United States Government Accountability Office GAO The Federal Government’s Long-Term Fiscal Outlook Spring 2012 Update GAO’s Long-Term Fiscal Federal deficits and debt have reached historic highs in recent years. Simulations Congress has taken action to address the fiscal imbalance, but longer- Since 1992, GAO has published term challenges remain. The Budget Control Act (BCA) of 2011 limits long-term fiscal simulations spending over the next decade and leads to an improved fiscal outlook. showing federal deficits and debt The act targets discretionary spending, and under both of GAO’s under different sets of policy simulations, discretionary spending as a share of the economy would be assumptions. GAO developed its long-term model in response to a lower in 2022 than at any point in the last 50 years. Further, as the bipartisan request from members economy recovers, revenue increases and spending decreases. While of Congress concerned about the the BCA improved the outlook, it did not eliminate the longer-term long-term effects of fiscal policy. challenge, in part because it did not focus on the fundamental drivers of GAO’s simulations provide context the government’s future fiscal imbalances—a structural gap between for consideration of policy options. revenues and spending driven by rising health care costs and They are not intended to suggest demographics. As our 2011 simulations showed, if the Patient Protection particular policy choices or to predict the economic impact of any and Affordable Care Act (PPACA) is implemented as intended it would set of choices but to help facilitate have a major effect on the gap but would not eliminate it. The aging of the a dialogue on this important issue. population and rising health care costs will continue putting upward GAO regularly updates its pressure on spending. Assuming revenue in the long term returns to the simulations as new data become 40-year historical average and remains stable at that share of GDP, the available from the Congressional imbalance between spending and revenues increases, resulting in Budget Office (CBO) and the increasing levels of debt held by the public. A continuing increase in debt Social Security and Medicare as a share of GDP means the federal government is on an unsustainable Trustees (Trustees). This update incorporates CBO’s January 2012 long-term fiscal path and underscores the need for policymakers to act to budget and economic projections. change the path. See figure 1. As in the past, GAO shows two simulations: Figure 1: Debt Held by the Public under Two Fiscal Policy Simulations The Baseline Extended simulation follows CBO’s January 2012 baseline, which generally reflects current law, for the first 10 years. The baseline includes the effects from the discretionary spending caps and automatic enforcement procedures put in place by the Budget Control Act (BCA). After the first 10 years, this fiscal constraint is maintained; revenue and spending other than interest on the debt and large entitlement programs (Social Security, Medicare, and Medicaid) are held constant as a share of gross domestic product (GDP). Over the long term, revenue as a share of GDP is higher and discretionary spending lower than historical averages. Note: Data are from GAO’s Spring 2012 simulations based on the Trustees’ assumptions for Social Security and the Trustees’ and the CMS Actuary’s assumptions for Medicare. GAO-12-521SP In the Alternative simulation, The pace at which deficits grow and the resulting debt buildup vary expiring tax provisions are depending on the assumptions used: deficits and debt grow less rapidly in extended to 2022 2022,and andthethe the Baseline Extended simulation than under the Alternative simulation, alternative minimum tax (AMT) exemption amount is indexed to which has both lower revenues and higher spending levels than the inflation through 2022. 2022; For revenues the Baseline Extended simulation. Under the Baseline Extended simulation, are then first 10 years, brought discretionary back to the debt held by the public would exceed its post–World War II historical high historical average spending reflects the as aoriginal share caps of of 109 percent of GDP by 2048; under the Alternative simulation it would GDP. set by For the theBCA first but10 notyears, the lower cross this threshold by 2026. discretionary caps triggeredspending by the automatic reflects the original caps enforcement procedures. set by the Over BCA but long the not theterm, lowerdiscretionary caps triggered The growing fiscal imbalance is driven on the spending side by rising by the automatic spending and revenueenforcement are held at health care costs and the aging of the population. The oldest members of procedures. historical averages. Over the long term, the baby-boom generation are already eligible for Social Security discretionary spending and retirement benefits and for Medicare. The Social Security program, which The Baseline Extended simulation revenue are held at historical historically ran large cash surpluses that helped reduce the need to follows the Trustees’ 2011 averages. borrow from the public to finance other programs, is now projected to pay intermediate projections for Social The Baseline Security Extendedand and Medicare simulation CBO’s more in benefits than it receives in tax income each year into the future. 