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[1]. Kaiser Commission on Medicaid and the Uninsured, “The Medicaid Program at a Glance,” Policy Brief (Washington, DC: Kaiser Family Foundation, September 2012).

[2]. Families USA, “Cutting Medicaid: Harming Seniors and People with Disabilities Who Need Long-Term Care” (Washington, DC: Families USA Foundation, May 2011).

[3]. Congressional Budget Office (CBO), An Update to the Budget and Economic Outlook: Fiscal Years 2012 to 2022 (Washington, DC: CBO, August 2012),

[4]. U.S. Treasury website, based on gross national debt as of January 31, 2001, and September 19, 2012 (

[5]. CBO, The 2012 Long-Term Budget Outlook (Washington, DC: CBO, June 2012),

[6]. Ibid.

[7]. The Concord Coalition, “Structural Deficits: What Are They, Why Do We Have One, and Why Should We Worry About It,” Issue Brief (Arlington, VA: The Concord Coalition, February 27, 2012),

[8]. Ibid.

[9]. Enrolled version of H.R. 8, the “American Taxpayer Relief Act of 2012,” U.S. Government Printing Office, January 1, 2013 (

[10]. U.S. Department of the Treasury, “Historical Debt Outlays,”

[11]. U.S. Department of the Treasury, “Interest Expense on the Debt Outstanding,”

[12]. Ginsberg, P. B., “High and Rising Health Care Costs: Demystifying U.S. Health Care Spending,” Research Synthesis Report No. 16 (Princeton, NJ: Robert Wood Johnson Foundation, October 2008).

[13]. Centers for Medicare and Medicaid Services, “Table 1: National Health Expenditures Aggregate, Per Capita Amounts, Percent Distribution and Average Annual Percent Change: Selected Calendar Years 1960–2010” (

[14]. “OECD Health Data: Health Expenditures and Financing,” Organization for Economic Co-operation (, data accessed by the Kaiser Family Foundation, August 23, 2012.

[15]. CBO, The 2012 Long-Term Budget Outlook, p. 12.

[16]. P.L. 146, The Patient Protection and Affordable Care Act, as amended by P.L. 111-152, the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), collectively referred to as the Affordable Care Act (ACA).

[17]. Kaiser Family Foundation (KFF), “Health Care Costs: A Primer – Key Information on Health Care Costs and Their Impact,” (Washington, DC: KFF, May 2012), pp. 29–30 (

[18]. Ibid.

[19]. Kaiser Commission on Medicaid and the Uninsured, “The Medicaid Program at a Glance,” pp. 1–2.

[20]. Peterson, G. E., and D. S. Nightingale, “What Do We Know About Block Grants?” (Washington, DC: Urban Institute, 1995).

[21]. Sard, B., and W. Fischer, “Housing Block Grant Bills Would Jeopardize an Effective Program and Likely Lead to Cuts in Assistance for Low-Income Families” (Washington, DC: Center for Budget Policy and Priorities, 2003).

[22]. Feingold, K., L. Wherry, and S. Schardin, “Block Grants: Historical Overview and Lessons Learned,” New Federalism Series A, No.A-63 (Washington, DC: Urban Institute, April 2004).

[23]. U.S. General Accounting Office, Lessons Learned from Past Block Grants: Implications for Congressional Oversight, GAO/IPE-82-8 (Washington, DC: GAO, September 23, 1982).

[24]. Ibid.

[25]. Feingold, Wherry, and Schardin, April 2004.

[26]. Section 401(b) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 101 STAT. 2105, Government Printing Office.

[27]. “Child Recipients of Welfare (AFDC/TANF): Indicators on Children and Youth,” Child Trends Data Bank, updated: July 2012 (

[28]. U.S. Department of Health and Human Services, Administration on Children and Families, Temporary Assistance to Needy Families (TANF): Ninth Annual Report to Congress, 2012, Table 12:7, pp. xii-109–xii-110.

[29]. American Recovery and Reinvestment Act of 2009 (P.L. 111-5).

[30]. DeParle, J., “Welfare Limits Left Poor Adrift as Recession Hit,” New York Times (April 7, 2012).

[31]. Like AFDC, social services aid to the states began as an open-ended entitlement authority. However, federal financial participation was capped in 1972, nine years before the Social Services Block Grant program was established.

[32]. Website of the Budget Committee, U.S. House of Representatives (

[33]. House Budget Committee, A Pathway to Prosperity: A Blueprint for America’s Renewal, FY 2013 Budget Resolution, U.S. House of Representatives, March 20, 2012 (

[34]. The Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the P.L. 111-151.

[35]. The enhanced federal aid that states received during FY 2009–FY 2011 as a result of the stimulus legislation would be excluded in calculating a state’s base allocation.

