year span. Taken together, Medicare overpaid an estimated $105 billion for Eliquis alone between 2013 and 2025, and beneficiaries paid roughly $13.6 billion in copays.

Source Derived

Imperative Foundation analysis, derived from CMS Medicare Part D Drug Spending Dashboard and CMS Medicare Drug Price Negotiation Program documents

The $24.2 billion figure covers actual 2022–2023 spending. The $54.9 billion and $7.5 billion figures are projections for 2024–2025, built by applying Eliquis's own 2022-to-2023 growth rate forward and holding beneficiary count flat as a conservative floor; CMS has not yet published actual 2024–2025 data.

Eliquis's negotiated price, effective January 1, 2026, is $231 for a 30-day supply — a 56 percent discount off the 2023 list price and a 62 percent discount off the 2025 list price. Across eleven peer nations, the average price for the same 30-day supply is $76; Australia, the lowest-priced, pays $45, less than the $47 median copay Medicare itself charges beneficiaries for the identical drug.

Source

KFF (Juliette Cubanski), "Eliquis's New Lower Direct-to-Consumer Price Is Still Higher Than Medicare's Negotiated Price," July 18, 2025; CMS, Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026

The 56 percent figure measures against the 2023 list price ($521); the 62 percent figure measures against the 2025 list price ($606). Both are accurate; they use different baseline years for the same $231 negotiated price.

The manufacturer's own published pricing data shows the average Medicare beneficiary's monthly cost for Eliquis fell from $54 to $51 (a 6 percent reduction), and the amount paid by half of all Medicare patients or less fell from $40 to $30 (a 25 percent reduction) — a disproportion of roughly ten to one against Medicare's own 62 percent price reduction.

Source

Bristol Myers Squibb / Pfizer, official ELIQUIS patient pricing page (eliquis.bmscustomerconnect.com/price): December 20, 2025 snapshot via the Internet Archive Wayback Machine (pre-negotiation) compared to the current page, accessed August 3, 2026 (post-negotiation)

In June 2023, Merck, Bristol Myers Squibb, the U.S. Chamber of Commerce, and a coalition led by PhRMA filed four separate lawsuits arguing the IRA's Medicare negotiation program was unconstitutional. Every federal appeals court to rule upheld the law. On May 18, 2026, the U.S. Supreme Court declined without comment to hear the appeals of six companies — AstraZeneca, Johnson & Johnson, Bristol Myers Squibb, Novartis, Novo Nordisk, and Boehringer Ingelheim — allowing the program to remain fully in force.

Source

Annika Kim Constantino, "Pharmaceutical trade group sues Biden administration over Medicare drug price negotiations," CNBC, June 21, 2023; Greg Stohr, "Drug Companies Spurned by Supreme Court on Price Negotiation Law," Bloomberg, May 18, 2026

Medicare's Hospital Insurance Trust Fund is projected to be depleted in Q2 2033, after which reserves will cover 89% of scheduled costs absent Congressional action.

Source

2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds, released June 9, 2026

Over 25 years, the U.S. paid $7 trillion more for brand-name prescription drugs than peer nations.

Source Derived

Imperative Foundation analysis, derived from CMS National Health Expenditure data and RAND Corporation international drug price comparison research, 1998–2022