What does the ballpoint pen in your pocket have in common with a weak economy?

Both can produce vicious cycles—one in your washer-dryer, the other in state budgets, as decreased tax revenues must be balanced with the costs of thousands of newly-unemployed applicants for Medicaid. And while the forgotten pen may leave you muttering beside a pair of khakis, the fiscal crisis has state lawmakers lobbying hard for federal help, the Associated Press reports.

With unemployment topping six percent, states across the nation have seen a rapid increase in Medicaid enrollment at a time when budgets are tight. A recent study done by researchers at the Urban Intsitute for the Kaiser Family Foundation found that every one percentage point rise in the unemployment rate led to a 3 to 4 percent decrease in a state's general revenue fund below expected levels. Nationally, the study found a one point increase in unemployement led to a 1.1 million increase in the uninsured population and a one million person increase in Medicaid and SCHIP enrollment. In Nevada actual enrollment has soared nearly 30,000 above predicted levels. In Arizona, enrollment is up 9 percent over predictions. And just this week, Mississippi, with some 600,000 Medicaid enrollees, was saved from raising hospital taxes and cutting services to finance its Medicaid program after receiving more than $92 million in Medicaid reimbursements to make cover its budget shortfall.

The Center on Budget and Policy Priorities reports that "at least 29 states plus the District of Columbia, including several of the nation's largest states, faced an estimated $48 billion in combined shortfalls in their budgets for fiscal year 2009." Rhode Island's Republican Governor Donald Carcieri recently called Medicaid "the single largest expenditure of the state's budget." His controversial proposal to cap Rhode Island's Medicaid expenditures at 23 percent of the state's general fund budget (about $754 million for 2009) has worried some lawmakers enough to request a special briefing of the Senate Finance Committee

As Congress considers a second stimulus package, some economists and congressional aides suggested that increasing federal money for Medicaid could be one possible component. Considering most states are required by law to balance their budgets', such federal aid may help states ride out the economic crunch, especially if, as the authors of the Kaiser report suggest, such assistance is fully targeted to match the length and depth of a state's economic distress. But Representative Nathan Deal (R-GA) had a point when he told the AP: "We're coming to the point that if we want to keep the entitlement programs more solvent than they are now, we need to look at ways to improve the health care delivery system."

Like the pen stains on your Dockers, the strains of health care costs on the fiscal and economic future of our nation won't just disappear. Both state and federal lawmakers need to think beyond short term patches and begin working for long term solutions to make our health care system more sustainable.