1 follows June the long-term 2011 Trustees’ 2011 projections Although health care spending growth recently slowed, it has been intermediate for projections Medicaid adjusted for Social to reflect growing faster than the overall economy and is expected to continue to Securitycost excess andgrowth Medicare and CBO’s consistent with June the 2011 long-term Trustees’ projections.projections In the grow at an increased rate as more members of the baby-boom generation for Medicaidsimulation, Alternative adjusted to reflect Medicare become eligible for federal health programs. As shown in figure 2, the excess cost spending growthon is based consistent the Centers with number of baby boomers turning 65 is projected to grow in coming years, the Medicare for Trustees’ &Medicare Medicaidprojections. Services averaging about 7,600 per day in 2011, and about 11,400 per day by In the Alternative Office of the Actuary’s simulation, (CMS 2029. Medicarealternative Actuary) spending is based on that projections the Centers for assume Medicare reductions in & Medicaid Medicare Services Office physician rates do of the not Actuary’s occur as (CMS Actuary) scheduled under alternative current law and projections that certain thatcost-assume containment reductions in Medicare physician mechanisms intended rates to slow dothe not occur as growth ofscheduled health careunder cost current are not law and that sustained overcertain the longcost- term. GAO containment also shows the mechanisms outlook using intended to slow long-term CBO’s the growthprojections of health care for cost are Social not sustained Security and theover major the long term. health GAO alsothe entitlements; showsresultstheare outlook using consistent withCBO’s GAO’slong-term simulations projections based largely foron Social Security and the Trustees. the major health entitlements; the results are consistent with the Additional information on the fiscal other simulations. outlook and federal debt is available at Additional information on the fiscal www.gao.gov/special.pubs/longterm/. outlook and federal debt is available at For more information, contact Susan J. www.gao.gov/special.pubs/longterm/. Irving at (202) 512-6806 or 1 For more information, contactJ.Susan J. Social Security trust fund assets and reserves are used to make up the annual cash email@example.com or Thomas McCool, Irving at 512-2642 at (202) (202) 512-6806 or or firstname.lastname@example.org. deficit. The Trustees project that trust fund reserves will be exhausted by 2036. See the email@example.com or Thomas J. McCool, Board of Trustees, Federal Old-Age and Survivors Insurance and Federal Disability at (202) 512-2642 or firstname.lastname@example.org. Insurance Trust Funds, The 2011 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds (Washington, D.C.: May 13, 2011). Page 2 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 Figure 2: Daily Average Number of People Turning 65 Each Year Note: Data are from the U.S. Census Bureau’s National Population Projections. For this analysis, we used data from the low net international migration series. Several provisions of PPACA were designed to control the growth of health care costs. The full implementation and effectiveness of these cost-control provisions, which are reflected in the Baseline Extended simulation, would slow the growth in federal health care spending over the long term. Under the Baseline Extended simulation, spending on Medicare and Medicaid grows from 5 percent of GDP in 2010 to over 7 percent by 2030.There are, however, significant uncertainties surrounding the growth of health care costs. Spending is influenced not only by policies and laws, but also by future demographic and economic trends, development and deployment of medical technology, the cost and availability of insurance, and the responses of health care providers, consumers, and policymakers to these trends. The Trustees, CBO, and the CMS Actuary have expressed concerns about the sustainability of certain health care cost-control measures over the long term. For example, they note that reductions in physician payment rates scheduled to occur under current law have routinely been overridden. They have also questioned whether a provision in PPACA that would restrain spending growth by reducing the payment rates for certain Medicare services based on productivity gains observed throughout the economy is sustainable over the long term. According to CMS, health care productivity gains have historically been small, and may be difficult Page 3 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 to achieve in the future due to several factors, including the labor- intensive nature of the industry and the individual customization of treatments in many cases. These concerns are reflected in our Alternative simulation, which, consistent with CBO’s and the CMS Actuary’s alternative