A shortfall to the federal deficit is expected to increase over the long term largely because of increased spending on federal health care programs, according to a budget outlook by the Congressional Budget Office (CBO).

The gradual recovery from the recent recession, as well as changing tax and spending policies, has resulted in the federal deficit reaching 4% of the gross domestic product. CBO expects the deficit to continue to fall, reaching 2% of GDP in 2015.

However, the report predicted that deficits could soon begin to rise monthly because of increasing costs for Medicare, Medicaid, CHIP and the Affordable Care Act’s federal subsidies. The report states that spending on major health care programs will rise from 4.6% of GDP in 2013 to 8% in 2038, more than half of which would be made up by Medicare spending

CBO Director Douglas Elmendorf said, “[A]s a society [we] have a fundamental choice of whether to cut back on those programs or raise taxes to pay for them,” adding, “And so far, we’ve chosen to do very little of either”.