The Rundown

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The Share of State Budgets Spent on Medicaid Posts Largest Annual Increase in 20 Years

In fiscal year 2023, the combination of expiring federal COVID-19 pandemic aid, slowing tax revenue growth, and rising costs for Medicaid led to an increase in the share of state revenue dedicated to Medicaid of 17.8%, or $44.4 billion, over the previous year—the largest single-year rise in at least two decades. States spent 15.1% of every state-generated dollar on Medicaid, up 2.2 percentage points from the previous year, though still about half a cent less than the 15-year average.

A child wearing a colorful owl backpack and an adult pushing a stroller walk past a storefront on a tree-lined city street on a fall day.
Philadelphians Cite Safety and Finances as Top Concerns

Philadelphians’ views of their city have improved dramatically since the height of the COVID-19 pandemic in 2022, despite lingering concern about public safety and personal finances. In a Pew survey conducted from January to March 2025, nearly two-thirds of respondents cited crime as the top issue facing the city. Half of those surveyed reported hearing gunshots in their neighborhood in the previous year.

Most States' Tax Revenue Falls Below Long-Term Trends Amid Federal Uncertainties

After two consecutive fiscal years of widespread tax revenue declines, states had fewer resources to work with at the start of calendar year 2025 than they had in recent years, which limited their capacity to fund tax cuts, expanded public services, recession preparedness, and other priorities.

Hurricane's Staggering Costs Test States’ Fiscal Resilience

Hurricane Helene ravaged the southeastern United States for three days in September 2024, leaving a path of destruction and hundreds of casualties throughout North Carolina and five other states. Record-breaking rainfall devastated western North Carolina and triggered landslides that left many areas cut off from essential services for days. The mountain tourist hub of Asheville faced unprecedented destruction, including widespread property damage and disruptions to critical infrastructure.

Our Work

Pew's work spans 7 key topics...

Professional psychologist doctor listening and giving the consult to female patients

Good health is important to everyone. Pew conducts research and provides information and fact-based recommendations to state agencies, hospitals, researchers, and other health partners to help them provide better care. We find and share evidence-based practices to improve Americans’ health and well-being, including services that can prevent suicide, improve mental health care, and treat substance use disorder.

Bustleton Free Library in Philadelphia, PA, on Thursday September 12 2024.

Communities throughout the country share common needs: affordable connections to broadband Internet, modern and reliable energy infrastructure, effective responses to mental health challenges, and ways to resolve legal disputes more quickly and fairly. To address these issues, Pew collaborates with states and local governments to find and promote evidence-based solutions that help provide stability and opportunity.

Sunshine

Economic opportunity is the foundation of American society. Pew supports national, state, and local efforts to expand opportunity and promote financial well-being. Our work helps people pay off student loans, navigate court proceedings such as debt collection, buy or rent a home, access affordable internet, and save for their retirement.

High angle helicopter shot of the Capitol Building in Washington, D.C. at twilight on a clear evening in Fall, with Pennsylvania Avenue beyond.

Nonpartisan, fact-based improvements in federal policy can create jobs, lower costs, and help the nation prepare for the future. When our research shows that small changes can have a big impact, we work across party lines to improve national challenges like housing affordability, internet access, energy reliability, and health care.

Turkish world record-holder free-diver and divers of the Underwater Federation Sahika Encumen dives amid plastic waste in Ortakoy coastline to observe the life and pollution of Bosphorus in Istanbul,

The global ocean teems with life, and it contributes to the vital cycles that keep people and our planet healthy. But the seas are vulnerable to overfishing, loss of habitat such as seagrasses and mangroves, ineffective fisheries management, plastic pollution, and declining biodiversity. These mounting losses affect the coastal communities that depend on the ocean for food and jobs.

The House Chamber at the Kentucky State Capitol is shown as the legislature tries to wrap up its session

States and cities are the “laboratories of democracy” in America—the places where lawmakers and governors look for new ways to help their communities succeed. Whether in Pew’s hometown of Philadelphia or any of the 50 state capitals, we help elected leaders respond to the needs of their citizens, use public dollars wisely, fix outdated policies, and build a better future for all.

A view of steep cliff, grand canyon and Colorado river from Toroweap overlook.

Conserving natural spaces conveys benefits far beyond the gains to wildlife and their habitats. As scores of studies show, protecting and restoring lands and waters, particularly when done in close partnership with local communities, also improves people’s lives—and local economies—by increasing tourism and outdoor recreation.

How We Work

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Fact of the Matter

49,449
AMERICANS
die by suicide in 2022.
18%
OF AMERICANS
with opioid use disorders received any medication to treat them in 2023.
30%
INCREASE IN SUICIDE RATE
in the U.S. from 2000 to 2020.
178,000
DEATHS EACH YEAR
from frequent or excessive drinking.

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