This is the accessible text file for CG Presentation number GAO-08- 501CG entitled 'Saving Our Future Requires Tough Choices Today' which was released on February 11, 2008. United States Government Accountability Office: GAO: Saving Our Future Requires Tough Choices Today: The Woodrow Wilson School of Public and International Affairs: Princeton University: Princeton, NJ: February 6, 2008: The Honorable David M. Walker: Comptroller General of the United States: GAO-08-501CG: Composition of Federal Spending: [See PDF for image] There are three pie charts, containing the following compositions of spending by category: Year: 1966; Defense: 43%; Social Security: 15%; Medicare and Medicaid: 1%; Net Interest: 7%; All Other: 34%. Year: 1986; Defense: 28%; Social Security: 20%; Medicare and Medicaid: 10%; Net Interest: 14%; All Other: 29%. Year: 2006; Defense: 20%; Social Security: 21%; Medicare and Medicaid: 19%; Net Interest: 9%; All Other: 32%. Source: Office of Management and Budget and the Department of the Treasury. [End of figure] Federal Spending for Mandatory and Discretionary Programs: [See PDF for image] There are three pie charts, containing the following compositions of spending by category: Year: 1966; Discretionary: 67%; Mandatory: 26%; Net Interest: 7%. Year: 1986; Discretionary: 44%; Mandatory: 42%; Net Interest: 14%. Year: 2006; Discretionary: 38%; Mandatory: 53%; Net Interest: 9%. Source: Office of Management and Budget. [End of figure] Table: Fiscal Year 2006 and 2007 Deficits and Net Operating Costs: On-Budget Deficit, Fiscal Year 2006 ($ Billion): (434); On-Budget Deficit, Fiscal Year 2007 ($ Billion): (344); Unified Deficit[a], Fiscal Year 2006 ($ Billion): (248); Unified Deficit[a], Fiscal Year 2007 ($ Billion): (163); Net Operating Cost, Fiscal Year 2006 ($ Billion): (450); Net Operating Cost, Fiscal Year 2007 ($ Billion): (276); Sources: Office of Management and Budget and Department of the Treasury. [a] Includes $185 billion in Social Security surpluses for fiscal year 2006 and $186 billion for fiscal year 2007; $1 billion in Postal Service surpluses for fiscal year 2006 and $5 billion for fiscal year 2006. Short-term Fiscal Position versus Long-term Fiscal Exposures: [See PDF for image] This figure is a multiple line graph illustrating short-term fiscal position versus long-term fiscal exposures. The following data is depicted: Fiscal year: 2004; Long-term Fiscal Exposures: $43.4 trillion; Net Operating Cost: $615.6 billion; Operating Deficit: $568 billion; Unified Deficit: $412.7 billion. Fiscal year: 2005; Long-term Fiscal Exposures: $46.4 trillion; Net Operating Cost: $760.2 billion; Operating Deficit: $493.6 billion; Unified Deficit: $318.3 billion. Fiscal year: 2006; Long-term Fiscal Exposures: $50.5 trillion; Net Operating Cost: $449.5 billion; Operating Deficit: $434 billion; Unified Deficit: $247.6 billion. Fiscal year: 2007; Long-term Fiscal Exposures: $52.7 trillion; Net Operating Cost: $275.5 billion; Operating Deficit: $344.284 billion; Unified Deficit: $162.8 billion. Source: GAO analysis. Note: Data are from the Congressional Budget Office and the Department of Treasury. Estimates of the federal government’s long-term fiscal exposures are based on the Financial Report of the U.S. Government. These estimates include the present value of future social insurance obligations over a 75-year time horizon as of January 1st of the preceding year. These estimates have not been adjusted for inflation. [End of figure] Surplus or Deficit as a Share of GDP (1797-2007) [expressed in percent of GNP/GDP]: [See PDF for image] This figure is a graph illustrating the surplus or deficit as a share of GDP (1797-2007). The vertical axis of the graph represents percent of GNP/GDP from -35 to 10. The horizontal axis of the graph represents years from 1797 to 2007. The following data is depicted: Year: 1797; Percent of GNP/GDP: 0.8. Year: 1820; Percent of GNP/GDP: -0.1. Year: 1840; Percent of GNP/GDP: -0.6. Year: 1860; Percent of GNP/GDP: -0.2. Year: 1880; Percent of GNP/GDP: 0.6. Year: 1900; Percent of GNP/GDP: 0.2. Year: 1920; Percent of GNP/GDP: 0.3. Year: 1921; Percent of GNP/GDP: 0.7. Year: 1922; Percent of GNP/GDP: 1. Year: 1923; Percent of GNP/GDP: 0.8 Year: 1924; Percent of GNP/GDP: 1.1. Year: 1925; Percent of GNP/GDP: 0.8. Year: 1925; Percent of GNP/GDP: 0.9. Year: 1926; Percent of GNP/GDP: 1.2. Year: 1927; Percent of GNP/GDP: 1. Year: 1928; Percent of GNP/GDP: 0.7. Year: 1929; Percent of GNP/GDP: 0.8 Year: 1930; Percent of GNP/GDP: -0.6. Year: 1940; Percent of GNP/GDP: -3. Year: 1941; Percent of GNP/GDP: -4.3. Year: 1942; Percent of GNP/GDP: -14.2. Year: 1943; Percent of GNP/GDP: -30.3. Year: 1944; Percent of GNP/GDP: -22.7. Year: 1945; Percent of GNP/GDP: -21.5. Year: 1946; Percent of GNP/GDP: -7.2. Year: 1947; Percent of GNP/GDP: 1.7. Year: 1948; Percent of GNP/GDP: 4.6. Year: 1949; Percent of GNP/GDP: 0.2. Year: 1950; Percent of GNP/GDP: -1.1. Year: 1960; Percent of GNP/GDP: 0.1. Year: 1970; Percent