From fiscal year 2003 through fiscal year 2012, state general fund budgets increased 34 percent, almost exactly in line with population growth and inflation. But that growth wasn't evenly shared across program areas.

In the wake of a 2012 Supreme Court ruling, states face complex decisions con cerning whether to expand Medicaid coverage as specified in the Affordable Care Act (ACA). With the federal government no longer able to coerce expansion, states must base their decisions on subjective value judgments that will vary from state to state, incorporating each state's unique budgetary circumstances, the needs of its uninsured population, and the incentives established by interactions between the ACA's provisions. A first important consideration is that states face substantial near-term Medicaid cost increases irrespective of coverage expansion decisions.

Changes would punch varying-size holes in Gov. John Kasich's proposed two-year, $63.3 billion budget. But unlike some of the more recent budgets, lawmakers would have choices in how to fill those holes.

Gov. Chris Christie today unveiled a $32.9 billion election-year budget, including an expansion of Medicaid for uninsured residents, a $1.67 biliion payment into the state's troubled pension fund and a $97 million rise in spending on education.

The Jindal administration kicked off a months-long state budget debate by presenting a $24.7 billion budget that relies on the finalization of contracts involving public hospitals, property sales and other unresolved issues.

Savings from cuts to the Illinois Medicaid program have fallen short by $464 million, about 30 percent of the expected $1.6 billion in projected savings that Gov. Pat Quinn pushed for last year.

In 2045, federal revenues could equal 18.5 percent of the nation's gross domestic product, according to this CBO view. That includes all sources of federal revenue, including income taxes and corporate taxes as well as payroll taxes that are supposed to cover Social Security and a portion of Medicare.

The cuts, known in the parlance of budgetary legislation as "sequestration," would shave $1.2 trillion from federal spending over nine years. The first trim, to take effect March 1, amounts to $85 billion through the end of the fiscal year in September.

Gov. Rick Scott said Wednesday he supports expanding Medicaid and funneling billions of federal dollars to Florida, a significant policy reversal that could bring health care coverage to 1 million additional Floridians.

On Wednesday, Florida Gov. Rick Scott, a Republican, completed a major turnaround when he announced his state would take part in a key element of Obama's plan to enroll more poor people in Medicaid.

In the wake of a 2012 Supreme Court ruling, states face complex decisions con cerning whether to expand Medicaid coverage as specified in the Affordable Care Act (ACA). With the federal government no longer able to coerce expansion, states must base their decisions on subjective value judgments that will vary from state to state, incorporating each state's unique budgetary circumstances, the needs of its uninsured population, and the incentives established by interactions between the ACA's provisions. A first important consideration is that states face substantial near-term Medicaid cost increases irrespective of coverage expansion decisions.

Was the slow recovery of the U.S. economy from the trough of the Great Recession anticipated? 

Alternative views on the problem the United States is facing: financing retirement consumption as its population ages.

The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, made significant changes to the way eligibility for the Medicaid program will be determined and who the program will cover. State governments will play a key role in implementing many aspects of this reform, which must be in place by the beginning of 2014. States will need to address the financial implications of implementing this Medicaid expansion and accompanying enrollment systems.

State finances are not transparent and often include hidden liabilities as well as rapidly growing responsibilities which are difficult to control.  While state revenues are gradually recovering from the drastic decline of the Great Recession, they are not growing sufficiently to keep pace with the spending required by Medicaid costs, pensions, and other responsibilities and obligations.  This has resulted in persistent and growing structural deficits in many states which threaten their fiscal sustainability.

A map and chart ranking Medicaid spending for each of the 50 states in FY2010.

In the long term, the decline in the sector's operating balance is primarily driven by the rising health-related costs of state and local expenditures on Medicaid and the cost of health care compensation for state and local government employees and retirees.

Among the 50 state employee health benefit plans, there is considerable variation in premium rates and in how the costs are shared between the state and employee.The average premium for a standard family policy was $1,377.03, with the state paying an average of $1,096.63 (80 percent) and the employee paying the remainder. (Based on 42 states.) The average premium rate for the lowest cost family insurance option was $1,101.28, with the state paying an average of $974.66 (88 percent).

An examination of Medicaid spending by state over a decade.  In 2009, the 10 states where per capita spending was highest ranged from 13 to 36 percent higher than the national average, and the 10 states where per capita spending was lowest ranged from 8 to 26 percent below the national average.

The sixth-annual Tennessee Pork Report is chock-full yet again, of waste, fraud, abuse, and mismanagement of taxpayer money by state and local government officials. Despite a changing political landscape in Tennessee, wasteful government spending has not disappeared.

Three Things to Fix Health Care Now:

#1: Reject the Health Insurance Exchange
#2: Don't Expand Medicaid
#3: Offer an Alternative

This paper examines the ongoing fiscal crisis caused by health-care plans for retirees (known as "other post-employment benefits," or OPEB) in one of the hardest-hit states, California, and outlines necessary reforms that should come before tax increases or cuts to government services.

Supporters of Obamacare claim that expanding Medicaid will entail little to no cost to state governments, since the federal government will fund the vast majority of the additional costs. Indeed, some analyses project states achieving savings from adopting the expansion. However, state lawmakers should be wary of accepting such analyses at face value.

Block-granting Medicaid is the best way to deliver better, cost-effective care to the most vulnerable Americans.

With some reasonable reforms to the program to make the State Health Plan benefits more closely aligned with those offered in the private sector and other state governments, however, the state can put the State Health Plan back onto a sustainable path.

Any serious attempt at state budget reform in North Carolina must include an examination of its Medicaid program. Costs have been soaring, and past cost-containment efforts have proven both insufficient and detrimental to enrollees' access to care. Moreover, Medicaid enrollees are merely passive participants in the program with little or no choices, and at the mercy of the whims of politicians.

During its five years of operations, Florida's Medicaid Reform Pilot has improved the health of enrolled patients, achieved high patient satisfaction, and kept cost increases below average, saving Florida up to $118 million annually.

Medicaid services not required by the federal government but approved by the state legislature in years past cost North Carolin $4.4 billion in 2010-2011. That accounted for 46 percent of the state's $10 billion Medicaid budget.

To better understand best practices in Medicaid reform, we explore five recent state-level Medicaid reforms and their ability to simultaneously reduce costs, maintain or increase access, and survive the politics of reform.

The Health Care Compact is an interstate compact - which is really just "an agreement between two or more states that is consented to by Congress" - that would return the authority and the responsibility to regulate health care back to the member states.