Ken Paxton on Medicare: Mandatory Spending Cuts, Orphan Drug Costs, and Lost Coverage for Some Immigrants
Ken Paxton, the Texas attorney general and Republican nominee for U.S. Senate in Texas, told Washington lobbyists at a September 24, 2026 fundraiser that "there's no doubt we have to cut some of the mandatory spending," spending that is driven by Social Security, Medicare and Medicaid, according to a recording obtained by the Texas Tribune.
Paxton also endorsed the One Big Beautiful Bill Act on July 1, 2025 and July 3, 2025. That law exempts more rare-disease drugs from Medicare price negotiation, which KFF says will raise costs for people with Medicare who take them, and ends Medicare coverage for some lawfully present immigrants (KFF). Texans on Medicare are among those who pay.
Ken Paxton's Statements on Medicare and Mandatory Spending
- Paxton Said in 2026 That Cuts to Mandatory Spending Are Unavoidable. In the recording obtained by the Texas Tribune, Ken Paxton, asked about reducing the federal deficit, called for "reasonable cuts to mandatory spending" and said, "Or there is no solution. That's just the reality. We have to suck it up." Around three-quarters of mandatory federal spending went to Social Security, Medicare and Medicaid in the most recent fiscal year, according to the Congressional Budget Office.
- Paxton Backed the Law That Raises Medicare Costs for Some Orphan Drugs. Ken Paxton urged passage of the One Big Beautiful Bill Act on July 1, 2025. The law makes orphan drugs designated for multiple rare diseases ineligible for Medicare price negotiation, a change KFF says could result in close to $10 billion in additional Medicare spending over time and higher out-of-pocket costs for people with Medicare.
- Paxton Praised the Law That Ends Medicare for Some Lawfully Present Immigrants. Ken Paxton called the One Big Beautiful Bill Act "HISTORIC legislation" on July 3, 2025. The law terminates Medicare coverage for currently eligible beneficiaries who are not citizens, green card holders or certain other groups, and CBO estimates 0.1 million people will lose Medicare by 2034, according to KFF.
What the Medicare Changes Ken Paxton Backed Mean for Texas Seniors
- Negotiated prices for major cancer drugs are pushed back. KFF reports that the orphan drug change is expected to delay Medicare price negotiation for drugs including the cancer treatments Keytruda and Opdivo, keeping prices higher for longer for patients, including Texans on Medicare, who rely on them.
- Lawfully present immigrants who paid into Medicare lose coverage. Older lawfully present immigrants who qualified for Medicare will lose it no less than 18 months after enactment, leaving them to find other coverage or go without, according to KFF's analysis of the law.
- Older Texans also lose help through Medicaid enrollment rules. The same law puts a moratorium on two Biden-era rules meant to streamline Medicaid and Medicare Savings Program enrollment, which KFF says puts older adults at risk of losing coverage that helps pay Medicare premiums and cost sharing.
Frequently Asked Questions Ken Paxton on Medicare
What is Ken Paxton's record on Medicare under Trump?
Ken Paxton endorsed the One Big Beautiful Bill Act in July 2025, a law that exempts more orphan drugs from Medicare price negotiation and that KFF says will raise Medicare spending and patient costs. The law also ends Medicare for some lawfully present immigrants (KFF). In September 2026, Paxton told lobbyists that cuts to mandatory spending, which is driven by Social Security, Medicare and Medicaid, were unavoidable (Texas Tribune).
Did Ken Paxton say he would cut Medicare?
Ken Paxton said in a recording from a September 24, 2026 fundraiser, "There's no doubt we have to cut some of the mandatory spending," without saying which programs, according to the Texas Tribune. Medicare is one of the three programs that make up around three-quarters of mandatory spending (CBO).
How does the law Ken Paxton backed affect Medicare drug prices?
Ken Paxton backed the One Big Beautiful Bill Act, which widens the orphan drug exemption from Medicare price negotiation; KFF says this could add close to $10 billion in Medicare spending and raise out-of-pocket costs for Texans and others who take those drugs.
Last updated: 2026-10-28