of GNP/GDP: -0.3. Year: 1980; Percent of GNP/GDP: -2.7. Year: 1990; Percent of GNP/GDP: -3.9. Year: 1991; Percent of GNP/GDP: -4.5. Year: 1992; Percent of GNP/GDP: -4.7. Year: 1993; Percent of GNP/GDP: -3.9. Year: 1994; Percent of GNP/GDP: -2.9. Year: 1995: Percent of GNP/GDP: -2.2. Year: 1996; Percent of GNP/GDP: -1.4. Year: 1997; Percent of GNP/GDP: -0.3. Year: 1998; Percent of GNP/GDP: 0.8. Year: 1999; Percent of GNP/GDP: 1.4 Year: 2000; Percent of GNP/GDP: 2.4. Year: 2001; Percent of GNP/GDP: 1.3. Year: 2002; Percent of GNP/GDP: -1.5. Year: 2003; Percent of GNP/GDP: -3.5. Year: 2004; Percent of GNP/GDP: -3.6. Year: 2005; Percent of GNP/GDP: -2.6. Year: 2006; Percent of GNP/GDP: -1.9. Year: 2007; Percent of GNP/GDP: -1.2. Note: Data until 1929 are shown as a percent of gross national product (GNP); data from 1930 to present are shown as a percent of GDP. Source: Department of Commerce,Office of Management and Budget, and Congressional Budget Office. [End of figure] Foreign Investors Now Own More of America’s Publicly Held Debt: [See PDF for image] This figure contains two pie-charts, depicting the following data: Year: 1996; Total Debt Held by the Public: $3.73 trillion; Foreign and international investors: 28%; Federal Reserve: 10%; Domestic investors and state and local governments: 62%. Year: 2006; Total Debt Held by the Public: $4.87 trillion; Foreign and international investors: 44%; Federal Reserve: 16%; Domestic investors and state and local governments: 40%. Source: Department of the Treasury. [End of figure] Table: Major Fiscal Exposures ($ trillions): Explicit liabilities (Publicly held debt, Military & civilian pensions & retiree health, Other): 2000: $6.9; 2007: $10.8; Percent increase: 57. Commitments & contingencies (e.g., PBGC, undelivered orders): 2000: 0.5; 2007: 1.1; Percent increase: 97. Implicit exposures: 2000: 13.0; Future Social Security benefits: 3.8; Future Medicare Part A benefits: 2.7; Future Medicare Part B benefits: 6.5; Future Medicare Part D benefits: 0. 2007: 40.8; Future Social Security benefits: 6.8; Future Medicare Part A benefits: 12.3; Future Medicare Part B benefits: 13.4; Future Medicare Part D benefits: 8.4. Percent increase: 197. Total, 2000: $20.4; Total, 2006: $52.7; Percent increase: 158. Source: 2000 and 2007 Financial Report of the United States Government. Note: Totals and percent increases may not add due to rounding. Estimates for Social Security and Medicare are at present value as of January 1 of each year and all other data are as of September 30. [End of table] Table: How Big is Our Growing Fiscal Burden? This fiscal burden can be translated and compared as follows: Total major fiscal exposures: $52.7 trillion; Total household net worth[1]: $58.6 trillion; Burden/Net worth ratio: 90 percent. Burden[2]: Per person: $175,000; Per full-time worker: $410,000; Per household: $455,000. Income: Median household income[3]: $48,201; Disposable personal income per capita[4]: $33,253. Source: GAO analysis. Notes: (1) Federal Reserve Board, Flow of Funds Accounts, Table B.100, 2007:Q3 (December 6, 2007); (2) Burdens are calculated using estimated total U.S. population as of 10/01/07, from the U.S. Census Bureau; full- time workers reported by the Bureau of Economic Analysis, in NIPA table 6.5D (Aug. 1, 2007); and households reported by the U.S. Census Bureau, in Income, Poverty, and Health Insurance Coverage in the United States: 2006 (Aug. 2007); (3) U.S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2005 (Aug. 2007); and (4) Bureau of Economic Analysis, Personal Income and Outlays table 2, (Nov. 29, 2007). [End of table] Potential Fiscal Outcomes Under Baseline Extended (January 2001); Revenues and Composition of Spending as a Share of GDP. [See PDF for image] This is a line/stacked bar graph with one line (revenue) and four stacked bars containing four spending items (Net interest, Social Security, Medicare and Medicaid, and All other spending). The vertical axis represents Percent of GDP and the horizontal axis represents fiscal years 2005, 2015[a], 2030[a], and 2040[a]. The following data is depicted: Fiscal year 2005: Net interest: 0.8%; Social Security: 4.3%; Medicare & Medicaid: 3.7%; All other spending: 7.994%; Revenue: 20.3%. Fiscal year 2015[A]: Net interest: 0%; Social Security: 5.1%; Medicare & Medicaid: 4.9%; All other spending: 5.574%; Revenue: 20.4%. Fiscal year 2030[A]: Net interest: 0%; Social Security: 6.6%; Medicare & Medicaid: 9.4%; All other spending: 3.991%; Revenue: 20.4%. Fiscal year 2040[A]: Net interest: 0%; Social Security: 6.7%; Medicare & Medicaid: 9%; All other spending: 4.361%; Revenue: 20.4%. Source: GAO’s January 2001 analysis. [a] All other spending is net of offsetting interest receipts. [End of graph] Potential Fiscal Outcomes Under Alternative Simulation; Revenues and Composition of Spending as a Share of GDP. [See PDF for image] This is a line/stacked bar graph with one line (revenue) and four stacked bars containing four spending