published projections of the potential impact of the ppaca were for the year ebiner c et al it does not inform about how quickly the new equilibrium would be reached although some researchers have made a deduction about the dynamics the model is not intended to generate longterm projections of health expenditures and therefore is not comprehensive of the set of drivers of public health spending growth the model also does not include the impact of broader macroeconomic effects such as firm births and deaths changes in firm size and changes in worker s employment statuses either due to business cycles effects or to policy reforms