Requires a two‑thirds vote of members present and voting in either chamber before Congress can even consider any bill, joint resolution, or amendment that would reduce an existing benefit administered by the Social Security Administration or the Centers for Medicare & Medicaid Services (e.g., Social Security, Medicare, Medicaid). This supermajority requirement applies to taking up the measure, not to final passage.

Any judgment about whether a proposal would reduce or change benefits must rely solely on the determination of the Social Security Administration’s Office of the Chief Actuary. There is a narrow exception for cuts to Medicare Advantage plan payments when they are fully offset by equal or greater increases to other Medicare payments under title XVIII.