items (Net interest, Social Security, Medicare and Medicaid, and All other spending). The vertical axis represents Percent of GDP and the horizontal axis represents fiscal years 2006, 2015, 2030, and 2040. The following data is depicted: Fiscal year 2006: Net interest: 1.7%; Social Security: 4.2%; Medicare & Medicaid: 3.9%; All other spending: 10.6%; Revenue: 18.4%. Fiscal year 2015: Net interest: 2.3%; Social Security: 4.8%; Medicare & Medicaid: 5.7%; All other spending: 9.6%; Revenue: 18%. Fiscal year 2030: Net interest: 5.8%; Social Security: 6.6%; Medicare & Medicaid: 8.8%; All other spending: 9.6%; Revenue: 18.6%. Fiscal year 2040: Net interest: 11.6%; Social Security: 7.2%; Medicare & Medicaid: 10.8%; All other spending: 9.6%; Revenue: 18.6%. Source: GAO’s August 2007 analysis. Notes: AMT exemption amount is retained at the 2006 level through 2017 and expiring tax provisions are extended. After 2017, revenue as a share of GDP returns to its historical level of 18.3 percent of GDP plus expected revenues from deferred taxes, i.e. taxes on withdrawals from retirement accounts. Medicare spending is based on the Trustees April 2007 projections adjusted for the Centers for Medicare and Medicaid Services alternative assumption that physician payments are not reduced as specified under current law. [End of graph] Debt Held by the Public Under GAO’s Alternative Simulation: [See PDF for image] This figure is a line graph. The vertical axis of the graph represents percent of GDP from 0 to 200. The horizontal axis of the graph represents fiscal years from 2000 through 2040. The following data is depicted: Fiscal year: 2000; Percent of GDP: 35.122; Fiscal year: 2001; Percent of GDP: 32.999. Fiscal year: 2002; Percent of GDP: 34.113. Fiscal year: 2003; Percent of GDP: 36.223. Fiscal year: 2004; Percent of GDP: 37.34. Fiscal year: 2005; Percent of GDP: 37.504. Fiscal year: 2006; Percent of GDP: 37.082. Fiscal year: 2007; Percent of GDP: 36.391. Fiscal year: 2008; Percent of GDP: 36.377. Fiscal year: 2009; Percent of GDP: 36.757. Fiscal year: 2010; Percent of GDP: 37.702. Fiscal year: 2011; Percent of GDP: 38.967. Fiscal year: 2012; Percent of GDP: 40.252. Fiscal year: 2013; Percent of GDP: 42.019. Fiscal year: 2014; Percent of GDP: 43.965. Fiscal year: 2015; Percent of GDP: 46.094. Fiscal year: 2016; Percent of GDP: 48.559. Fiscal year: 2017; Percent of GDP: 51.196. Fiscal year: 2018; Percent of GDP: 54.258. Fiscal year: 2019; Percent of GDP: 57.657. Fiscal year: 2020; Percent of GDP: 61.397. Fiscal year: 2021; Percent of GDP: 65.627. Fiscal year: 2022; Percent of GDP: 70.362. Fiscal year: 2023; Percent of GDP: 75.555. Fiscal year: 2024; Percent of GDP: 81.296. Fiscal year: 2025; Percent of GDP: 87.613. Fiscal year: 2026; Percent of GDP: 94.405. Fiscal year: 2027; Percent of GDP: 101.73. Fiscal year: 2028; Percent of GDP: 109.559. Fiscal year: 2029; Percent of GDP: 117.945. Fiscal year: 2030; Percent of GDP: 126.858. Fiscal year: 2031; Percent of GDP: 136.352. Fiscal year: 2032; Percent of GDP: 146.399. Fiscal year: 2033; Percent of GDP: 157.061. Fiscal year: 2034; Percent of GDP: 168.399. Fiscal year: 2035; Percent of GDP: 180.316. Fiscal year: 2036; Percent of GDP: 192.918. Fiscal year: 2037; Percent of GDP: 206.302. Fiscal year: 2038; Percent of GDP: 220.444. Fiscal year: 2039; Percent of GDP: 235.313. Fiscal year: 2040; Percent of GDP: 251.132. Source: GAO's August 2007 analysis. [End of figure] Growth in Spending for Social Security, Medicare, and Medicaid Expected to Outpace Economic Growth: [See PDF for image] This image is a bar graph depicting Growth in Spending for Social Security, Medicare, and Medicaid Expected to Outpace Economic Growth. The vertical axis of the graph represents growth in constant dollars, 2007-2032 in percentage from 0 to 150. The horizontal axis represents spending growth in the four areas. The following data is depicted: Growth in Constant dollars, 2007-2032: GDP: 71%; Social Security Spending: 127%; Medicaid Spending: 224%; Medicare Spending: 235%. Source: GAO analysis based on data from the Office of the Chief Actuary, Social Security Administration; Office of the Actuary,Centers for Medicare and Medicaid Services; and the Congressional Budget Office. Notes: Social Security and Medicare projections based on the intermediate assumptions of the 2007 Trustees’ Reports. Medicaid projections based on CBO’s August 2007 short-term Medicaid estimates and CBO’s December 2005 long-term Medicaid projections under mid-range assumptions. [End of graph] Social Security, Medicare, and Medicaid Spending as a Percent of GDP: [See PDF for image] This is a line graph with three stacked lines (Social Security, Medicaid, and Medicare). The vertical axis represents Percent of GDP and the horizontal axis represents fiscal years 2000 through 2080. The following data is depicted: 2000: Social Security: 4.229; Medicaid: 1.23; Medicare: 2.277; Total: 7.736. 2001: Social Security: 4.334; Medicaid: 1.322; Medicare: 2.433; Total: 8.089. 