FY2026-2035 · CBO February 2026 baseline

High-Earner Medicare Surcharge 2pp

2pp Medicare surcharge on wage **and investment** income above $400K, scored on the AGI-inclusive base Treasury's FY2025 Green Book row uses. Extends the NIIT's 3.8% surtax logic to a broader base. Similar in structure to the Biden 2025 Medicare surtax proposal.

Ten-year deficit effect, conventional-$439.3Breduces the deficit
With macroeconomic feedback and debt service-$492.4BFRB/US-Lite (Federal Reserve calibrated)
Checked against

No published score for this exact policy is on file.

Typical error for this kind of policy: -$470.9B to -$407.7B, from 4 out-of-sample AGI-inclusive surtax cases.

Out-of-sample accuracy, AGI-inclusive surtax: 4 pre-registered rows miss their published scores by 7.2% on average (median 5.2%), worst 18.2% — 2 of the 4 fall inside the average. On this figure that is -$470.9B to -$407.7B typical, -$519.3B to -$359.4B at the worst row. Read off the out-of-sample tier only — not the calibrated tiers, whose agreement is by construction. It is the observed spread of this model against published scores for this class of policy, not a confidence interval.

Year by year

billions, conventional
Fiscal yearRevenueDeficit, conventionalMacro feedbackDebt serviceDeficit, dynamic
2026+$41.9B-$36.6B-$6.4B-$1.5B-$31.7B
2027+$43.7B-$38.3B-$7.6B-$3.0B-$33.7B
2028+$45.5B-$39.8B-$6.7B-$4.6B-$37.7B
2029+$47.3B-$41.4B-$5.3B-$6.2B-$42.3B
2030+$49.1B-$42.9B-$4.0B-$8.0B-$46.9B
2031+$50.9B-$44.6B-$2.9B-$9.7B-$51.4B
2032+$52.9B-$46.3B-$2.1B-$11.6B-$55.8B
2033+$54.9B-$48.0B-$1.4B-$13.5B-$60.1B
2034+$56.9B-$49.8B-$1.0B-$15.5B-$64.3B
2035+$59.1B-$51.7B-$0.7B-$17.6B-$68.6B

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Who pays

first year, by income group
Total tax change, 2026+$24.1Bpeople pay more
Returns paying more1.7%
Returns paying less0.0%
Income groupReturnsAverage changeShare of incomeShare of totalPaying morePaying lessTax rate beforeTax rate after
Lowest Quintile56.4M$00.00%0.0%0.0%0.0%-3.5%-3.5%
Second Quintile37.8M$00.00%0.0%0.0%0.0%3.5%3.5%
Middle Quintile28.4M$00.00%0.0%0.0%0.0%7.4%7.4%
Fourth Quintile19.5M$00.00%0.0%0.0%0.0%9.9%9.9%
Top Quintile18.3M+$1,3150.39%100.0%15.0%0.0%20.3%20.6%

Return-level microsimulation on CPS ASEC tax units calibrated to IRS data: the validated distributional tier. Groups are ranked by adjusted gross income per return. Average change is in dollars per return; positive means the group pays more tax.

Economic effects

difference from the CBO baseline
GDP, summed over the window-0.54percent-years
Jobs at the largest effect-69K
Deficit effect of the GDP change+$38.1Bless tax collected
Deficit effect of interest on the debt-$91.2Bless debt, less interest
Fiscal yearGDP levelJobsUnemployment10-year rateGDP change, deficitInterest, deficit
2026-0.092%-59K+0.05 pt-0.00 pt+$6.4B-$1.5B
2027-0.108%-69K+0.05 pt-0.01 pt+$7.6B-$3.0B
2028-0.096%-61K+0.05 pt-0.01 pt+$6.7B-$4.6B
2029-0.076%-49K+0.04 pt-0.02 pt+$5.3B-$6.2B
2030-0.057%-36K+0.03 pt-0.02 pt+$4.0B-$8.0B
2031-0.041%-26K+0.02 pt-0.03 pt+$2.9B-$9.7B
2032-0.029%-19K+0.01 pt-0.03 pt+$2.1B-$11.6B
2033-0.021%-13K+0.01 pt-0.04 pt+$1.4B-$13.5B
2034-0.014%-9K+0.01 pt-0.04 pt+$1.0B-$15.5B
2035-0.010%-6K+0.00 pt-0.05 pt+$0.7B-$17.6B

FRB/US-Lite (Federal Reserve calibrated). Demand effects fade over five to seven years as monetary policy responds; there is no supply-side channel. The dynamic score is the conventional score, plus the deficit effects of the GDP change and of interest on the debt: -$439.3B + $38.1B - $91.2B = -$492.4B.

Other scoring models

exploratory
ModelTen-year deficit effectMethod
CBO-Style-$439.3BStatic + ETI behavioral response + optional FRB/US dynamic feedback
TPC-Microsim Pilot-$273.5BSingle-year CPS-style microsimulation with flat-horizon annualization and quintile distribution output. Default microdata is already SOI-calibrated (top tail included); no separate top-tail augmentation applied. Maps to microsim reforms: income_rate_change, income_rate_change_threshold. Income-tax rate changes are applied to ordinary taxable income above the policy threshold ($400,000) in the pilot microsim.

CBO-Style is the model behind the headline above. The TPC-style microsimulation is a pilot: where the two disagree, the gap tells you how much the answer depends on method. It is not an official range.

Limitations

Cite asWilse-Samson, Laurence. “High-Earner Medicare Surcharge 2pp.” Fiscal Policy Calculator, CBO February 2026 baseline, FY2026-2035. https://fiscal.lwilsesamson.com/explore/medicare-surcharge-2pp