State health care spending: a systems perspective.

According to recent reports, the state of the states in 2002 is one of budget crisis. Forty-five states and the District of Columbia report that revenues have failed to meet projections. Twenty-eight states and the District of Columbia report that spending is above budgeted targets. Medicaid is over budget in 23 states, with another five reporting that the program could exceed budgeted levels in coming months. At least 20 states have already implemented budget cuts or holdbacks to address fiscal problems in 2002, and nine others report that cuts are possible before the fiscal year ends. In 19 states, tax proposals are under consideration to help balance 2003 budgets.