2002: Social Security: 4.409; Medicaid: 1.44; Medicare: 2.523; Total: 8.372. 2003: Social Security: 4.371; Medicaid: 1.501; Medicare: 2.56; Total: 8.432. 2004: Social Security: 4.283; Medicaid: 1.516; Medicare: 2.629; Total: 8.428. 2005: Social Security: 4.254; Medicaid: 1.457; Medicare: 2.7; Total: 8.411. 2006: Social Security: 4.28; Medicaid: 1.383; Medicare: 3.072; Total: 8.735. 2007: Social Security: 4.29; Medicaid: 1.401; Medicare: 3.185; Total: 8.876. 2008: Social Security: 4.24; Medicaid: 1.449; Medicare: 3.255; Total: 8.944. 2009: Social Security: 4.26; Medicaid: 1.490; Medicare: 3.333; Total: 9.083. 2010: Social Security: 4.32; Medicaid: 1.531; Medicare: 3.414; Total: 9.265. 2011: Social Security: 4.36; Medicaid: 1.578; Medicare: 3.49; Total: 9.428. 2012: Social Security: 4.44; Medicaid: 1.630; Medicare: 3.588; Total: 9.658. 2013: Social Security: 4.54; Medicaid: 1.683; Medicare: 3.694; Total: 9.917. 2014: Social Security: 4.65; Medicaid: 1.739; Medicare: 3.806; Total: 10.195. 2015: Social Security: 4.76; Medicaid: 1.799; Medicare: 3.918; Total: 10.477. 2016: Social Security: 4.86; Medicaid: 1.864; Medicare: 4.044; Total: 10.768. 2017: Social Security: 4.976; Medicaid: 1.930 Medicare: 4.183; Total: 11.089. 2018: Social Security: 5.08; Medicaid: 2.2; Medicare: 4.331; Total: 11.611. 2019: Social Security: 5.2; Medicaid: 2.2; Medicare: 4.483; Total: 11.883. 2020: Social Security: 5.31; Medicaid: 2.3; Medicare: 4.642; Total: 12.252. 2021: Social Security: 5.41; Medicaid: 2.3; Medicare: 4.809; Total: 12.519. 2022: Social Security: 5.22; Medicaid: 2.4; Medicare: 4.988; Total: 12.608. 2023: Social Security: 5.61; Medicaid: 2.4; Medicare: 5.173; Total: 13.183. 2024: Social Security: 5.71; Medicaid: 2.5; Medicare: 5.359; Total: 13.569. 2025: Social Security: 5.8; Medicaid: 2.6; Medicare: 5.547; Total: 13.947. 2026: Social Security: 5.89; Medicaid: 2.6; Medicare: 5.739; Total: 14.229. 2027: Social Security: 5.97; Medicaid: 2.7; Medicare: 5.935; Total: 14.605. 2028: Social Security: 6.05; Medicaid: 2.7; Medicare: 6.131; Total: 14.881. 2029: Social Security: 6.12; Medicaid: 2.8; Medicare: 6.322; Total: 15.242. 2030: Social Security: 6.17; Medicaid: 2.8; Medicare: 6.505; Total: 15.475. 2031: Social Security: 6.22; Medicaid: 2.9; Medicare: 6.682; Total: 15.802. 2032: Social Security: 6.27; Medicaid: 2.9; Medicare: 6.851; Total: 16.021. 2033: Social Security: 6.3; Medicaid: 3; Medicare: 7.017; Total: 16.317. 2034: Social Security: 6.32; Medicaid: 3.1; Medicare: 7.279; Total: 16.669. 2035: Social Security: 6.33; Medicaid: 3.1; Medicare: 7.34; Total: 16.77. 2036: Social Security: 6.34; Medicaid: 3.2; Medicare: 7.498; Total: 17.038. 2037: Social Security: 6.34; Medicaid: 3.3; Medicare: 7.643; Total: 17.283. 2038: Social Security: 6.34; Medicaid: 3.3; Medicare: 7.774; Total: 17.414. 2039: Social Security: 6.33; Medicaid: 3.4; Medicare: 7.894; Total: 17.624. 2040: Social Security: 6.31; Medicaid: 3.4; Medicare: 8.01; Total: 17.72. 2041: Social Security: 6.3; Medicaid: 3.5; Medicare: 8.121; Total: 17.921. 2042: Social Security: 6.28; Medicaid: 3.6; Medicare: 8.229; Total: 18.109. 2043: Social Security: 6.27; Medicaid: 3.6; Medicare: 8.334; Total: 18.204. 2044: Social Security: 6.25; Medicaid: 3.7; Medicare: 8.437; Total: 18.387. 2045: Social Security: 6.24; Medicaid: 3.7; Medicare: 8.54; Total: 18.48. 2046: Social Security: 6.23; Medicaid: 3.8; Medicare: 8.64; Total: 18.67. 2047: Social Security: 6.22; Medicaid: 3.8; Medicare: 8.737; Total: 18.757. 2048: Social Security: 6.21; Medicaid: 3.9; Medicare: 8.829; Total: 18.939. 2049: Social Security: 6.2; Medicaid: 3.9; Medicare: 8.916; Total: 19.016. 2050: Social Security: 6.2; Medicaid: 4; Medicare: 9.002; Total: 19.202. 2051: Social Security: 6.19; Medicaid: 4.063; Medicare: 9.008; Total: 19.261. 2052: Social Security: 6.19; Medicaid: 4.127; Medicare: 9.172; Total: 19.489. 2053: Social Security: 6.19; Medicaid: 4.192; Medicare: 9.256; Total: 19.638. 2054: Social Security: 6.2; Medicaid: 4.258; Medicare: 9.344; Total: 19.802. 2055: Social Security: 6.2; Medicaid: 4.325; Medicare: 9.439; Total: 19.964. 2056: Social Security: 6.21; Medicaid: 4.393; Medicare: 9.538; Total: 20.141. 2057: Social Security: 6.21; Medicaid: 4.462; Medicare: 9.634; Total: 20.306. 2058: Social Security: 6.22; Medicaid: 4.533; Medicare: 9.728; Total: 20.481. 2059: Social Security: 6.23; Medicaid: 4.604; Medicare: 9.82; Total: 20.654. 2060: Social Security: 6.23; Medicaid: 4.676; Medicare: 9.91; Total: 20.816. 2061: Social Security: 6.24; Medicaid: 4.75; Medicare: 10; Total: 20.99. 2062: Social Security: 6.24; Medicaid: 4.825; Medicare: 10.087; Total: 21.152. 2063: Social Security: 6.24; Medicaid: 4.901; Medicare: 10.175; Total: 21.316. 2064: Social Security: 6.25; Medicaid: 4.978; Medicare: 10.262; Total: 21.49. 2065: Social Security: 6.25; Medicaid: 5.056; Medicare: 10.349; Total: 21.655. 2066: Social Security: 6.25; Medicaid: 5.136; Medicare: 10.429; Total: 21.815. 