In a testimony presented to the U.S. Senate Special Committee on Aging, Robert Berenson argues that the proposed Financial Alignment Initiative is much too ambitious and represents not a series of demonstration but rather the equivalent of Medicaid waivers that would produce permanent programmatic change for duals. Given that 80 percent of Medicare and Medicaid dollars represent federal dollars, Berenson further argues that Medicare should be the primary platform for improvement in care to the duals and that programs and demonstrations enacted in the Affordable Care Act are important steps in the right direction and threatened by the priority being given to the Administration's Financial Alignment Initiative.