scenarios, assumes that certain cost-containment mechanisms are not sustained over the long term. 2 Spending on health care grows much more rapidly under this more pessimistic set of assumptions. Absent changes to these programs, spending on Medicare and Medicaid under the Alternative simulation grows to over 8 percent of GDP by 2030. Under either set of assumptions about health care cost growth, spending for the major health and retirement programs will increase, putting greater pressure on the rest of the federal budget. In 2010, about 47 cents of every federal dollar spent went to Social Security, Medicare, Medicaid, and interest on the federal debt. Figures 3 and 4 below show revenue and the composition of spending under the Baseline Extended and Alternative simulations moving forward. 2 While both CBO and the CMS Actuary assume that certain cost-containment mechanisms are not sustained, they make different assumptions that affect spending on health care. For example, CBO’s assumes that physician payment rates are maintained at 2011 levels. In the CMS Actuary’s alternative scenario, physician payment rates grow with inflation (using the Medicare Economic Index), which results in higher spending than under CBO’s assumption. Page 4 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 Under the Baseline Extended simulation, revenues as a share of the economy are higher and discretionary spending is lower than historical averages. As figure 3 shows, spending on Social Security, Medicare, Medicaid, and interest would grow to about 70 cents of every dollar spent by 2040. By this time, there is little room for “all other spending,” which includes not only national defense, homeland security, veteran’s health care, and investment in highways and mass transit, but also smaller entitlement programs such as farm price supports and student loans. Figure 3: Potential Fiscal Outcomes under the Baseline Extended Simulation: Revenues and Composition of Spending Notes: Data are from GAO’s Spring 2012 simulations based on the Trustees’ assumptions for Social Security and the Trustees’ and the CMS Actuary’s assumptions for Medicare. a This also includes spending for insurance exchange subsidies and the Children’s Health Insurance Program. Page 5 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 In the Alternative simulation, revenue and discretionary spending are at their historical averages over the long term. In this simulation, spending on Social Security, Medicare, Medicaid, and interest exceeds revenues by 2030 and by 2040, 73 cents of every federal dollar spent would go to these categories. Overall, our simulations illustrate the difficult trade-offs that policymakers will have to consider in order to rebalance the federal government’s fiscal position. Figure 4: Potential Fiscal Outcomes under the Alternative Simulation: Revenues and Composition of Spending Notes: Data are from GAO’s Spring 2012 simulations based on the Trustees’ assumptions for Social Security and the Trustees’ and the CMS Actuary’s assumptions for Medicare. a This also includes spending for insurance exchange subsidies and the Children’s Health Insurance Program. Page 6 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 When considering action to address the longer-term fiscal challenge, it is Balancing Near-Term important to balance the near-term effects. One tool used to measure the and Long-Term challenge over the long term is the “fiscal gap.” The fiscal gap represents the difference, or gap, between revenue and noninterest spending in Considerations present value terms over a certain period, such as 75 years, that would need to be closed in order to achieve a specified debt level (e.g., today’s debt to GDP ratio) at the end of the period. From the fiscal gap, one can calculate the size of action needed—in terms of tax increases, spending reductions, or, more likely, some combination of the two—to close the gap. For example, under our Alternative simulation, the fiscal gap is 8.2 percent of GDP (see table 1). This means that, on average over the next 75 years, revenue would have to increase by more than 45 percent or noninterest spending would have to be reduced by about 32 percent (or some combination of the two) to keep debt held by the public at the end of the period from exceeding its level at the beginning of 2012 (roughly 68 percent of GDP). Even-more significant changes would be needed to reduce debt to lower levels. Table 1: Federal Fiscal Gap under GAO’s Simulations Average percentage change required to close gap If action is delayed until If action is taken today 2022 Solely Solely Fiscal gap through through Solely decreases Solely decreases 2012–2086 through in through in (percent of increases noninterest increases noninterest Simulation GDP) in revenue spending in revenue spending Baseline 1.8 8.4 8.0 9.9 9.4 Extended Alternative 8.2 45.7 32.2 54.3 37.0 Source: GAO. Note: Data are from GAO’s Spring 2012 simulations based on the Trustees’ assumptions for Social Security and the Trustees’ and CMS Actuary’s assumptions for Medicare. While immediate action would reduce the