(HealthDay)—From 1991 to 2014 there was minimal change in health spending by state, according to a study published online June 14 in Health Affairs.

David Lassman, from the Centers for Medicare & Medicaid Services in Baltimore, and colleagues examined per capita spending by state of residence and per enrollee spending for Medicare, Medicaid, and from 1991 through 2014. They also assessed the effects of implementation of the Affordable Care Act and the most recent economic recession and recovery on .

The researchers note that the lagged impact of severe recession and extended modest recovery as well as the enactment and implementation of comprehensive health reform legislation had effects on , as well as its financing and delivery. However, during these years there was almost no change in overall by state, resulting in negligible movement in the relative rankings of overall per capita health spending by state.

"Future vintages of state health expenditure data will permit further evaluation of state-level health spending experiences beyond 2014, as coverage continues to expand and economic factors continue to evolve," the authors write.