What Were the Causes of the Recent Reduction of the Rate

What were the causes of the recent reduction of the rate of increased spending on health care?

A) an increase in Americans' health and reduced federal investment in health care
B) the adoption of the ACA and fewer observed instances of serious diseases
C) lower prices on medical equipment, cheaper pharmaceuticals, and a drop in health workers' salaries
D) low growth in Medicare and Medicaid expenditures, the economic recession, and reduced demand