State Medicaid programs are large and complex and their directors are faced with implementing changes required by the Affordable Care Act at the same time they continue to work with limited resources, both fiscal and human. Medicaid programs are also leading by example in major transformations of the health care system, including payment reforms, quality oversight, system accountability, and targeted care coordination.
Challenging fiscal times have created a unique window of opportunity for court leaders to critically examine current business practices. One extant court function that has been the focus of reengineering efforts is the creation of the court record. Making the verbatim record is an essential court function that historically has relied on court reporters. Recent reform in several states suggests systemic change to incorporate digital recording technology in creating the record is difficult to achieve, but not insurmountable.
Fiscal conditions for states continued to moderately improve in the 2013 fiscal year. Revenue collections exceeded projections for the vast majority of states and spending from both state funds and federal funds experienced stronger growth in comparison to the 2012 fiscal year. Additionally, the number of states making midyear budget cuts remained low and states have continued to replenish their rainy day funds and reserves. In the 2014 fiscal year, states are expected to have continued positive revenue and spending growth. Revenue and spending growth rates, however, are expected to be slower than last year. States are cautiously optimistic that fiscal conditions will continue to slowly improve in the 2015 fiscal year and beyond, although challenges remain.
Inflation-adjusted gross domestic product grew 1.9 percent in the United States during 2013, which is somewhat lower than long-term expectations for economic growth. Employment rose a relatively healthy 1.6 percent, but nearly 1.2 million fewer people have a job than before the recession. Most analysts expect better GDP growth during 2014 and anticipate employment will finally rise above the pre-recession peak sometime during the second half of 2014. Economic growth will improve because the short-term drag caused by sequestration and the debt ceiling debate has played through the economy, improvements in household balance sheets are allowing solid consumer spending increases, business investment is rising with better business equipment purchases and housing construction is healthier in many regions.
A state with a well-structured, fully utilized office of lieutenant governor is at an advantage in this globally competitive world. Gubernatorial succession is the shared and essential role of all lieutenant governors. Beyond succession, governors, legislators and lieutenant governors may direct the structure and/or duties of the office in a way to leverage the position as a competitive advantage to a state in the global marketplace
The State Budget Crisis Task Force, established by Richard Ravitch and Paul Volcker, examined major threats to state fiscal sustainability, including federal deficit reduction, underfunded retirement promises, rapid Medicaid growth, and narrow and eroding tax bases. It recommended better federal-state communication, improved state budgeting and reporting practices, and broader state tax bases.