If current policies go unchanged the CBO estimates that public debt is expected to grow to the highest rates since period shortly after World War II, thanks in large part to Medicare and Social Security. The latest is that debt will rise to $15 trillion by the end of this year and tick up to $25 trillion in 2027. Such dramatic deficit estimates could put lawmakers in a the difficult position of either cutting spending or increasing revenue from taxes despite Trump’s promises not to cut major programs like Social Security and Medicare.

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“The sort of change we’d need to really change our future, 20 to 30 years down the road, are pretty significant,” CBO director Keith Hall said on Tuesday. “We are starting from a very high level of debt.”

Republican leaders in Congress have vowed to cut spending but economists estimate that many of Trump’s policies, like deep cuts to tax rates and increased infrastructure spending, could continue to drive up the deficit.

“We have new leadership in the White House, and Republicans in Congress are preparing pro-growth legislation that will get our economy moving at full steam again and tackle our fiscal problems head on,” House Budget Committee Chairwoman Diane Black (R-Tenn.) said in a statement.

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Trump has not provided much detail on any of his policy proposals but experts at the nonpartisan Tax Policy Center estimate that Trump’s tax proposals could add around $7 trillion to the deficit in a decade. A more-conservative estimate from the right-leaning Tax Foundation, concluded that same tax proposals would create a $4.4 trillion budget hole in the same timeframe.

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Recent Congressional legislation estimates the cost of a border wall at around $10 billion. Repealing the entire Affordable Care Act would increase deficits by $350 billion over a decade, according to a previous CBO report.

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The new report also showed that the number of people without insurance has remained close to previous projections of around 27 million, even though fewer people are buying insurance on the exchanges.

Approximately 12 million people under 65 are expected to have insurance in any given month as the result of the ACA and around 9 million will receive subsides for coverage purchased through the marketplace, Hall said. A supplemental report said that the number of people insured on the marketplace is lower than previously expected because fewer employers are ending employee health benefits than the CBO previously expected.

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The nonpartisan congressional scorekeepers expect that unemployment will fall from 4.7 to 4.4 percent by the end of 2018 and economic growth will remain modest.

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Republican leaders in Congress have not yet weighed in on all of Trump’s proposals but many, including Black argue that their policies will lead to significant economic growth.