Document Number: 10734State and Local Government's Fiscal Outlook, April 2013 Update - State and local sectors will see a gap between revenue and spending that will grow through 2060 “absent any policy changes,” according to simulations released last month. Near term, the good news is that state and local governments saw an increase in tax receipts after 2008’s decline which went into 2009. Long term, the decline is mostly due to rising health-related costs of state and local expenditures on Medicaid and health care compensation for state and local government employees and retirees. The simulations are in the aggregate and cannot be used to predict outcomes in individual states and localities. (U.S. Government Accountability Office, April 2013)...