size of the changes necessary to close the fiscal gap, the risk to near-term economic growth is also a factor. With this in mind, policy changes could be designed to phase in over time allowing for the economy to fully recover and for people to adjust to the changes. Table 1 illustrates how much greater fiscal policy changes would have to be if no actions were taken for the next decade. Such a delay would increase the risk that the eventual changes will be disruptive and destabilizing. Under our Alternative simulation, waiting 10 years would increase the fiscal gap to nearly 10 percent of GDP— Page 7 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 meaning a revenue increase of about 54 percent or a noninterest spending cut of 37 percent or some combination of the two would be required to bring debt held by the public back to today’s level by 2086. The economy continues to recover from the nation’s most severe Concluding recession since the end of World War II, and while there are calls for Observations continued federal action to support the economy, these must be balanced with the need to act soon to develop a plan for addressing the long-term fiscal imbalance. Absent policy changes, increasingly significant changes will be needed to close the fiscal gap. However, action taken to address the fiscal outlook needs to be balanced with the importance of sustaining economic growth in the near term. If policy changes designed to correct the federal government’s fiscal path are too sharp, they could stifle the pace of the recovery in the near term. Conversely, changes in policy designed to encourage near-term recovery could worsen the long-term outlook and increase the size of necessary changes in the long run. Our simulations show deficits declining over the next several years, but this trend reverses before the decade is over under the assumptions in our simulations. Despite limits on discretionary spending that would bring discretionary spending to levels not seen in recent history, our simulations show total federal spending continuing to exceed revenues and feeding an unsustainable growth in debt. The policy actions required to close the fiscal gap are significant, and changing the long-term outlook will likely require difficult decisions about both federal spending and revenue. Page 8 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 This update incorporates CBO’s January 2012 baseline projections that Changes since the follow current law at that time. 3 A key change from CBO’s prior baseline Last Update estimates—and our prior long-term fiscal outlook update—was the treatment of deficit reduction related to the BCA. At the time of our last update in fall 2011, it was not known whether lawmakers would enact legislation originating from the Joint Select Committee on Deficit Reduction, and thus whether such legislation or the Budget Control Act’s automatic enforcement procedures would be implemented. Therefore, we assumed that deficit reduction resulting from the act would take effect under both the Baseline Extended and the Alternative simulations, but did not make assumptions about the allocation between spending and revenues. Because no such legislation was enacted, CBO’s January 2012 baseline reflects the act’s automatic procedures—cuts among discretionary, Medicare, and other mandatory spending—that go into effect under current law. Consistent with CBO’s baseline, our Baseline Extended simulation also reflects the changes to discretionary and mandatory spending under the automatic enforcement procedures. However, we do not apply the effects of the automatic enforcement procedures to the Alternative simulation in this update. In this regard, our Alternative simulation is consistent with the alternative scenario CBO described in its January 2012 update. Table 2 lists the key assumptions incorporated in the Baseline Extended Key Assumptions in and Alternative simulations based on the Trustees’ assumptions for Our Federal Social Security and the Trustees’ and CMS Actuary’s assumptions for Medicare. Simulations 3 The CBO report is available at www.cbo.gov. When CBO analyzes the President’s budget proposals, usually in March, it also updates its baseline. This year CBO’s update includes the effects of the Middle Class Tax Relief and Job Creation Act of 2012 (Pub. L. No. 112-96) that was enacted on February 22, 2012 and extended the payroll tax reduction and emergency unemployment insurance benefits through the end of December 2012 and prevented scheduled cuts in reimbursement rates to physicians. Consistent with past practice, we use the January baseline and so do not include the effects of that legislation. Doing so would have only minimal effect on the longer-term fiscal outlook. Page 9 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 Table 2: Assumptions for Baseline Extended and Alternative Simulations Model inputs Baseline Extended simulation Alternative simulation Revenue CBO’s January 2012 baseline that assumes tax cuts CBO’s estimates assuming expiring tax provisions other will expire as scheduled under current law and that an than the