Economic and Fiscal Trends in Expansion and Non-Expansion States: What We Know Leading Up to 2014

Executive Summary
  1. Status of State Action on the Medicaid Expansion Decision, update July 20, 2015. Kaiser Family Foundation, State Health Facts. https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.

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How Do Expansion And Non-Expansion States Compare? - State Budgets
  1. Over a quarter of hospitals in Non-expansion states were owned by state and local governments in 2013 compared to 16% of hospitals in Expansion states. Hospitals by Ownership Type, 2013. Kaiser Family Foundation, State Health Facts. https://www.kff.org/other/state-indicator/hospitals-by-ownership/#

    Additionally, the higher spending per capita for higher education in the typical non-expansion state may be due, in part, to the fact that most expansion states are industrialized, urbanized, northeastern states which have extensive network of private higher education institutions. Therefore, these states may be outliers when it comes to higher education because they don’t spend as much per capita due to existence of large number of private higher education institutions.

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  2. The American Recovery and Reinvestment Act (ARRA) provided states with enhanced Medicaid matching rates between October 2008 and June 2011. This enhanced match provided states with $103 billion over the 11 quarters it was in effect. This allowed for state spending on the program to fall; the only two years in the history of Medicaid when annual state funds spending decreased.

    Miller, Vic, Andy Schneider, Laura Snyder and Robin Rudowitz. Impact of the Medicaid Fiscal Relief Provisions in the American Recovery and Reinvestment Act (ARRA). Kaiser Commission on Medicaid and the Uninsured, October 2011. https://www.kff.org/medicaid/issue-brief/impact-of-the-medicaid-fiscal-relief-provisions/.

    Smith, Vern et al. Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014. Kaiser Commission on Medicaid and the Uninsured, October 2014. https://www.kff.org/medicaid/report/medicaid-budget-survey-archives/.

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Appendix A - Methodology and Definitions
  1. Direct expenditures spent on medical vendor payments (E74) may include funds spent from any kind of source the state or local government has available to use for. State and local government expenditures data in this survey are collected by function and do not distinguish if the source of funds used was coming from a federal, state or local fund. It may be possible that state and local governments are using federal receipts also to fund medical vendor payments which are not reflected in these expenditure statistics.

    Email correspondence with officials at the Census Bureau, June 2015.

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