2067: Social Security: 6.25; Medicaid: 5.217; Medicare: 10.502; Total: 21.969. 2068: Social Security: 6.26; Medicaid: 5.299; Medicare: 10.574; Total: 22.133. 2069: Social Security: 6.26; Medicaid: 5.383; Medicare: 10.648; Total: 22.291. 2070: Social Security: 6.26; Medicaid: 5.467; Medicare: 10.718; Total: 22.445. 2071: Social Security: 6.27; Medicaid: 5.553; Medicare: 10.784; Total: 22.607. 2072: Social Security: 6.27; Medicaid: 5.641; Medicare: 10.845; Total: 22.756. 2073: Social Security: 6.27; Medicaid: 5.73; Medicare: 10.906; Total: 22.906. 2074: Social Security: 6.27; Medicaid: 5.82; Medicare: 10.964; Total: 23.054. 2075: Social Security: 6.27; Medicaid: 5.912; Medicare: 11.022; Total: 23.204. 2076: Social Security: 6.27; Medicaid: 6.005; Medicare: 11.079; Total: 23.354. 2077: Social Security: 6.27; Medicaid: 6.099; Medicare: 11.134; Total: 23.503. 2078: Social Security: 6.28; Medicaid: 6.195; Medicare: 11.187; Total: 23.662. 2079: Social Security: 6.28; Medicaid: 6.293; Medicare: 11.239; Total: 23.812. 2080: Social Security: 6.28; Medicaid: 6.392; Medicare: 11.29; Total: 23.962. Source: GAO analysis based on data from the Office of the Chief Actuary, Social Security Administration, Office of the Actuary, Centers for Medicare and Medicaid Services, and the Congressional Budget Office. Note: Social Security and Medicare projections based on the intermediate assumptions of the 2007 Trustees’ Reports. Medicaid projections based on CBO’s August 2007 short-term Medicaid estimates and CBO’s December 2005 long-term Medicaid projections under mid-range assumptions. [End of graph] State and Local Governments Face Increasing Fiscal Challenges: [See PDF for image] This is a line graph with two lines (Operating Surplus/Deficit Measure and Net-lending/Net-borrowing). The vertical axis represents Percent of GDP from -6 to +2 and the horizontal axis represents fiscal years 1980 through 2050. The following data is depicted: 1980: Operating Surplus/Deficit Measure: 0.35873454; Net-lending/Net-borrowing: -0.236601541. 1981: Operating Surplus/Deficit Measure: 0.34624089; Net-lending/Net-borrowing: -0.169415676. 1982: Operating Surplus/Deficit Measure: 0.363124424; Net-lending/Net-borrowing: -0.387096774. 1983: Operating Surplus/Deficit Measure: 0.774990811; Net-lending/Net-borrowing: -0.138547233. 1984: Operating Surplus/Deficit Measure: 0.8152395; Net-lending/Net-borrowing: 0.223736398. 1985: Operating Surplus/Deficit Measure: 0.810172263; Net-lending/Net-borrowing: 0.035542497. 1986: Operating Surplus/Deficit Measure: 0.820186878; Net-lending/Net-borrowing: -0.103074303. 1987: Operating Surplus/Deficit Measure: 0.348462918; Net-lending/Net-borrowing: -0.346028062. 1988: Operating Surplus/Deficit Measure: 0.415329754; Net-lending/Net-borrowing: -0.289980015. 1989: Operating Surplus/Deficit Measure: 0.461047699; Net-lending/Net-borrowing: -0.302676683. 1990: Operating Surplus/Deficit Measure: 0.12076304; Net-lending/Net-borrowing: -0.649652772. 1991: Operating Surplus/Deficit Measure: -0.002324922; Net-lending/Net-borrowing: -0.823896329. 1992: Operating Surplus/Deficit Measure: 0.105991132; Net-lending/Net-borrowing: -0.675323856. 1993: Operating Surplus/Deficit Measure: 0.17518701; Net-lending/Net-borrowing: -0.573797579. 1994: Operating Surplus/Deficit Measure: 0.15154266; Net-lending/Net-borrowing: -0.429852097. 1995: Operating Surplus/Deficit Measure: 0.226784; Net-lending/Net-borrowing: -0.446084594. 1996: Operating Surplus/Deficit Measure: 0.382430375; Net-lending/Net-borrowing: -0.292955008. 1997: Operating Surplus/Deficit Measure: 0.540310442; Net-lending/Net-borrowing: -0.225184543. 1998: Operating Surplus/Deficit Measure: 0.711478221; Net-lending/Net-borrowing: -0.113181662. 1999: Operating Surplus/Deficit Measure: 0.528375987; Net-lending/Net-borrowing: -0.240602477. 2000: Operating Surplus/Deficit Measure: 0.51757156; Net-lending/Net-borrowing: -0.309666904. 2001: Operating Surplus/Deficit Measure: 0.213052923; Net-lending/Net-borrowing: -0.800750395. 2002: Operating Surplus/Deficit Measure: -0.212758845; Net-lending/Net-borrowing: -1.20443952. 2003: Operating Surplus/Deficit Measure: -0.034231078; Net-lending/Net-borrowing: -1.04098241. 2004: Operating Surplus/Deficit Measure: 0.03822412; Net-lending/Net-borrowing: -0.899039488. 2005: Operating Surplus/Deficit Measure: 0.262769152; Net-lending/Net-borrowing: -0.762696896. 2006: Operating Surplus/Deficit Measure: 0.21944499; Net-lending/Net-borrowing: -0.788126765. 2007: Operating Surplus/Deficit Measure: 0.412715768; Net-lending/Net-borrowing: -0.638191188. 2008: Operating Surplus/Deficit Measure: 0.345168264; Net-lending/Net-borrowing: -0.630180116. 2009: Operating Surplus/Deficit Measure: 0.333020741; Net-lending/Net-borrowing: -0.603351831. 2010: Operating Surplus/Deficit Measure: 0.302656141; Net-lending/Net-borrowing: -0.605141837. 2011: Operating Surplus/Deficit Measure: 0.257109542; Net-lending/Net-borrowing: -0.630946404. 2012: Operating Surplus/Deficit Measure: 0.206218592; Net-lending/Net-borrowing: -0.658720463. 