A Check-Up on the Government’s Fiscal Health

2017_fiscaloutlook_slider_thumbAfter 6 years of declining deficits, the federal deficit increased to $587 billion in 2016 and U.S. debt held by the public stood at about $14.2 trillion at the end of 2016. These figures are only expected to grow.

The federal government’s long-term fiscal outlook is unsustainable.

To help policymakers grapple with this problem, we regularly prepare long-term fiscal simulations to show how the federal debt could grow or shrink based on different policy choices.

Today, we released the first of an annual overview report on the federal government’s fiscal condition and long-term fiscal health, and updated our fiscal outlook webpage. Read on for some of the highlights, our latest video explaining the issue, and some solutions to this growing problem.

Structural imbalance

There is a structural imbalance between federal revenue and spending under current law. This leads to ever rising debt as a share of the economy—this is unsustainable.

Congress and the incoming administration will need to consider the whole range of federal activities and spending—entitlement and other mandatory programs, discretionary spending, and revenues.  They will also need to make some tough policy choices in order to put the federal government on a path of long-term fiscal sustainability.

The issue is complicated, and the solutions won’t be easy, but our video explains some of the key facts, considerations, and potential solutions:

What are the drivers?

On the spending side, the two key drivers are mandatory spending programs, including Social Security, Medicare and Medicaid, and the interest the federal government pays on the national debt. As these grow they put pressure on other areas of the government and could limit the ability to respond to unforeseen events.

Figure 5: Drivers of Long-Term Federal Spending

(Excerpted from GAO-17-237SP)


Although any long-term changes in spending and revenue will require legislation, federal agencies can help ensure a sustainable fiscal future. We identified four key actions for them:

  • Reduce improper payments—estimated to be $144 billion in 2016, this is the amount of payments that should not have been made or that were made in an incorrect amount.
  • Close the tax gap—the $458 billion difference between taxes owed to the government and taxes paid on time
  • Eliminate duplication and inefficiencies in federal programs—our duplication and cost savings body of work has already resulted in over $55 billion in cost savings, and addressing all of our recommendations could result in billions more.
  • Provide better information on programs and operations which can help, for example, improve transparency in federal spending data.

Check out our updated fiscal outlook page for the underlying assumptions, data, key reports, and more.

  • Questions on the content of this post? Contact Susan J. Irving at irvings@gao.gov
  • Comments on GAO’s WatchBlog? Contact blog@gao.gov
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Tracking Foreign Aid

Table 1: U.S. Government Foreign Assistance ReportingYou can find out how much money the United States spends on foreign assistance, and where that money is going, on ForeignAssistance.gov—an official U.S. website that publishes this data.

For example, ForeignAssistance.gov indicated that foreign assistance funding will be almost $34 billion for fiscal year 2017. But is that data accurate?

We recently examined foreign assistance data on ForeignAssistance.gov and today’s WatchBlog shares what we found.

Incomplete data

ForeignAssistance.gov publishes data from 10 federal agencies on a quarterly basis. However, we found that this website did not include data on $5.9 billion in committed funds and $10.5 billion in spending for fiscal year 2014—based on comparison with data collected, verified, and published by the U.S. Agency for International Development on the Foreign Aid Explorer website.

Comparison of Foreign Assistance Funding Data Reported by 10 U.S. Agencies and Published on ForeignAssistance.gov and Foreign Aid Explorer, Fiscal Year 2014(Excerpted from GAO-16-768)

Tracking the missing pieces

The State Department, which manages ForeignAssistance.gov, conducts some accuracy checks on the website’s data (including ensuring that all fields are populated) but primarily relies on the agencies to report complete and accurate data.

Among the 10 agencies whose data are published on the website, we found that the Departments of Agriculture, Defense, Health and Human Services, and State reported incomplete funding data for fiscal year 2014. Reasons include:

  • Multiple data sources—an agency may not have a single IT system from which to pull all required data.
  • Lack of detailed data—an agency’s existing IT systems may not track data at the required level of detail (e.g., at the country level).
  • Limited staff time—an agency may not have dedicated staff to report data, relying instead on existing staff who have other responsibilities.
  • Lack of funding—an agency may not have the resources to improve its data collection and reporting.

Figure 2: State’s Quarterly Data Collection and Publishing Process for ForeignAssistance.gov(Excerpted from GAO-16-768)

Room for improvement?

These data gaps may undermine ForeignAssistance.gov’s goal of increasing the public’s understanding and oversight of U.S. foreign assistance. We’ve made recommendations on how the State Department could improve the quality and transparency of data on this website.

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Life’s Difficult Decisions: Choosing a Nursing Home for a Loved One

photo of elderly hands on a keyboardEvery year, millions of Americans seek care in nursing homes. If you or a close friend or family member are in this position, how would you choose the right one?

Fortunately, the government runs a website called Nursing Home Compare, which has information that is meant to help people research and compare nursing homes. While the website is generally helpful to people, we found some ways it could be improved. Today’s WatchBlog looks at Nursing Home Compare—and its Five-Star Rating System.

Comparing Nursing Home Quality

Choosing a nursing home for a loved one can be stressful. Often times the decision needs to be made quickly, and finding reliable information can be tough.

To help assist people with this difficult choice, the Centers for Medicare & Medicaid Services (CMS) created the Nursing Home Compare website in 1998. The website contains nursing home information, such as:

  • Health inspection ratings,
  • Ratio of nursing staff to residents,
  • Performance quality measures, and
  • Number of registered complaints against the home.

The Five-Star Quality Rating System

As of 2008, the Nursing Home Compare website also contains a tool called the Five-Star Quality Rating System. Based on a calculation involving the bulleted information above, the Five-Star System assigns each participating nursing home an overall star rating, ranging from 1 (below average) to 5 (above average).