temporary Social Security payroll tax reduction increasing share of taxpayers will be subject to higher are extended through 2022, and the 2011 alternative tax rates through 2022; thereafter remains constant at minimum tax (AMT) exemption amount is indexed to a 21.0 percent of GDP (CBO’s projection in 2022) inflation for years 2012–2022; thereafter is phased into the 40-year historical average of 17.9 percent of GDP Social Security CBO’s January 2012 baseline through 2022; Same as Baseline Extended spending thereafter based on 2011 Social Security Trustees’ intermediate projections Medicare CBO’s January 2012 baseline through 2022 that Based on CMS Actuary’s alternative scenario that spending assumes cuts in physician payment rates will occur assumes that physician payment rates grow with b d as scheduled under current law at the time and that inflation (using the Medicare Economic Index) in all the implementation of the Budget Control Act’s future years, that spending reductions under the BCA do automatic enforcement procedures reduces not occur, and policies that would restrain spending c spending; thereafter 2011 Medicare Trustees’ growth are applied fully through 2019 but begin to phase intermediate projections out thereafter Medicaid, the CBO’s January 2012 baseline through 2022; CBO’s January 2012 baseline through 2022; thereafter Children’s thereafter CBO’s June 2011 long-term projections CBO’s 2011 long-term projections adjusted to reflect Health adjusted to reflect excess cost growth consistent with excess cost growth consistent with CMS Actuary’s Insurance the 2011 Medicare Trustees’ intermediate projections alternative scenario and CBO’s alternative assumption Program, and that a policy that would slow the growth of subsidies for exchange health insurance coverage is not in effect subsidies spending Other CBO’s January 2012 baseline through 2022, which Baseline Extended adjusted for extension of certain tax mandatory incorporates the reductions in spending scheduled to credits and to exclude the effects of the Budget Control spending occur under the Budget Control Act’s automatic Act’s automatic enforcement procedures through 2022; enforcement procedures; thereafter remains constant thereafter is phased back to 2.3 percent of GDP by as a share of GDP at 2.3 percent of GDP (implied by 2025 (same as Baseline Extended) CBO’s projection in 2022) Discretionary CBO’s January 2012 baseline through 2022, which Follows the original caps set by the Budget Control Act spending reflects the original caps set by the Budget Control but not the lower caps triggered by the act’s automatic Act, as well as the lower caps triggered by the enforcement procedures; after 2022 it gradually phases automatic enforcement procedures; thereafter to 7.5 percent of GDP (the 20-year historical average) remains constant at 5.6 percent of GDP (CBO’s projection in 2022) Source: GAO. Notes: CBO’s projections are from The Budget and Economic Outlook: Fiscal Years 2012 to 2022 (January 2012) and CBO’s 2011 Long-Term Budget Outlook (June 2011). Trustees projections are from The 2011 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds and The 2011 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, which were both issued on May 13, 2011. Projections from the CMS Actuary are based on Projected Medicare Expenditures under an Illustrative Scenario with Alternative Payment Updates to Medicare Providers (May 13, 2011). We assume that Social Security and Medicare benefits are paid in full regardless of the amounts available in the trust funds. Page 10 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 a Both simulations assume that the temporary Social Security payroll tax reduction would expire at the end of February 2012. However, the Middle Class Tax Relief and Job Creation Act of 2012 (Pub. L. No. 112-96) extended the reduction through the end of December 2012. The act did not offset the cost of the extended reduction, but we expect that the change would have a minimal effect on the overall outlook. b The Middle Class Tax Relief and Job Creation Act prevented scheduled cuts in reimbursement rates to physicians for 2012 that were assumed to occur under CBO’s January 2012 baseline projections. We did not incorporate the effects of this override into the Baseline Extended simulation. Because the act included provisions to offset the costs of the extension, it would have a minimal effect on the longer-term fiscal outlook. c The Budget Control Act established limits on discretionary budget authority for 2013 through 2021. In addition, it specified additional limits on discretionary spending and automatic reductions in mandatory spending, including Medicare, that would take effect if lawmakers did not enact legislation originating from the Joint Select Committee on Deficit Reduction that would reduce projected deficits by at least $1.2 trillion. Because no such legislation was enacted, those procedures are now scheduled to go into effect. d Since 2003, Congress took a series of legislative actions to prevent scheduled reductions in physician payment rates that would otherwise occur