2013: Operating Surplus/Deficit Measure: 0.16406332; Net-lending/Net-borrowing: -0.681176041. 2014: Operating Surplus/Deficit Measure: 0.119677687; Net-lending/Net-borrowing: -0.707576964. 2015: Operating Surplus/Deficit Measure: 0.076206951; Net-lending/Net-borrowing: -0.734940534. 2016: Operating Surplus/Deficit Measure: 0.026942361; Net-lending/Net-borrowing: -0.769406462. 2017: Operating Surplus/Deficit Measure: -0.032335263; Net-lending/Net-borrowing: -0.814653671. 2018: Operating Surplus/Deficit Measure: -0.109446599; Net-lending/Net-borrowing: -0.878965311. 2019: Operating Surplus/Deficit Measure: -0.19227354; Net-lending/Net-borrowing: -0.950160744. 2020: Operating Surplus/Deficit Measure: -0.28349272; Net-lending/Net-borrowing: -1.030954125. 2021: Operating Surplus/Deficit Measure: -0.386388384; Net-lending/Net-borrowing: -1.123450085. 2022: Operating Surplus/Deficit Measure: -0.483216203; Net-lending/Net-borrowing: -1.211277239. 2023: Operating Surplus/Deficit Measure: -0.557423995; Net-lending/Net-borrowing: -1.275859781. 2024: Operating Surplus/Deficit Measure: -0.667104614; Net-lending/Net-borrowing: -1.376919803. 2025: Operating Surplus/Deficit Measure: -0.781500085; Net-lending/Net-borrowing: -1.482014441. 2026: Operating Surplus/Deficit Measure: -0.866176187; Net-lending/Net-borrowing: -1.558258502. 2027: Operating Surplus/Deficit Measure: -0.971014018; Net-lending/Net-borrowing: -1.654401786. 2028: Operating Surplus/Deficit Measure: -1.059403133; Net-lending/Net-borrowing: -1.733838263. 2029: Operating Surplus/Deficit Measure: -1.167739726; Net-lending/Net-borrowing: -1.833479877. 2030: Operating Surplus/Deficit Measure: -1.259948277; Net-lending/Net-borrowing: -1.916759702. 2031: Operating Surplus/Deficit Measure: -1.372065386; Net-lending/Net-borrowing: -2.020169149. 2032: Operating Surplus/Deficit Measure: -1.467520327; Net-lending/Net-borrowing: -2.107108096. 2033: Operating Surplus/Deficit Measure: -1.596865114. Net-lending/Net-borrowing: -2.227702996. 2034: Operating Surplus/Deficit Measure: -1.728257684; Net-lending/Net-borrowing: -2.350527637. 2035: Operating Surplus/Deficit Measure: -1.829728717; Net-lending/Net-borrowing: -2.443203659. 2036: Operating Surplus/Deficit Measure: -1.964429157. Net-lending/Net-borrowing: -2.569286091. 2037: Operating Surplus/Deficit Measure: -2.100986709; Net-lending/Net-borrowing: -2.697381312. 2038: Operating Surplus/Deficit Measure: -2.205225568; Net-lending/Net-borrowing: -2.7928813. 2039: Operating Surplus/Deficit Measure: -2.325201615; Net-lending/Net-borrowing: -2.904115765. 2040: Operating Surplus/Deficit Measure: -2.430489372; Net-lending/Net-borrowing: -3.00097328. 2041: Operating Surplus/Deficit Measure: -2.569712106; Net-lending/Net-borrowing: -3.131648373. 2042: Operating Surplus/Deficit Measure: -2.709424661; Net-lending/Net-borrowing: -3.262966376. 2043: Operating Surplus/Deficit Measure: -2.818508477; Net-lending/Net-borrowing: -3.363795891. 2044: Operating Surplus/Deficit Measure: -2.947568546; Net-lending/Net-borrowing: -3.484450067. 2045: Operating Surplus/Deficit Measure: -3.058317306; Net-lending/Net-borrowing: -3.58693672. 2046: Operating Surplus/Deficit Measure: -3.188512473; Net-lending/Net-borrowing: -3.709010629. 2047: Operating Surplus/Deficit Measure: -3.300350183; Net-lending/Net-borrowing: -3.812861884. 2048: Operating Surplus/Deficit Measure: -3.432143889; Net-lending/Net-borrowing: -3.936539309. 2049: Operating Surplus/Deficit Measure: -3.545556545; Net-lending/Net-borrowing: -4.041974237. 2050: Operating Surplus/Deficit Measure: -3.686995315; Net-lending/Net-borrowing: -4.175627129. Sources: Historical data from National Income and Product Accounts. Historical data from 1980–2006, GAO projections from 2007–2050 using many CBO projections and assumptions, particularly for next 10 years. [End of graph] State and Local Fiscal Challenges Add to the Federal Government’s Fiscal Challenge: [See PDF for image] This is a line graph with two lines (Federal Surplus/Deficit and Combined Surplus/Deficit). The vertical axis represents Percent of GDP from -20 to +5 and the horizontal axis represents fiscal years 2000 through 2050. The following data is depicted: Fiscal year: 2000: Federal Surplus/Deficit: 2.4; Combined Surplus/Deficit: 2.141. Fiscal year: 2001: Federal Surplus/Deficit: 1.3; Combined Surplus/Deficit: 0.596. Fiscal year: 2002: Federal Surplus/Deficit: -1.5; Combined Surplus/Deficit: -2.624. Fiscal year: 2003: Federal Surplus/Deficit: -3.5; Combined Surplus/Deficit: -4.577. Fiscal year: 2004: Federal Surplus/Deficit: -3.6; Combined Surplus/Deficit: -4.516. Fiscal year: 2005: Federal Surplus/Deficit: -2.6; Combined Surplus/Deficit: -3.389. Fiscal year: 2006: Federal Surplus/Deficit: -1.9; Combined Surplus/Deficit: - 2.677. Fiscal year: 2007: Federal Surplus/Deficit: -1.2; Combined Surplus/Deficit: -1.8. Fiscal year: 2008: Federal Surplus/Deficit: -1.6; Combined Surplus/Deficit: -2.2. Fiscal year: 2009: