Marion County: Medicaid dependency reached 3.2% in 2022

John Lettieri, President and CEO of Economic Innovation Group
John Lettieri, President and CEO of Economic Innovation Group - Official Website
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In 2022, Medicaid transfers in Marion County totaled $64.07 million, amounting to $1,904 per capita, or 17.8% of total government transfers, according to information from the Economic Innovation Group.

Among all government transfer programs, Medicaid was the second smallest contributor in the county. Social Security was the largest contributor, totaling $144.58 million, equating to $4,298 per capita and making up 40.1% of total transfers.

Comparatively, Medicaid transfers across Iowa amounted to $6.99 billion, ranking second lowest among all transfer types within the state. This translates to an average of $2,185 per capita, or 20.3% of total government transfers. Including all transfer types, government transfer payments totaled $34.48 billion, accounting for 17.9% of residents’ total income, with an average of $10,773 per resident.

Medicare was the second largest contributor in Marion County in 2022, accounting for $92.93 million, averaging $2,762 per capita, representing 25.8% of transfers. Income Maintenance transfers provided another $22.11 million, averaging $657 per capita and comprising 6.1% of government support, making them the smallest contributors.

Government transfer payments are non-repayable funds provided by federal, state, or local governments to support individuals in need. These payments aim to stabilize economic conditions and provide financial support during hardships. Key programs include Social Security transfers (retirement benefits), Medicare transfers (healthcare for seniors), Medicaid transfers (healthcare for low-income individuals), and income maintenance transfers (financial assistance for basic needs).

With 19.5% of the population aged 65 and older, Marion County has a significant demand for programs like Social Security and Medicare. Despite this aid, the total per capita income in Marion County, excluding government transfers was $49,009, which is noticeably below the county’s total income of $59,715, emphasizing the role of government transfers in overall income.

When comparing 2022 to the previous year, Marion County saw an increase in its Medicaid transfer dependency by 0.4%, reflecting both rising transfer amounts and stagnating or insufficient other sources of income.

Government transfers have long been a modest financial safety net, historically comprising only a small fraction of Americans’ income. However, since the 1970s—sometimes dubbed the “Great Transfer-mation”—dependency has surged from 8.2% (or $2,022 per capita in inflation-adjusted 2022 dollars) in 1970 to 17.6% (or $11,542 per capita) in 2022 nationwide. In Marion County, reliance on government transfers has similarly increased from 9% (or $2,122 per capita) in 1970 to 17.9% (or $10,706 per capita) in 2022.

According to the Economic Innovation Group’s analysis, these trends are not merely short-term responses to economic pressures but rather reflect a profound, long-term transformation in how government support is integrated into American life. The study illustrates that structural shifts—from rising healthcare expenses and demographic changes to stagnant wages—have significantly increased dependency on government transfers.

