The ACA paid for its coverage expansion with Medicare savings (payment cuts and reforms) and taxes on higher income people.In the long run, the hope is that Medicare savings from payment reforms will increase their share of the financing burden.This will serve to keep all taxes - income and Medicare-specific taxes -- lower than they would otherwise be.Unfortunately, one of the most prominent payment reforms, the shared savings version of accountable care organizations, has been shown to cost Medicare more than it saved, at least through 2016.This was primarily because:

a.Less than 1/3 of Medicare beneficiaries chose to be in an ACO

b.It takes at least 7 years to save money with payment reforms in health care

c.Shared savings with no downside risk impart weak incentives to control total cost of care

d.Primary care is the key to saving health care spending and ACOs mostly ignored primary care

Please pick the correct answer