The State of Washington has wiped out funding for early childhood education. Arizona no longer covers the cost of organ transplants for low-income residents. Some public defender offices in Missouri won’t take new cases because they are overworked and understaffed.

“From Oregon to Rhode Island, state governments today are smaller, stingier versions of what they were just a few years ago, even as more than half of them are asking residents to pay more in taxes,” John Gramlich says at “The changes are beginning to reshape the relationship between state governments and the citizens they serve, as well as the public employees who work for them.”

The tightest squeeze is in health care. At a time when demand for Medicaid is surging as people lose jobs and health benefits, Gramlich reports, states are unable to keep up with the costs.

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