Hawaii, Massachusetts, Minnesota, Washington, Connecticut and Vermont rank at the top of the Commonwealth Fund’s 2019 Scorecard on State Health System Performance released on Wednesday.
The scorecard assesses all 50 states and the District of Columbia on 47 health care measures, covering access, quality, service use and costs of care, health outcomes, and income-based health care disparities. Arkansas, Nevada, Texas, Oklahoma and Mississippi rank at the bottom in the report.
California had the largest jump in rankings, and Rhode Island improved on the most indicators that are tracked over time. Only Delaware – which fell 17 spots in the rankings – Hawaii, New Mexico and Wyoming performed worse on more measures than they improved on over a five-year period.
Key findings from the scorecard include:
- Deaths from suicide, alcohol, and drugs are a national crisis, but affect states in different ways. States are losing ground when it comes to deaths from suicide, alcohol, and drugs. A number of states in New England, the Mid-Atlantic region, and the Southeast have been hard-hit by the opioid epidemic. West Virginia had the highest rate of drug overdose deaths in 2017 (57.8 deaths per 100,000 residents) — more than double the national average. Ohio, with 46.3 drug-related deaths per 100,000 residents, had the second-highest rate.
- Montana, Nebraska, the Dakotas, Oregon, and Wyoming had higher rates of death from suicide and alcohol use than from drugs in 2017. The state differences show that approaches for combating these challenges must be tailored to local circumstances, the authors say.
- States’ progress in expanding health care coverage and access since the Affordable Care Act (ACA) was enacted has stalled. Although nearly all states saw widespread reductions in their uninsured rates between 2013 and 2016, progress stalled after 2015. Between 2016 and 2017, more than half of states simply held on to earlier coverage gains among working-age adults. And 16 states, including those that have expanded Medicaid and those that have not, experienced one-percentage-point upticks in their adult uninsured rate.
- Medicaid expansion is associated with lower uninsured rates and better access to care. For example, uninsured rates among adults ages 19 to 64 ranged from a low of 4 percent in Massachusetts — which expanded Medicaid and made coverage enhancements like offering extra subsidies — to a high of 24 percent in Texas, which did not expand Medicaid. Of the 17 states that have yet to expand Medicaid, five had the highest adult uninsured rate in 2017 in the U.S., ranging from 18 percent to 24 percent.
- Health care costs are the primary driving force behind rising premiums, which are an increasing financial burden to working families in all states. Per-enrollee cost growth in employer plans grew at a faster pace than in Medicare from 2013 to 2016 in five of eight regions of the country and in 31 states. Across states, per-enrollee spending growth in employer plans was more variable than in Medicare.
The Commonwealth Fund’s 2019 Scorecard on State Health System Performance evaluates 47 health care indicators as well as income-based differences in performance within states. Findings are based on the authors’ analysis of the most recent publicly available data from federal agencies including the U.S. Census Bureau, Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services, as well as other data sources.
For more detail, see “Scorecard Methods” in the report.