In invited testimony before the House of Representatives Democratic Steering and Policy Committee, Commonwealth Fund president Karen Davis discussed two approaches to sustaining Medicare: continuing to use the program's administrative efficiencies and leverage as the largest purchaser of health care to achieve lower medical and administrative costs than private insurance, and building on the innovations in the Affordable Care Act. Davis testified that Governor Romney's plan to pay beneficiaries a fixed sum, with a cap tied to growth in the economy—and without cost controls for overall health spending—would shift costs to beneficiaries already struggling with out-of-pocket medical expenses and limited incomes.