under law. Physician fee updates set by Congress have averaged 0.9 percent per year over this period. Growth in the Medicare Economic Index is projected to average 1.9 percent from 2012 to 2020. Thus, the assumption used by CMS, and in our Alternative simulation, implies physician payment rates will grow almost two times faster than they have since 2003. Table 3 shows the key economic assumptions that underlie all of our simulations. GDP is held constant across simulations and does not respond to changes in fiscal policy. Also, the implied interest rate on federal debt held by the public in our simulations is held constant over the long term even when deficits climb. With large budget deficits, there could be a rise in the rate of interest and a more rapid increase in federal interest payments than our simulations display. Table 3: Key Economic Assumptions Underlying All of GAO’s Long-Term Federal Simulations Model inputs All simulations Real GDP Growth CBO’s January 2012 baseline through 2022; thereafter averages 2.1 percent based on the intermediate assumptions of the 2011 Social Security and Medicare Trustees reports Inflation (percentage CBO’s January 2012 baseline through 2022; 2.0 percent thereafter (CBO’s projection in 2022) change in GDP price index) Interest rate (on Rate implied by CBO’s January 2012 baseline net interest payment projections through 2022; phasing to publicly held debt) 5.2 percent in 2025 and then constant thereafter (CBO’s June 2011 long-term projection) Source: GAO. A more detailed description of the federal model and key assumptions can be found at www.gao.gov/special.pubs/longterm/fed/aboutlongterm.html. The simulation results depend largely on what is assumed about growth in large entitlement programs. As in previous updates, we also show the Baseline Extended simulation using CBO estimates for long-term spending on Social Security and major health entitlement programs Page 11 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 (Medicare, Medicaid, and others). In addition, we show the Alternative simulation using different assumptions about certain health care cost- containment provisions based on CBO alternative projections. As figure 5 shows, the results are similar to our simulations using the Trustees and CMS Actuary’s projections. Figure 5: Debt Held by the Public under Fiscal Policy Simulations with Different Assumptions for Major Entitlement Programs Note: The two Alternative simulations are so close that their separate lines are not visible on this graph. Table 4 shows the CBO assumptions incorporated into the simulations that were used in the comparison shown in figure 5. Page 12 GAO-12-521SP Long-Term Fiscal Outlook Spring 2012 Table 4: Key Assumptions Underlying GAO’s Simulations Using CBO’s Spending Projections for Major Entitlement Programs Model inputs Baseline Extended simulation Alternative simulation Social Security CBO’s January 2012 baseline through 2022; Same as Baseline Extended spending thereafter based on CBO’s June 2011 long-term projections for Social Security Medicare CBO’s January 2012 baseline through 2022; Based on CBO’s projections under its alternative fiscal spending thereafter based on CBO’s June 2011 long-term scenario that assume physician payment rates are projections under its extended-baseline scenario maintained at 2011 levels through 2022 and that policies to restrain growth are not in effect after 2021 Medicaid, the CBO’s January 2012 baseline through 2022; CBO’s January 2012 baseline through 2022; thereafter Children’s Health thereafter based on CBO’s June 2011 long-term CBO’s June 2011 projections under its alternative fiscal Insurance projections under its extended-baseline scenario scenario in which a policy that would slow the growth of Program, and per-participant subsidies for health insurance coverage exchange is assumed not to be in effect and eligibility subsidies thresholds are assumed to be modified to maintain the spending share of the population eligible for subsidies Source: GAO. Notes: CBO’s projections are from CBO’s 2011 Long-Term Budget Outlook (June 2011). CBO assumes that full benefits are paid regardless of the amounts available in the trust funds. This product is part of a body of work on federal debt and the long-term fiscal challenge. Related products can be found at www.gao.gov/special.pubs/longterm/past/. We conducted our work from January 2012 to April 2012 in accordance with all sections of GAO’s Quality Assurance Framework that are relevant to our objectives. The framework requires that we plan and perform the engagement to obtain sufficient and appropriate evidence to meet our stated objectives and to discuss any limitations in our work. We believe that the information and data obtained, and the analysis conducted, provide a reasonable basis for any findings and conclusions in this product. 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The Federal Government's Long-Term Fiscal Outlook: Spring 2012 Update
Published by the Government Accountability Office on 2012-04-02.
Below is a raw (and likely hideous) rendition of the original report. (PDF)