The Census Bureau has released newly compiled government survey tables that drive home a key health policy point: Cities, counties and special districts help pay plenty for health care.

Policymakers usually talk about the health care spending coming out of the federal government, state governments, private insurers, employers and patients, but local governments are also playing a part. They spent $90 billion on hospitals alone in 2012, up from $41 billion in 2002.

The local governments’ big and growing health care costs may contribute to some of the tension in states that have resisted using Patient Protection and Affordable Care Act (PPACA) money to expand Medicaid, and to the tension in states in which decisions to expand Medicaid have been controversial. State officials have been in charge of deciding whether to take the Medicaid money, and, in some states, local governments may have different health care spending levels and revenue sources than in others.

Of course, some states have high local government hospital spending levels because they’re huge. In California, for example, local governments spent a total of $37 billion on hospitals in 2012, but only $381 per capita.

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The national average local government hospital spending level was $292 per person.

For a look at the 10 states with the highest local government hospital levels, and a 50-state local government hospital spending table, read on. 

Alabama state seal

1. Alabama: $662

The Yellowhammer State has 4.8 million residents and about $3.2 billion in local government hospital spending.

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north carolina seal

2. North Carolina: $672

The Tar Heel State has 9.5 million residents and $6.4 billion in local government hospital spending.

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south carolina seal

3. South Carolina: $788

The Palmetto State has 4.6 million residents and $3.6 billion in local government hospital spending.

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Mississippi

4. Mississippi: $792

The Magnolia State is known for high health costs. It has about 3 million residents, and its local governments have been spending about $2.3 billion on hospitals to care for them.

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Wyoming state seal

5. Wyoming: $1,708

Local governments in the Cowboy State served just 564,000 residents in 2012 but spent about $1 billion on hospitals.

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All 50 states’ local government hospital spending

 

  Local government spending on hospitals, in thousands Local government hospital spending per state resident
     
Alabama 3,162,233 662
Alaska 332,601 468
Arizona 777,106 122
Arkansas 168,714 58
California 14,181,979 381
Colorado 1,733,200 345
Connecticut 0 0
Delaware 0 0
Florida 7,485,408 398
Georgia 4,043,418 417
Hawaii 0 0
Idaho 488,330 312
Illinois 1,548,399 121
Indiana 3,333,587 514
Iowa 1,599,900 525
Kansas 825,483 289
Kentucky 502,237 116
Louisiana 2,546,732 562
Maine 87,161 66
Maryland 50 0
Massachusetts 1,047,029 160
Michigan 1,001,010 101
Minnesota 1,613,096 304
Mississippi 2,349,965 792
Missouri 1,630,398 272
Montana 113,714 115
Nebraska 689,665 378
Nevada 761,440 282
New Hampshire 0 0
New Jersey 374,734 43
New Mexico 194,075 94
New York 9,251,290 477
North Carolina 6,410,021 672
North Dakota 172 0
Ohio 1,403,088 122
Oklahoma 964,539 257
Oregon 310,578 81
Pennsylvania 9,974 1
Rhode Island 0 0
South Carolina 3,643,356 788
South Dakota 53,754 66
Tennessee 2,680,706 422
Texas 8,758,836 348
Utah 47,393 17
Vermont 10 0
Virginia 281,072 35
Washington 2,364,585 352
West Virginia 246,977 133
Wisconsin 30,182 5
Wyoming $962,530 1,708
UNITED STATES 90,241,027 292