The cost of insuring the health of employees, retirees and poor people could swamp state and local government finances starting in the 2020s.
Analysts at the U.S. Government Accountability Office make that prediction in a review of state and local finances.
Government finance discussions in the United States tend to focus on the federal government.
But the 50 state governments and 87,525 U.S. local governments collected a total of about $1.4 trillion in taxes and fees in 2006 and about $400 billion in grants, loans and loan guarantees from the federal government, GAO officials report.