In 2016, health and healthcare programs consumed 29% of all federal spending. Over the past 55 years, various Congresses and Presidents have established and expanded four major healthcare programs that can spend money without Congress passing annual spending bills. These are Medicare, Medicaid, the Children's Health Insurance Program, and the Affordable Care Act exchange subsidies. Under current federal policies, the Congressional Budget Office projects that these four programs will consume 60% of all federal revenues by 2060.