In this ten-year projection, the United States Government Accountability Office begins with the “baseline projection” prepared by the Congressional Budget Office, and makes three assumptions to arrive at its “alternative simulation.” (1) discretionary spending grows with the economy after 2008; (2) all expiring tax provisions are extended including the 2007 AMT exemption amount; and (3) Medicare spending is based on the April 2007 Trustee‘s intermediate projections adjusted for CMS’s alternative assumption that physician payments are not reduced as required under current law. These three modifications would result in sizable deficits, mostly as a result of lower than projected tax receipts contained in the CBO baseline projection.