US Healthcare spending to consume 20% of GDP by 2028

Claude AI

Rank	Expense	$ billions	Share of total	1-yr change	Year	Source
1	Social Security	1,654	22%	+5%	FY2026	[CBO MBR]
2	Net interest on the debt	1,143	15%	+11%	FY2026	[CBO MBR]
3	Medicare (net of premiums)	1,069	14%	+8%	FY2026	[CBO MBR]
4	Defense (DoD military)	916	12%	+5%	FY2026	[CBO MBR]
5	Medicaid	723	10%	+8%	FY2026	[CBO MBR]
6	Veterans Affairs (benefits + VA health care)	416	6%	+10%	FY2026	[CBO MBR]
7	Federal civilian + military retirement	210	3%	—	FY2025	[CBO mandatory]
8	ACA premium tax credits	140	2%	—	FY2025	[CBO mandatory]
9	Food and nutrition (SNAP, school meals, WIC)	137	2%	−8%	FY2026	[CBO MBR]
10	Transportation (highways, FAA, transit)	128	2%	—	FY2025	[Eno Center]

Some things stand out:

Healthcare would be #1 if you count it as one item. Medicare plus Medicaid comes to $1.79 trillion, more than Social Security. Adding the ACA credits brings it to about $1.9 trillion. CBO's FY2025 breakdown shows the same pattern: major health care programs at $1,819 billion versus Social Security at $1,575 billion.
Interest is now #2. It is larger than both Medicare and defense. Net interest rose by $115 billion (or 11 percent) because the debt was larger than in fiscal year 2025 and long-term interest rates were higher.
The top six make up about 80% of all spending. Everything else the government does shares the remaining 20%.
Just missing the list: earned income, child, and other tax credits at $115 billion in FY2025, and Homeland Security, whose spending is rising.

Caveats:

The FY2026 figures are CBO estimates. Treasury's final September statement should come out in mid-October.
Ranks 7, 8 and 10 use FY2025 numbers because CBO's FY2026 monthly review doesn't break those items out. They are close enough in size that their order may have shifted.
The DoD figure excludes nuclear weapons spending, which runs through the Department of Energy.

Sources: