B7 · Pillar B · Spending Efficiency
Means-testing refinement for high-income beneficiaries
Extend income-related premium adjustments under Medicare Parts B and D further up the income distribution; modest agricultural-subsidy means-testing; tighter means-testing for select benefits where program data support it. Thresholds preserve middle-class access.
- 10-year fiscal
- −$180BSavings
- Implementation
- Years 2–5
- Middle class
- Neutral
- Planetary
- Neutral
$100B–$250B · Medium-High confidence
Income thresholds preserve middle-class benefit access.
No material climate effect.
Global precedent
Most OECD social-insurance systems use income-related contributions. U.S. Medicare IRMAA already exists and is being recalibrated, not invented.
Lead mechanism
CMS; SSA; USDA; Treasury.
Bipartisan framing
Conservative case
Targets benefits to need; reduces federal cost.
Progressive case
Asks higher-income beneficiaries to contribute more under universal-program architecture.
Figures in this framework are illustrative directional estimates derived from publicly available data and conventional Congressional Budget Office budget-window logic. They are not official CBO scores. Any provision adopted from this framework would require formal CBO scoring before legislative consideration. This document is a policy white paper, not an introduced bill.