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“Sin taxes” are often viewed as budget saviors, despite their rather small role in state budgets. While states can and do raise revenue from sin taxes, they should be mindful about the limitations of these taxes. The longer-term growth patterns for sin tax revenue often have been weak and limited, absent policy changes such as increased tax rates. Moreover, greater dependence on sin tax revenues can set up odd incentives, as part of the reason for taxing some of these activities is to discourage consumption and use, not to maximize revenue.

“Sin taxes” are often viewed as budget saviors, despite their rather small role in state budgets. While states can and do raise revenue from sin taxes, they should be mindful about the limitations of these taxes. The longer-term growth patterns for sin tax revenue often have been weak and limited, absent policy changes such as increased tax rates. Moreover, greater dependence on sin tax revenues can set up odd incentives, as part of the reason for taxing some of these activities is to discourage consumption and use, not to maximize revenue.

The COVID-19 pandemic and resulting recession put enormous strain on state and local government budgets. State personal income and sales tax revenues, which together account for more than 60 percent of general own-source funds, fell further and faster than in the depths of the Great Recession. Although some personal income tax losses stemmed from filing deadline extensions and would be recovered later in the year, states in particular also contended with increased direct and indirect costs stemming from COVID-19. As in prior downturns, the federal government stepped in to help states and localities facing massive gaps between projected revenues and spending, but aid provided thus far has been incommensurate to the scale and timing of the challenge. This paper provides a point-in-time description of state and local government finances as of July 2020, the start of a new fiscal year in most states and localities. It also assesses federal relief compared to prior recessions and offers a few directions for reform.

Health Information Technology (HIT) has become an important and necessary vehicle for various stakeholders, including medical doctors, nurses, patients, health care administrators, managers, providers, insurers, researchers, professionals, and the public in general. The past decade has seen the rapid advancement, development, adoption and diffusion of HIT. In general, Health Information Technology is a broad concept and encompasses various functions (i.e., clinical, administrative, managerial) and various goals (i.e., improving efficiency, effectiveness, and quality of the health care system; reducing medical errors; interconnecting clinicians and health care professionals; reducing health care costs; decreasing paperwork; and facilitating the speed of health care delivery). Therefore, the study of HIT is inherently challenging as it involves many facets that are often interconnected. The rapid advancement and proliferation of HIT in the last decade has stimulated an increased interest among academicians in understanding the key drivers of HIT adoption and diffusion. The focus of this dissertation is to assess the value, significance and adoption patterns of HIT at both micro (i.e., physician) and macro (i.e., hospital) levels using alternative theoretical lenses and methodologies. The overall results indicate that the adoption of HIT in its current form at the macro level is not necessarily dependent on organizational, financial or environmental characteristics of hospitals but is more a reflection of targeted policies for facilitating HIT adoption among the late majority hospitals. With the passage of time, the importance of hospital characteristics in terms of HIT adoption is diminishing; particularly for the long-existing HIT applications. On the contrary, the adoption of HIT at the micro level is at least partially driven by organizational factors, such as social and financial influence. Therefore, there is a disconnect between drivers and diffusion of HIT adoption at macro versus micro levels. Successful HIT adoption requires bridging the gap between HIT adoption at the macro and micro levels by promoting the potential benefits of HIT adoption and taking into consideration the unique needs of end-users.

Researchers in state and local finance have placed increasing focus in recent years on “fiscal sustainability,” the ability of governments to meet existing spending commitments with existing resources. The Governmental Accounting Standards Board (GASB), which establishes accounting and financial reporting standards for states and local governments, is considering setting standards in this area. This article analyzes recent history of states’ expenditures and revenues as context for potential trends. It examines descriptions of fiscal sustainability that have been offered in previous literature and suggests a need for clear definition. The article discusses potential implications of action by GASB in this area, as well as developments in the economy and potential action at the federal level that may influence state and local budgets in the years ahead.

New York State and its local governments decide on spending and tax policies in a complicated political, legal, and fiscal environment. The environment can pit one state against another and one part of New York against another, but it also can create surprising incentives to work together. The federal government influences state and local governments—and especially states—in many different ways. It provides grants in aid that can be large relative to state and local budgets. It designs grant programs in ways that encourage some kinds of activity while discouraging others. The federal government imposes mandates on state and

This paper analyzes and describes major changes in state and local government finances since the Great Recession. Governments have been struggling with three major sources of fiscal stress: slow tax revenue growth; growth in pension contributions heavily concentrated in a few states; and Medicaid spending growth driven by recession-related enrollment. Conditions vary greatly across states but the combined effect has been substantial: between 2008 and 2015 real per capita state and local government pension contributions plus state-funded Medicaid grew by more than state and local government tax revenue in 31 states. In response, state and local governments have cut infrastructure investment, slashed support for higher education, cut social benefits other than Medicaid, cut spending on K-12 education, reduced administrative staff, and reduced most other areas of the budget. The paper concludes that many states will continue to struggle with these three pressures, at least in the near term.