Breakdown of Government Transfers by Program in Marion County, 2022

2022 Iowa County Rankings and Government Transfer Dependency Metrics
CountyRankDependency on Transfers (%)% Population 65+Social Security Transfers (%)Medicare Transfers (%)Medicaid Transfers (%)Income Maintenance Transfers (%)Per Capita Transfers ($)
Polk County115%14%5.3%3.1%3.7%1.5%$9,413
Linn County216.9%17.3%6.5%3.9%3.6%1.4%$10,324
Scott County317.7%17.6%6.3%4%3.9%1.9%$11,177
Black Hawk County421.2%17.8%7.7%4.8%4.7%2.2%$11,318
Johnson County512.2%13.3%4.8%2.6%2.4%1.2%$7,627
Pottawattamie County623.9%18.8%7.8%5.5%5.5%2.2%$12,497
Woodbury County721.1%15.6%6.7%4.6%5.4%2.4%$10,754
Dubuque County818.1%19.3%7.1%4.5%3.4%1.4%$10,866
Story County915%13.4%6%3.6%2.4%1.1%$7,479
Dallas County107.8%12.8%3.4%1.7%1.3%0.5%$6,201
Clinton County1124.8%20.4%8.8%6.1%5.4%2.1%$13,023
Cerro Gordo County1220.2%23.7%7.5%5.3%4%1.4%$13,655
Des Moines County1323.1%21.4%8%5.5%4.8%2.2%$13,973
Warren County1415.1%16.7%6.3%3.8%2.4%0.9%$9,127
Marshall County1524.8%18.3%8.6%5.4%6.2%2.2%$12,085
Muscatine County1620.8%18.3%7.8%4.9%4.5%2%$11,296
Wapello County1728.4%18.6%8.8%6.9%7.1%3%$12,990
Lee County1827.3%22%9.8%6.5%5.9%2.5%$13,652
Webster County1922.9%19.7%7.8%5.6%5%2%$12,228
Jasper County2021.8%19.7%8.7%5.1%4.4%1.7%$11,022
Marion County2117.9%19.5%7.2%4.6%3.2%1.1%$10,706
Sioux County2212.7%16.4%4.8%3.8%2.1%0.9%$8,560
Boone County2320.8%20%8.2%4.9%4%1.3%$11,247
Benton County2415%19.6%6.4%3.7%2.6%1%$10,395
Fayette County2526%22.9%8.8%7.3%5.4%2%$13,683
Bremer County2617.4%19.7%7.6%5%2.3%1%$10,380
Plymouth County2715.1%19.5%6.1%4.4%2.4%0.9%$10,186
Washington County2814.6%20.3%5.6%4.1%2.7%1%$11,508
Jackson County2922.8%22.1%8.5%6.3%4.1%1.6%$12,656
Carroll County3018.3%21.5%6.9%4.7%3.9%1.3%$11,862
Mahaska County3121.5%19.2%7.8%5.3%4.5%1.9%$11,039
Dickinson County3217.6%28.2%8.2%4.9%2.1%0.9%$13,066
Henry County3323.2%19.8%8.6%6.1%4.4%1.9%$11,630
Clayton County3421.2%25%7.8%6.5%3.5%1.3%$13,690
Jones County3520.4%21%8.3%5.5%3.4%1.4%$10,902
Buchanan County3618.1%18.7%7.2%4.8%3.2%1.3%$10,847
Winneshiek County3718.2%23.1%7.5%5%2.3%0.9%$11,134
Page County3826.9%24%9.4%8.8%4.8%1.8%$14,318
Hardin County3919%23.7%7%5.8%3.1%1.3%$13,078
Jefferson County4024.3%26.9%9.4%6.3%4.6%1.9%$13,339
Buena Vista County4118.5%16.8%6%4.9%4%2%$10,025
Floyd County4222.4%22.6%8.1%6.1%4.6%1.7%$13,242
Tama County4320.4%20.7%7.9%5.2%4.1%1.6%$11,840
Poweshiek County4419.2%21.5%8.2%4.9%3%1.3%$10,792
Clay County4519.5%22.4%7.7%5.2%3.7%1.4%$12,073
Cass County4625%23.5%8.8%7.5%5%1.8%$14,767
Kossuth County4720%25.2%7.8%6.4%3%1.2%$13,300
Mills County4818.3%20.5%6.3%4.3%4.1%1.1%$12,959
Harrison County4921.3%20.1%7.4%5.9%3.9%1.5%$12,406
Cedar County5015.1%21.3%6.9%3.7%2.3%0.9%$9,879
Crawford County5120.3%18.4%7.2%5.4%4.4%1.8%$11,087
Delaware County5216.6%21.5%6.9%4.4%2.7%1.1%$10,098
Butler County5320.7%23.5%8.5%6.1%3.1%1.2%$12,423
Iowa County5417.6%20%7.4%5%2.6%1%$10,671
Appanoose County5530.3%24%10.2%7.8%6.6%2.7%$14,476
Hamilton County5618.3%20.9%7%5.5%2.8%1.3%$11,633
Wright County5719.3%22.4%6.5%5.5%4.4%1.3%$13,586
Union County5828.8%21.1%9%8.1%6%2.4%$14,422
O’Brien County5918.4%21.5%6.8%5.1%3.9%1.2%$11,958
Madison County6016.9%17.5%6.9%4.3%2.6%1.1%$9,830
Allamakee County6121.7%23.4%8.3%5.6%3.5%1.7%$11,955
Shelby County6220.1%23.6%7.5%6.2%3.5%1.3%$13,397
Montgomery County6329.4%22.3%10.1%9%5.6%2.3%$14,815
Guthrie County6420%24%8.1%5.5%3.4%1.2%$13,600
Chickasaw County6513.8%22.8%5.3%4.4%2.1%0.8%$12,294
Cherokee County6615%25.1%6.1%4%2.6%0.9%$12,473
Winnebago County6722.9%22.1%8.5%6.7%3.6%1.5%$12,584
Grundy County6816.2%21.3%7.4%4.7%2.1%0.8%$10,590
Hancock County6918%24%7%5.9%2.5%1%$12,013
Calhoun County7020.5%23.6%7.8%6.6%3.3%1.3%$13,175
Keokuk County7123.3%22.4%8.4%6.8%4.3%1.8%$12,889
Emmet County7224.9%23.5%8.8%7.4%3.9%1.8%$13,469
Sac County7316.2%24.2%6.5%5.1%2.3%1%$12,638
Mitchell County7412.1%21.6%4.6%3.9%1.8%0.7%$11,594
Greene County7522.4%23.9%8.4%6.7%4%1.6%$13,863
Franklin County7618.7%22.2%7%5.4%3.3%1.3%$12,147
Louisa County7721.2%20.3%8.4%5.5%3.9%1.6%$11,229
Monona County7823.3%24.1%8.5%6.8%4.2%1.7%$14,095
Humboldt County7920.3%21.7%7.3%6.4%3.4%1.3%$12,297
Clarke County8024.5%19.2%8.2%6.6%5.3%2%$11,832
Howard County8119%20.4%6.9%5.7%2.9%1.4%$11,986
Lyon County8212.9%18.9%4.9%4.1%1.7%0.9%$9,240
Palo Alto County8319.6%22.9%7.1%5.5%3.9%1.3%$12,755
Lucas County8426%22.2%9.2%6.9%5.2%2.4%$12,808
Decatur County8530%21.1%9.2%8.2%6.3%2.9%$13,362
Van Buren County8627.7%22.9%9.7%9.2%4.5%2.1%$13,284
Monroe County8722.9%20.2%8.1%6.7%4%1.7%$12,571
Fremont County8823.3%24.4%8.5%7.1%3.9%1.6%$14,565
Adair County8918.3%22.6%6.5%5.7%3.3%1.3%$12,370
Davis County9018.7%18.4%6.7%5.6%3.2%1.4%$9,666
Pocahontas County9119.6%24.1%7.6%5.5%3.3%1.5%$12,435
Ida County9216%22.1%5.9%5.1%2.6%1.1%$12,303
Worth County9320.1%22.6%8.1%5.2%3.2%1.4%$11,130
Taylor County9424.1%22.5%8%8.3%3.8%1.9%$13,862
Wayne County9522.7%22.8%8.4%6.2%4.3%2%$12,089
Audubon County9619.8%25%7.5%6.1%3.3%1.3%$13,703
Ringgold County9726.6%23.1%8.4%8.8%4.9%1.8%$15,253
Osceola County9817.2%23%6.6%4.9%2.7%1.4%$11,259
Adams County9922.3%24.6%7.2%7.7%4%1.7%$15,106



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