In a recent report, “Medicare Advantage: Quality Bonus Payment Demonstration Undermined by High Estimated Costs and Design Shortcomings,” the GAO recommends that CMS cancel its Medicare Advantage (MA) Quality Bonus Payment Demonstration and allow the MA quality bonus payment system established by the ACA to take effect. The CMS demonstration, announced in November 2010, provides bonus payments to MA plans with 3 or more stars under a quality rating system and accelerates and increases bonuses for plans with higher quality ratings than envisioned under a separate ACA bonus structure. The GAO reports that the demonstration will cost $8.35 billion over 10 years, dwarfing all other Medicare demonstrations, and that most of the funds will be paid to average performing plans. Moreover, the demonstration’s design precludes a credible evaluation of its effectiveness in achieving CMS’s stated research goal of determining whether its bonus structure boosts quality improvement more than the ACA structure.