▁sp ending ▁of ▁~ $ 7 ▁tr ill ion ▁for ▁the ▁period . ▁ ▁In ▁March ▁ 2 0 1 1 , ▁the ▁C BO ▁estimated ▁the ▁Medic are ▁bas eline ▁level ▁of ▁sp ending ▁would ▁not ▁exceed ▁targets ▁throughout ▁the ▁years ▁of ▁ 2 0 1 5 ▁to ▁ 2 0 2 1 ; ▁thus , ▁the ▁IP AB ▁was ▁not ▁expected ▁to ▁affect ▁any ▁Medic are ▁sp ending . ▁ ▁F is cal ▁commission ▁report ▁The ▁ 2 0 1 0 ▁president ial ▁commission , ▁the ▁National ▁Commission ▁on ▁F is cal ▁Res p ons ibility ▁and ▁Reform , ▁issued ▁a ▁report ▁on ▁reducing ▁the ▁federal ▁def ic it ▁and ▁voted ▁ 1 1 ▁to ▁ 7 ▁to ▁strength en ▁the ▁IP AB . ▁It ▁wished ▁to ▁bring ▁forward ▁the ▁time ▁by ▁which ▁health ▁care ▁prov iders ▁would ▁be ▁affected ▁by ▁IP AB ▁dec isions . ▁The ▁recommend ations ▁" w ould ▁hit ▁hosp it als ▁the ▁hard est , ▁which ▁gained ▁an ▁exem ption ▁from ▁the ▁group ' s ▁dec isions ▁for ▁several ▁years ." ▁ ▁Law suit ▁ ▁As ▁part ▁of ▁legal ▁challeng es ▁from ▁conserv ative ▁organizations ▁and ▁state ▁att or ne ys ▁general ▁in ▁about ▁twenty ▁states ▁to ▁the ▁Aff ord able ▁Care ▁Act , ▁Arizona ' s ▁conserv ative ▁Gold water ▁Institute , ▁along ▁with ▁three ▁Republican ▁con gress man ▁from ▁Arizona , ▁file d ▁a ▁suit ▁challeng ing ▁the ▁constitution ality ▁of ▁the ▁IP AB . ▁The ▁Hill ▁reported ▁that ▁" while ▁the ▁suit ▁illustr