The country spends heavily to support the healthcare system�$4.1 trillion per year, nearly 20% of the nation’s GDP. The bulk of this comes from the federal government and U.S. households, but state and local governments contribute as well. States and localities frequently fund public hospitals, mental health and substance abuse programs, water and air quality programs, and payments to private hospitals for public health services. While this spending is one of the most significant budgetary responsibilities of state and local governments, it varies from state to state. Researchers calculated health and hospital spending as a share of total spending for each state, then ranked states accordingly.

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