265 pages. "While the physician payment updates and new incentives ... avoid the significant short-range physician payment issues that would have resulted from the SGR system approach, they nevertheless raise important long-range concerns.... [The ACA] introduced large policy changes and additional projection uncertainty.... The methodology for projecting Medicare finances assumes a substantial long-term reduction in per capita health expenditure growth rates relative to historical experience, to which the ACA's cost -reduction provisions would add substantial further savings. Notwithstanding recent favorable developments, current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation."