The ACA includes provisions for cutting payments and raising revenues that will achieve about $ 670 billion of gross
savings for the Centers for Medicare & Medicaid Services (CMS) as a payer between 2011 and 2019, according to the
CMS Office of the Actuary. These estimates focus on “direct” savings, which are realized whether or not physicians, hospitals, insurers, and other stakeholders in the health care system change their behavior; that is, they neither assume nor require reducing waste. The estimate of total savings theoretically achievable through waste reduction, as opposed to direct cuts, far exceeds that figure; it is more than $ 3 trillion for CMS in the same period and roughly $ 11 trillion for all payers. Eliminating on average an additional 4 % of this waste each year— reaching a 37% reduction in annual theoretical waste by 2020— would achieve the goal of sustain ability over this period.