[36]. Park, E., and M. Broaddus, “Ryan Medicaid Block Grant Proposal Would Cut Medicaid by One-Third by 2022 and More After That” (Washington, DC: Center on Budget and Policy Priorities, March 27, 2012).

[37]. Election campaign officials have indicated that Presidential candidate Mitt Romney supports a Medicaid block grant that adjusts annual increases in state allocations based on GDP growth plus 1 percent. They indicate that the 10-year savings associated with the proposal would total $100 billion, compared to the $163 billion in savings associated with the House-passed FY 2013 budget resolution (H. Con. Res. 112).

[38]. Holahan, M. Buettgens, C. Carroll, and V. Chen, “National and State-by-State Impact of the 2012 Republican Budget Plan for Medicaid,” Issue Paper (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, October 2012).

[39]. Ibid.

[40]. Ibid.

[41]. Holahan, J., M. Buettgens, V. Chen, C. Carroll, and E. Lawton, “House Republican Budget Plan: State-by-State Impact of Changes in Medicaid Financing,” Issue Paper (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, May 2011).

[42]. Holahan, M. Buettgens, C. Carroll, and V. Chen, October 2012.

[43]. Ibid. pp. 8–12.

[44]. Ibid, p. 16

[45]. Ibid, p. 20.

[46]. CBO, “Long-Term Analysis of Budget Proposals by Chairman Ryan,” April 5, 2011 (

[47]. See, for example, H.R. 5979, the “Medicaid Accountability and Care Act of 2012” (Rep. Bill Cassidy (R-LA).

[48]. Park, E., and M. Broaddus, “Medicaid Per Capita Cap Would Shift Costs to States and Place Low-Income Beneficiaries at Risk,” Center on Budget and Policy Priorities (October 4, 2012), p.4.

[49]. “The Medicaid Program at a Glance,” p. 3

[50]. Park et al., “Medicaid Per Capita Cap …,” Ibid, pp. 5–6.

[51]. Ibid, pp. 6–8.

[52]. Ibid, pp. 8–10.

[53]. Ibid, p.10.

[54]. “The Medicaid Program at a Glance,” p. 1.

[55]. Gettings, R. M., Forging a Federal-State Partnership: A History of Federal Developmental Disabilities Policy (Washington, DC, and Alexandria, VA: American Association on Intellectual and Developmental Disabilities and the National Association of State Directors of Developmental Disabilities Services, 2011), pp. 64–65.

[56]. Feingold, Wherry, and Schardin, April 2004.

[57]. Ibid, p. 2.

[58]. Ibid, pp. 86–88.

[59]. Ibid, pp. 88–92.

[60]. Lambrew, J., “Making Medicaid a Block Grant: An Analysis of the Implications of Past Proposals,” The Milbank Quarterly, Vol. 83, No. 1 (2005), p. 6.

[61]. Gettings, 2011, p. 108.

[62]. Office of Management and Budget, Budget of the United States Government: FY 2004 (Washington, DC: U.S. Government Printing Office, 2003), pp. 125–127.

[63]. Kaiser Commission on Medicaid and the Uninsured, “Bush Administration: Medicaid/SCRIP Proposal,” Issue Paper. Washington, D.C.: Kaiser Family Foundation, May 2003.

[64]. Office of Management and Budget, Budget of the United States Government: FY 2005 (Washington, DC: U.S. Government Printing Office, 2004), p.149.

[65]. Executive Order 13531, dated February 2, 2010 (

[66]. National Commission on Fiscal Responsibility and Reform, The Moment of Truth, December 2010 (

[67]. Under revised assumptions adopted later, the sequestration would result in a 9.4 percent reduction in nondefense discretionary funding and an 8.2 percent reduction in nonexempt, nondefense discretionary funding. The sequester also would impose cuts of 2 percent cut in Medicare spending; 7.6 percent in other nonexempt, nondefense mandatory programs; and 10 percent in nonexempt, defense mandatory programs (OMB Report Pursuant to the Sequestration Transparency Act of 2012 (P.L. 112-155)).

[68]. On September 14, 2012, the Office of Management and Budget issued a report providing a detailed, program-by-program breakdown of how to the spending reductions will be applied (OMB report, Ibid.).

[69]. The Tax Relief, Unemployment Compensation Reauthorization and Job Creation Act of 2010 (P.L. 111-312).

[70]. “Alternative Minimum Tax, Tax Guide to Investors,” (

[71]. KFF, “FAQ: The ‘Doc Fix” (February 17, 2012)

[72]. CBO, “Economic Effects of Reducing the Fiscal Restraint That Is Scheduled to Occur in 2013” (May 22, 2012),