‘‘(A) for Medicare, $652,180,000,000 in 
budget authority and the outlays flowing there-
from; 
‘‘(B) for Medicaid and other health-related 
spending, $297,823,000,000 in budget author-
ity and the outlays flowing therefrom; and 
‘‘(C) 
for 
all 
other 
direct 
spending, 
$412,225,000,000 in budget authority and the 
outlays flowing therefrom. 
‘‘(7) For fiscal year 2019— 
‘‘(A) for Medicare, $706,477,000,000 in 
budget authority and the outlays flowing there-
from; 
‘‘(B) for Medicaid and other health-related 
spending, $318,508,000,000 in budget author-
ity and the outlays flowing therefrom; and 
‘‘(C) 
for 
all 
other 
direct 
spending, 
$423,383,000,000 in budget authority and the 
outlays flowing therefrom. 
‘‘(8) For fiscal year 2020— 
‘‘(A) for Medicare, $753,235,000,000 in 
budget authority and the outlays flowing there-
from; 
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‘‘(B) for Medicaid and other health-related 
spending, $341,284,000,000 in budget author-
ity and the outlays flowing therefrom; and 
‘‘(C) 
for 
all 
other 
direct 
spending, 
$432,352,000,000 in budget authority and the 
outlays flowing therefrom. 
‘‘(9) For fiscal year 2021— 
‘‘(A) for Medicare, $803,952,000,000 in 
budget authority and the outlays flowing there-
from; 
‘‘(B) for Medicaid and other health-related 
spending, $348,739,000,000 in budget author-
ity and the outlays flowing therefrom; and 
‘‘(C) 
for 
all 
other 
direct 
spending, 
$440,804,000,000 in budget authority and the 
outlays flowing therefrom. 
‘‘(b) SEQUESTRATION.—(1) Within 15 calendar days 
after Congress adjourns to end a session and on the same 
day as a sequestration under sections 251, 251A, 253, but 
after any sequestration required by section 251 and 251A 
and before sections 252A and 253, there shall be a seques-
tration to eliminate any direct spending in excess of the 
direct spending limits set forth in subsection (a), as appli-
cable, for the budget year. 
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‘‘(2) The amount required to be sequestered in a fis-
cal year under paragraph (1)— 
‘‘(A) for Medicare spending shall be obtained 
from non-exempt direct spending accounts for Medi-
care; 
‘‘(B) for Medicaid and other health-related 
spending shall be obtained from non-exempt direct 
spending accounts for Medicaid and other health-re-
lated spending; and 
‘‘(C) for all other direct spending shall be ob-
tained from non-exempt direct spending accounts. 
‘‘(3) Each account referred to in subparagraph (A), 
(B), or (C) of paragraph (2) shall be reduced by the uni-
form percentage necessary to reduce any excess direct 
spending in accounts in that subparagraph to the applica-
ble level set forth in subsection (a), as applicable, for the 
budget year. 
‘‘(c) SCOREKEEPING GUIDELINES.—OMB and CBO, 
after consultation with each other and the Committees on 
the Budget of the House of Representatives and the Sen-
ate, shall— 
‘‘(1) determine common scorekeeping guide-
lines; and 
‘‘(2) in conformance with such guidelines, pre-
pare estimates under this section’’. 
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(b) DEFINITIONS.—Section 250(c) of the Balanced 
Budget and Emergency Deficit Control Act of 1985 is 
amended by adding at the end the following new para-
graphs: 
‘‘(22) The term ‘Medicare’ means programs 
within budget function 570. 
‘‘(23) The term ‘Medicaid and other health-re-
lated spending’ means programs within budget func-
tion 550. 
‘‘(24) The term ‘other direct spending’ means 
programs other than those within budget functions 
550 and 570, excluding Social Security and net in-
terest.’’. 
(c) CONFORMING AMENDMENT.—The item relating 
to section 252 in the table of contents set forth in 250(a) 
of the Balanced Budget and Emergency Deficit Control 
Act of 1985 is amended to read as follows: 
‘‘Sec. 252. Direct spending limits.’’. 
SEC. 102. TOTAL SPENDING LIMITS. 
(a) TOTAL SPENDING LIMITS.—The Balanced Budg-
et and Emergency Deficit Control Act of 1985 is amended 
by adding after section 252 the following new section: 
‘‘SEC. 252A. TOTAL SPENDING LIMITS. 
‘‘(a) SEQUESTRATION.—(1) Within 15 calendar days 
after Congress adjourns to end a session and on the same 
day as a spending reduction ordered under sections 251, 
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251A, 252, and 253, but after any spending reduction re-
quired by sections 251, 251A, and 252, and before section 
253, there shall be a sequestration of all non-exempt direct 
spending accounts and discretionary accounts to eliminate 
any total spending in excess of the total spending limits 
set forth in subsection (b) for the budget year. 
‘‘(2) Each account referred to in paragraph (1) shall 
be reduced by the uniform percentage necessary to reduce 
total spending to the applicable level set forth in sub-
section (b) for the budget year. 
‘‘(b) TOTAL SPENDING LIMITS.— 
‘‘(1) fiscal year 2013: 21.7 percent; 
‘‘(2) fiscal year 2014: 20.8 percent; 
‘‘(3) fiscal year 2015: 20.2 percent; 
‘‘(4) fiscal year 2016: 20.1 percent; 
‘‘(5) fiscal year 2017: 19.9 percent; 
‘‘(6) fiscal year 2018: 19.7 percent; 
‘‘(7) fiscal year 2019: 19.9 percent; 
‘‘(8) fiscal year 2020: 19.9 percent; and 
‘‘(9) fiscal year 2021: 19.9 percent; 
of the current projected gross domestic product of the 
United States for the budget year.’’. 
(b) DEFINITIONS.—Section 250(c) of the Balanced 
Budget and Emergency Deficit Control Act of 1985 (as 
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