Oldaker noted that what's going to happen in healthcare in the coming year goes well beyond PPACA. Healthcare, as a part of the national budget, will be subject to rigor as legislators look to make cuts.
"Beyond reform, healthcare is such a substantial portion of the federal budget that it will be under attack in the coming year," said Oldaker. "The discussion [between Republicans and Democrats] will go in two parts: one on sequestration and the other on revenue. The President realizes if he can't get agreement on revenue and then the tax cuts expire, it will be an issue."
Of the $3.6 trillion the U.S. government spent in 2011 (which accounts for nearly 24% of the nation's gross domestic product), $2.2 trillion was financed by federal tax revenues and $83 billion by excess profits on assets held by the Federal Reserve. The remainder—$1.3 trillion—was financed by borrowing, which will be paid with future tax revenue. The largest share of that $3.6 trillion, 21% ($769 billion), went to healthcare: Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). In comparison, 20% ($718 billion) went to defense and international security assistance, 20% ($731 billion) went to Social Security, and 13% ($466 billion) went to safety net programs. The government also spent $230 billion (6%) on interest on the national debt.