Federal Surplus/Deficit: -2; Combined Surplus/Deficit: -2.6. Fiscal year: 2010: Federal Surplus/Deficit: -2.6; Combined Surplus/Deficit: -3.2. Fiscal year: 2011: Federal Surplus/Deficit: -2.9; Combined Surplus/Deficit: -3.5. Fiscal year: 2012: Federal Surplus/Deficit: -2.8 Combined Surplus/Deficit: -3.5. Fiscal year: 2013: Federal Surplus/Deficit: -3.3; Combined Surplus/Deficit: -4. Fiscal year: 2014: Federal Surplus/Deficit: -3.6; Combined Surplus/Deficit: -4.3. Fiscal year: 2015: Federal Surplus/Deficit: -3.8; Combined Surplus/Deficit: -4.5. Fiscal year: 2016: Federal Surplus/Deficit: -4.2; Combined Surplus/Deficit: -4.9. Fiscal year: 2017: Federal Surplus/Deficit: -4.4; Combined Surplus/Deficit: -5.2. Fiscal year: 2018: Federal Surplus/Deficit: -4.8; Combined Surplus/Deficit: -5.7. Fiscal year: 2019: Federal Surplus/Deficit: -5.2; Combined Surplus/Deficit: -6.1. Fiscal year: 2020: Federal Surplus/Deficit: -5.6; Combined Surplus/Deficit: -6.6. Fiscal year: 2021: Federal Surplus/Deficit: -6.1; Combined Surplus/Deficit: -7.2. Fiscal year: 2022: Federal Surplus/Deficit: -6.7; Combined Surplus/Deficit: -7.8. Fiscal year: 2023: Federal Surplus/Deficit: -7.2; Combined Surplus/Deficit: -8.4. Fiscal year: 2024: Federal Surplus/Deficit: -7.8; Combined Surplus/Deficit: -9.2. Fiscal year: 2025: Federal Surplus/Deficit: -8.5; Combined Surplus/Deficit: -9.9. Fiscal year: 2026: Federal Surplus/Deficit: -9; Combined Surplus/Deficit: -10.6. Fiscal year: 2027: Federal Surplus/Deficit: -9.7; Combined Surplus/Deficit: -11.3. Fiscal year: 2028: Federal Surplus/Deficit: -10.3; Combined Surplus/Deficit: -12. Fiscal year: 2029: Federal Surplus/Deficit: -10.9; Combined Surplus/Deficit: -12.7. Fiscal year: 2030: Federal Surplus/Deficit: -11.5; Combined Surplus/Deficit: -13.4. Fiscal year: 2031: Federal Surplus/Deficit: -12.2; Combined Surplus/Deficit: -14.2. Fiscal year: 2032: Federal Surplus/Deficit: -12.8; Combined Surplus/Deficit: -14.9. Fiscal year: 2033: Federal Surplus/Deficit: -13.5; Combined Surplus/Deficit:-15.7. Fiscal year: 2034: Federal Surplus/Deficit: -14.2; Combined Surplus/Deficit: -16.6. Fiscal year: 2035: Federal Surplus/Deficit: -14.8; Combined Surplus/Deficit: -17.3. Fiscal year: 2036: Federal Surplus/Deficit: -15.5; Combined Surplus/Deficit: -18.1. Fiscal year: 2037: Federal Surplus/Deficit: -16.3; Combined Surplus/Deficit: -18.9. Fiscal year: 2038: Federal Surplus/Deficit: -16.9; Combined Surplus/Deficit: -19.7. Fiscal year: 2039: Federal Surplus/Deficit: -17.6; Combined Surplus/Deficit: -20.5. Fiscal year: 2040: Federal Surplus/Deficit: -18.3; Combined Surplus/Deficit: -21.3. Fiscal year: 2041: Federal Surplus/Deficit: -19; Combined Surplus/Deficit: -22.1. Fiscal year: 2042: Federal Surplus/Deficit: -19.8; Combined Surplus/Deficit: -23. Fiscal year: 2043: Federal Surplus/Deficit: -20.4; Combined Surplus/Deficit: -23.8. Fiscal year: 2044: Federal Surplus/Deficit: -21.2; Combined Surplus/Deficit: -24.6. Fiscal year: 2045: Federal Surplus/Deficit: -21.9; Combined Surplus/Deficit: -25.5. Fiscal year: 2046: Federal Surplus/Deficit: -22.7; Combined Surplus/Deficit: -26.4. Fiscal year: 2047: Federal Surplus/Deficit: -23.4; Combined Surplus/Deficit: -27.2. Fiscal year: 2048: Federal Surplus/Deficit: -24.2; Combined Surplus/Deficit: -28.1. Fiscal year: 2049: Federal Surplus/Deficit: -24.9; Combined Surplus/Deficit:- 29. Fiscal year: 2050: Federal Surplus/Deficit: -25.8; Combined Surplus/Deficit: -29.9. Source: Historical data from National Income and Product Accounts, GAO Analysis. Note: Historical data from 2000–2006, projections from 2007–2050; state and local balance measure is similar to the federal unified budget measure. Federal Simulation Assumptions: Discretionary spending grows with GDP after 2007. AMT exemption amount is retained at the 2006 level through 2017 and expiring tax provisions are extended. After 2017, revenue as a share of GDP returns to its historical level of 18.3 percent of GDP plus expected revenues from deferred taxes, i.e. taxes on withdrawals from retirement accounts. Medicare spending is based on the Trustees’ April 2007 projections adjusted for the Centers for Medicare and Medicaid Services’ alternative assumption that physician payments are not reduced as specified under current law. [End of graph] Social Security and Medicare’s Hospital Insurance Trust Funds Face Cash Deficits: [See PDF for image] This is a bar graph with vertical bars representing the Medicare HI Cash Flow and Social Security Cash Flow for each fiscal year. The bars indicate a Medicare HI cash deficit beginning in 2007 and a Social Security cash deficit in 2017. The vertical axis of the graph depicts billions of 2007 dollars from -900 to +200. The horizontal axis depicts fiscal years from 2005 through 2040. The following data is depicted: 2005: Medicare HI cash flow: $0.42; Social Security cash flow: $81.68; Surplus: $82.1. 2006: Medicare HI cash flow: $3.26; Social Security cash flow: $88.75; Surplus: $90.01. 2007: Medicare HI cash flow: ($1.00); Social Security cash flow: $79.40; Surplus: $78.40. 2008: Medicare HI cash flow: ($4.88); Social Security cash flow: $90.10; Surplus: $85.22. 2009: Medicare HI cash flow: ($7.61); Social Security cash flow: $94.30; Surplus: $86.69. 2010: Medicare HI cash flow: ($11.11); Social Security cash flow: $89.80; Surplus: $78.69. 2011: Medicare HI cash flow: ($14.40); Social Security cash flow: $86.10; Surplus: $71.7. 2012: Medicare HI cash flow: ($19.27); Social Security cash flow: $76.30; Surplus: $57.03. 2013: Medicare HI cash flow: ($23.85); Social Security cash flow: $62.10; Surplus: $38.25. 2014: Medicare HI cash flow: ($29.83); Social Security cash flow: $45.90; Surplus: $16.07. 2015: Medicare HI cash flow: ($36.28); Social Security cash flow: $29.20; Deficit: $7.08. 2016: Medicare HI cash flow: ($43.13); Social Security cash flow: $11.50; Deficit: $31.63. 2017: Medicare HI cash flow: ($51.11); Social Security cash flow: ($6.70); Deficit: $57.81. 2018: Medicare HI cash flow: ($60.85); Social Security cash flow: ($26.30); Deficit: $87.15. 2019: Medicare HI cash flow: ($70.74); Social Security cash flow: ($46.80); Deficit: $117.54. 2020: Medicare HI cash flow: ($81.45); Social Security cash flow: ($67.80); Deficit: $149.25. 2021: Medicare HI cash flow: ($93.57); Social Security cash flow: ($88.40); Deficit: $181.97. 2022: Medicare HI cash flow: ($107.64); Social Security cash flow: ($109.00); Deficit: $216.64. 2023: Medicare HI cash flow: ($122.16); Social Security cash flow: ($129.70); Deficit: $251.86. 2024: Medicare HI cash flow: ($137.69); Social Security cash flow: ($150.30); Deficit: $287.99. 2025: Medicare HI cash flow: ($153.52); Social Security cash flow: ($170.90); Deficit: $324.42. 2026: Medicare HI cash flow: ($171.35); Social Security cash flow: ($191.30); Deficit: $362.65. 2027: Medicare HI cash flow: ($189.83); Social Security cash flow: ($211.30); Deficit: $401.13. 2028: Medicare HI cash flow: ($209.99); Social Security cash flow: ($231.30); Deficit: $441.29. 2029: Medicare HI cash flow: ($230.01); Social Security cash flow: ($249.50); Deficit: $479.51. 2030: Medicare HI cash flow: ($250.39); Social Security cash flow: ($266.50); Deficit: $516.89. 2031: Medicare HI cash flow: ($272.06); Social Security cash flow: ($282.50); Deficit: $554.56. 2032: Medicare HI cash flow: ($293.90); Social Security cash flow: ($297.30); Deficit: $591.2. 2033: Medicare HI cash flow: ($316.28); Social Security cash flow: ($310.30); Deficit: $626.58. 2034: Medicare HI cash flow: ($338.68); Social Security cash flow: ($321.40); Deficit: $660.08. 2035: Medicare HI cash flow: ($361.93); Social Security cash flow: ($330.90); Deficit: $692.83. 2036: Medicare HI cash flow: ($385.03); Social Security cash flow: ($339.60); Deficit: $724.63. 2037: Medicare HI cash flow: ($408.36); Social Security cash flow: ($347.30); Deficit: $762.06. 2038: Medicare HI cash flow: ($430.55); Social Security cash flow: ($353.70); Deficit: $784.25. 2039: Medicare HI cash flow: ($453.30); Social Security cash flow: ($358.80); Deficit: $812.1. 2040: Medicare HI cash flow: ($475.73); Social Security cash flow: ($363.40); Deficit: $839.13. Source: GAO analysis of data from the Office of the Chief Actuary, Social Security Administration and Office of the Actuary, Centers for Medicare and Medicaid Services. Note: Projections based on the intermediate assumptions of the 2007 Trustees’ Reports. The CPI is used to adjust from current to constant dollars. [End of graph] Growth in Health Care Spending Health Care Spending as a Percentage of GDP: [See PDF for image] This figure is a bar graph depicting Growth in Health Care Spending Health Care Spending as a Percentage of GDP for five specific years. The vertical axis of the graph represents percent from 0 to 25. The horizontal axis of the graph represents years 1975, 1985, 1995, 2005, and 2015. The following data is depicted: Year: 1975; National health expenditures as a percent of GDP: 8.1%. Year: 1985; National health expenditures as a percent of GDP: 10.4%. Year: 1995; National health expenditures as a percent of GDP: 13.7%. Year: 2005; National health expenditures as a percent of GDP: 16.0%. Year: 2015; National health expenditures as a percent of GDP: 19.2%. Source: The Centers for Medicare & Medicaid Services, Office of the Actuary. Notes: The most current data available on health care spending are for 2005. The figure for 2015 is projected. [End of graph] {End of presentation] On the Web: Web site: [hyperlink, http://www.gao.gov/cghome.htm]: Contact: Chuck Young, Managing Director, Public Affairs: youngc1@gao.gov: (202) 512-4800: U.S. Government Accountability Office: 441 G Street NW, Room 7149: Washington, D.C. 20548: Copyright: This is a work of the U.S. government and is not subject to copyright protection in the United States. The published product may be reproduced and distributed in its entirety without further permission from GAO. 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