[
  {
    "id": "GAO-16-189-M1",
    "title": "Medicare payments by place of service",
    "agency": "Congress / HHS",
    "action": "Matter for congressional consideration",
    "report": "GAO-16-189",
    "source": "https://www.gao.gov/products/gao-16-189",
    "status": "Open – Partially Addressed",
    "statusDate": "GAO comments through February 2026; includes November 2025 CMS rule",
    "retrieved": "2026-10-22",
    "estimate": "$156.9 billion",
    "horizon": "2025–2034; historical CBO broad alternative",
    "estimateSource": "https://www.cbo.gov/budget-options/60908",
    "recommendation": "Review remaining authority to equalize clinically comparable outpatient payments across settings.",
    "nextStep": "Request a current CBO score net of enacted laws and CMS rules, with rural access and beneficiary cost-sharing analysis.",
    "costs": "Implementation, transition support, and any targeted hospital protections require a fresh score; not separately quantified here.",
    "affected": "Medicare beneficiaries, physician practices, hospitals, and rural or safety-net providers.",
    "tradeoffs": "Could reduce incentives to relocate routine services into higher-paid settings. Lower provider revenue could affect access; phase-in and service-level exceptions need evaluation.",
    "overlap": "Do not add the broad CBO alternative to narrower imaging or drug-administration alternatives. Do not count already implemented policies again.",
    "annualVerified": 0,
    "priority": "First review"
  },
  {
    "id": "GAO-25-107497-R2",
    "title": "Evaluate VA–DOD health care sharing",
    "agency": "Department of Veterans Affairs",
    "action": "Executive recommendation 2",
    "report": "GAO-25-107497",
    "source": "https://www.gao.gov/products/gao-25-107497",
    "status": "Open",
    "statusDate": "Published status includes planned FY2027 Q3 performance review",
    "retrieved": "2026-10-22",
    "estimate": "Tens of millions of dollars",
    "horizon": "Annually; qualitative potential in GAO 2026 annual report",
    "estimateSource": "https://www.gao.gov/products/gao-26-108505",
    "recommendation": "Evaluate sharing agreements against performance goals and use findings to improve delivery.",
    "nextStep": "Request evaluation design, referral volumes, marginal costs and access metrics; assess a small facility pilot.",
    "costs": "Data collection, coordination and evaluation costs are unquantified; do not assume they are zero.",
    "affected": "Veterans, servicemembers, their families, and participating VA and DOD facilities.",
    "tradeoffs": "Sharing could improve access and utilization, but capacity, travel burden and continuity of care constrain expansion.",
    "overlap": "Report net federal costs across both departments; interagency reimbursements alone are transfers, not savings.",
    "annualVerified": 0,
    "priority": "First review"
  },
  {
    "id": "GAO-26-108018-R1",
    "title": "Evaluate nuclear waste classification options",
    "agency": "DOE Office of Environmental Management",
    "action": "Executive recommendation 1",
    "report": "GAO-26-108018",
    "source": "https://www.gao.gov/products/gao-26-108018",
    "status": "Open",
    "statusDate": "August 2026 agency implementation assertion; GAO requests supporting evidence",
    "retrieved": "2026-10-22",
    "estimate": "$73–210 billion",
    "horizon": "Lifecycle scenario in a 2020 DOE study cited by GAO; no annual profile",
    "estimateSource": "https://www.gao.gov/products/gao-26-108018",
    "recommendation": "Systematically assess lawful, safe treatment alternatives and communicate results and barriers to Congress.",
    "nextStep": "Obtain DOE evaluation evidence and independent technical review before endorsing any disposal change.",
    "costs": "Lifecycle modeling, treatment facilities, transport, monitoring and litigation risks need scenario-level costing.",
    "affected": "Cleanup workers, nearby communities, Tribal nations, receiving jurisdictions and taxpayers.",
    "tradeoffs": "Potentially faster cleanup must satisfy safety and environmental requirements, consultation duties and long-term disposal standards.",
    "overlap": "The scenario is not an incremental annual estimate; do not add it to other DOE cleanup totals.",
    "annualVerified": 0,
    "priority": "Second review"
  },
  {
    "id": "GAO-20-2-R6",
    "title": "Improve Navy sustainment cost-risk analysis",
    "agency": "Department of the Navy",
    "action": "Executive recommendation 6",
    "report": "GAO-20-2",
    "source": "https://www.gao.gov/products/gao-20-2",
    "status": "Open – Partially Addressed",
    "statusDate": "February 2026 comments: documentation of sensitivity analysis still needed",
    "retrieved": "2026-10-22",
    "estimate": "Billions of dollars",
    "horizon": "Potential across shipbuilding acquisition and sustainment; qualitative",
    "estimateSource": "https://www.gao.gov/products/gao-26-108505",
    "recommendation": "Use risk and sensitivity analysis in shipbuilding operating and support cost estimates.",
    "nextStep": "Request evidence supporting GAO closure criteria and a program-level cost-risk comparison.",
    "costs": "Cost-estimating staff, engineering review and corrective actions are unquantified.",
    "affected": "Sailors, acquisition staff, shipyards, suppliers and defense taxpayers.",
    "tradeoffs": "Earlier risk analysis can improve choices; added review effort and delivery schedules must be balanced against readiness.",
    "overlap": "The report’s $130 billion estimate growth is a cost problem, not a savings claim. Closed recommendations are not reopened here.",
    "annualVerified": 0,
    "priority": "Second review"
  },
  {
    "id": "GAO-19-347-R1",
    "title": "Verify zero-income student loan applications",
    "agency": "Education / Federal Student Aid",
    "action": "Executive recommendation 1",
    "report": "GAO-19-347",
    "source": "https://www.gao.gov/products/gao-19-347",
    "status": "Open – Partially Addressed",
    "statusDate": "December 2025 comments planned implementation by September 2026; completion needs reconfirmation",
    "retrieved": "2026-10-22",
    "estimate": "More than $2 billion",
    "horizon": "2020–2029 estimate associated with enacted FUTURE Act authority",
    "estimateSource": "https://www.gao.gov/products/gao-19-347",
    "recommendation": "Confirm current verification controls and remaining gaps for applicants who self-certify zero income.",
    "nextStep": "Request post-September 2026 implementation status; establish current-law baseline before any new proposal.",
    "costs": "Data matching, privacy safeguards, correction procedures and servicer implementation need costing.",
    "affected": "Student borrowers, loan servicers, Education and IRS data subjects.",
    "tradeoffs": "Verification could reduce errors but must accommodate income changes, protect tax data and allow corrections.",
    "overlap": "Exclude the historical enacted-authority estimate from additional savings. Public award data cannot validate individual borrower eligibility.",
    "annualVerified": 0,
    "priority": "Hold for update"
  }
]