WASHINGTON (AP) — The federal budget deficits caused by President Donald Trump’s tax and spending law could trigger automatic cuts to Medicare if Congress does not act, the nonpartisan Congressional Budget Office reported Friday.

The CBO estimates that Medicare, the federal health insurance program for Americans over age 65, could potentially see as much as $491 billion from 2027 to 2034 if Congress does not act to mitigate a 2010 law that forces across-the-board cuts to many federal programs once legislation increases the federal deficit. The latest report from CBO showed how Trump’s signature tax and spending law could put new pressure on federal programs that are bedrocks of the American social safety net.

Trump and Republicans pledged not to cut Medicare as part of the legislation, but the estimated $3.4 trillion that the law adds to the federal deficit over the next decade means that many Medicare programs could still see cuts. In the past, Congress has always acted to mitigate cuts to Medicare and other programs, but it would take some bipartisan cooperation to do so.

Democrats, who requested the analysis from CBO, jumped on the potential cuts.

“Republicans knew their tax breaks for billionaires would force over half a trillion dollars in Medicare cuts — and they did it anyway,” said Rep. Brendan F. Boyle, the top Democrat on the House Budget Committee, in a statement. “American families simply cannot afford Donald Trump’s attacks on Medicare, Medicaid, and Obamacare.”

Hospitals in rural parts of the country are already grappling with cuts to Medicaid, which is available to people with low incomes, and cuts to Medicare could exacerbate their shortfalls.

As Republicans muscled the bill through Congress and are now selling it to voters back home, they have been highly critical of how CBO has analyzed the bill. They have also argued that the tax cuts will spur economic growth and pointed to $50 billion in funding for rural hospitals that was included in the package.

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