The trust fund used to pay hospital insurance costs for Medicare will be wiped out two years earlier than expected, according to a government report released Wednesday.

The report also showed that the Social Security trust fund has enough cash to pay full benefits for another 18 years, the same timeline as last year. In the latest annual check-up on the two largest entitlement programs, the trustees overseeing both Social Security and Medicare said additional reforms are needed in order to avoid cutting health care and retirement benefits for American retirees.

“Social Security and Medicare remain secure in the medium-term,” said Treasury Secretary Jack Lew. “Nevertheless, future solvency challenges for both programs remain.”

The fund for Medicare is on track to run out of money by 2028, which is earlier than expected from last year but still 11 years later than projected before the Affordable Care Act was implemented. After the fund is depleted, the program will only have enough tax revenue to pay out 87 percent of hospital costs, projections show. Financing for the program suffered last year because of a drop in tax revenue and an increase in spending for inpatient hospital services.

In one bright spot of the report, the fund used to pay benefits for people with disabilities which was set to run out of funds by the end of this year — should last at least through 2023. Congress made changes last year that directed more cash to that part of the program by reallocating money from the trust fund used to pay benefits to retirees and survivors.

Although the forecasts have not budged that much from last year, efforts are still needed to prolong the life of these funds, which affect millions of Americans. Despite those challenges with the long-term financing of the program, President Obama and other Democrats, including presumptive presidential nominee Hillary Clinton and her opponent, Sen. Bernie Sanders of Vermont, have recently called for Social Security to be expanded, with benefits increasing for the neediest retirees and for the changes to be paid for with higher taxes to the wealthiest workers.

“It’s time we finally made Social Security more generous, and increased its benefits so that today’s retirees and future generations get the dignified retirement that they’ve earned,” Obama said at a speech earlier this month in Elkhart, Ind. “And we could start paying for it by asking the wealthiest Americans to contribute a little bit more. They can afford it. I can afford it.”

Presumptive Republican presidential nominee Donald Trump has said he would not cut Social Security or Medicare.

The trustees, which included officials from Treasury, the Social Security Administration, Health and Human Services and the Labor Department, said Wednesday that additional changes to the programs, such as an increase in taxes, could make it possible to improve the long-term health of the Social Security system. For example, the acting commissioner of the Social Security Administration, Carolyn Colvin, said that increasing payroll taxes by slightly more than 1 percent could improve the solvency of the fund over the next 75 years.

For Social Security, the trustees predicted the program’s separate trust funds will have enough money to pay all the retirement and disability benefits it owes until 2034, unchanged from last year’s forecast. Once the cash reserves are gone, the administration will only have enough revenue to pay about 75 percent of benefits through 2090.

On Wednesday, the trustees emphasized the role of social insurance programs at a time when many workers are not saving enough for retirement and fewer retirees are receiving pensions. “Few government agencies touch as many lives as we do in the Social Security Administration,” Colvin said.

Medicare insured 55.3 million Americans last year. Social Security paid benefits to 49.2 million retired workers and survivors and to 10.8 million people with disabilities and their families.

Clarification: This story has been updated to make clear that the trustees include officials from multiple government agencies beyond the Treasury Department. 

Correction: This article has been updated to note that the 10.8 million people receiving Social Security disability benefits include disabled workers and their family members.

Read more: