The United States took a potentially significant step towards fiscal sustainability in 2010 by reforming its system of health insurance. The legislated changes for Medicare, Medicaid, and other health coverage hold the prospect of lowering the long-term growth trend for future health care costs and significantly reducing the long-term fiscal gap. But even with the new law, the projections discussed above indicate that, under current policies and the assumptions used in this report, the debt-to-GDP ratio will continually increase over the next 75 years and beyond, which means current policies are not sustainable. As indicated earlier, the longer policy action to avert these trends is delayed, the larger are the projected revenue increases and/or spending decreases necessary to reach a target debt-to-GDP ratio. These projections, however, are neither forecasts nor predictions. They are presented here to provide a foundation upon which readers can form their own conclusions about fiscal sustainability.