Helpful Tips When Using Nursing Home Compare

We found that people think the website is a helpful starting place for finding a nursing home, and that it can provide valuable information. That said, people shouldn’t rely solely on the website when making such an important decision.

There are a few important weaknesses to consider. For example, the overall star rating can’t be compared nationally, but only within states. This means if you live in a town that borders multiple states, you don’t know if a 4-star home in one state is better than a 3-star home in another state. The figure below shows how this could cause problems.

Table 3: Stakeholder Responses to How Much Consumers Use Nursing Home Compare(Excerpted from  GAO-17-61)
[Image updated to reflect state-related issues. Check out the full report for
all of the images.]

Example of Consumer Making Nursing Home Decision across Multiple States

Another thing to consider is that the information and star rating provided on the website are often outdated, and may not reflect the current status of the nursing home. CMS encourages people to explore other sources of information about the nursing home, including an in-person visit to the home.

For more information about what groups found helpful (and not helpful) about Nursing Home Compare, read our full report. We also made several recommendations to CMS about how they could improve the website.

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Housing for Homeless Veterans through VA’s Enhanced-Use Lease Program (interactive graphics)

GAO graphics iconApproximately 39,000 U.S. veterans were homeless as of January 2016 due to factors such as mental health issues and substance abuse. The Department of Veterans Affairs’ enhanced-use lease program turns unused federal buildings into affordable housing for homeless veterans.

This housing comes with crucial supportive services, including access to medical care, mental health counseling, substance abuse treatment, and assistance with transportation.

The Department of Veterans Affairs' 70 Enhanced-Use Leases, as of September 2016

Our recent interactive graphics shows each state’s homeless veteran population, as well as the current and future location and status of enhanced-use leasing units. To interact with these graphics, visit the full report page.


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Reflections on Addiction and Recovery (videos)

GAO_Video_icon-largeOver 47,000 people died of drug overdoses in the United States in 2014—more than any previous year on record. In fact, drug overdoses are now the leading cause of death by injury in the country, surpassing auto accidents.

To help policymakers and the public understand drug abuse—including misuse of prescription drugs—and what can be done to address it, we added Illicit Drug Use to our collection of Key Issues. This new Key Issues page provides bottom line information about the issue and links to our key reports on the topic, including the results of our 2016 forum on strategies to prevent illicit drug use.

In order to illustrate the impact of illicit drug use on individuals and families, the forum began with two video testimonials of individuals who are in recovery from a substance abuse disorder—discussing how they started using drugs and their paths to recovery. Watch their stories:

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Nursing Home Compare Website (podcast)

GAO Podcast IconAbout 1.4 million Americans seek care in nursing homes every year. To help them—and their families—make informed choices about selecting the right one, the Nursing Home Compare website allows people to research nursing homes using a Five-Star Quality Rating System.

A team led by Nikki Clowers, Managing Director in our Health Care team, recently assessed the website and rating system to see how useful they were to consumers. Listen to what they found:


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Student Loan Income-driven Repayment Plans (podcast)

GAO Podcast IconIncome-driven repayment (IDR) plans can help borrowers who are struggling to repay their student loans. These plans allow federal student loan borrowers to make lower payments over longer periods of time based on their income. At the end of the repayment term, if there is any remaining balance in a loan that is being paid through an IDR plan, the balance is forgiven. The Department of Education estimated that these repayment plans will ultimately cost the federal government $74 billion— we think they may be under or over by billions.

A team led by Melissa Emrey-Arras, a director in our Education, Workforce, and Income Security team, recently looked into how Education came up with its estimate. Listen to Melissa explain:


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Prescription Drug Labeling for Individuals Who are Blind or Visually Impaired (podcast)

GAO Podcast IconAbout 7.4 million Americans are blind or visually impaired, and they may have trouble reading the labels on prescription drug containers. Accessible labels—including audible, Braille, and large-print labels—can help. In 2013 the government developed best practices for accessible labels, and conducted outreach to pharmacies about them.

A team led by John Dicken, a director in our Health Care team, recently looked at the extent to which pharmacies have implemented these best practices. Hear what they found:


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GAO Again Named Among Best Places to Work and #1 for Our Support of Diversity

Banner: best places to work in the federal government

The Partnership for Public Service announced that GAO has again placed on its roster of the Best Places to Work in the Federal Government. This year, we rose to 2nd among mid-size agencies, tying with Peace Corps for that honor.

And, for the 3rd year in a row, we ranked #1 in our support of diversity among mid-size agencies.

U.S. Comptroller General Gene L. Dodaro commented on the rankings:

GAO has long been known as a terrific place to serve the public in a positive work environment. The Partnership’s 2016 rankings validate our reputation as a leading employer.

We have a great fact-based, non-partisan mission and an outstanding workforce that is deeply committed to helping government work better and to holding agencies and programs accountable.

I’m also heartened that GAO’s commitment to diversity and inclusion is reflected in continuing high scores in that area.

Read our press release here and learn more about GAO’s work in these WatchBlog posts.

• Questions on the content of this post? Contact Chuck Young at youngc1@gao.gov.
• Comments on GAO’s WatchBlog? Contact blog@gao.gov.

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Zika Virus Prevention and Response (infographic)

The Zika virusinfographic thumbnail can cause symptoms including fever, rash, and joint pain. It has recently been linked to microcephaly in newborn babies and is possibly linked to Guillain-Barré syndrome in adults. The disease first started in the tropics, then individual travelers were diagnosed in many parts of the country. Subsequently it spread locally in parts of Florida and Texas. Continue reading

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