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State Health Care Scorecard: Hawaii Tops the List, Mississippi Last

Michael Rainey
A new analysis from The Commonwealth Fund finds that Hawaii has the best health system in the country. The non-partisan foundation’s 2019 Scorecard on State Health System Performance assesses all 50 states on dozens of health care variables, including access, quality, cost and outcomes. Massachusetts, Minnesota, Washington and Connecticut round out the top five in the rankings.At the other end of the spectrum, Mississippi is again the worst-performing state, with low marks for access and affordability, prevention and treatment, and health outcomes. Oklahoma, Texas, Nevada and Arkansas are also in the bottom five.Some key points from the report:* Record number of deaths from suicide, alcohol, and drugs. The U.S. is seeing a rising number of “deaths of despair,” although there are strong regional variations. Opioid addiction is particularly destructive in New England and Appalachia, for example, while alcohol is a bigger killer in the western states.* Improvements in access to health care have stalled. The number of people lacking health insurance fell sharply after the Affordable Care went into effect, but the numbers have stopped improving in most states. In 16 states, the percentage of uninsured adults rose by one point between 2016 and 2017.* Medicaid expansion improves access. The 10 states with the lowest uninsured rates, led by Massachusetts at 4%, expanded their Medicaid programs as allowed by the Affordable Care Act, while the highest uninsured rates were found in states that have not expanded Medicaid. Texas has the highest uninsured rate, with 24% of adults lacking health care coverage. The next four states on that variable – Oklahoma, Georgia, Florida and Mississippi – have also not expanded Medicaid.  * The financial burden of health care is rising everywhere. “Health care costs are the primary driving force behind rising premiums, which are an increasing financial burden to working families in allStates,” the report says. Rising costs mean that many families are “paying more for their insurancebut getting less.”The report includes estimates of how well the health care system would be performing if all states achieved the top level of performance for each variable. Such an improvement would result, for example, in 18 million more children and adults with health insurance; 11 million more adults receiving cancer screenings; 808,000 more children receiving all recommended vaccines; 6.7 million fewer unnecessary emergency room visits; and 90,000 fewer deaths from treatable diseases for those under 75.Like what you're reading? Sign up for our free newsletter.

A new analysis from The Commonwealth Fund finds that Hawaii has the best health system in the country. The non-partisan foundation’s 2019 Scorecard on State Health System Performance assesses all 50 states on dozens of health care variables, including access, quality, cost and outcomes. Massachusetts, Minnesota, Washington and Connecticut round out the top five in the rankings.

At the other end of the spectrum, Mississippi is again the worst-performing state, with low marks for access and affordability, prevention and treatment, and health outcomes. Oklahoma, Texas, Nevada and Arkansas are also in the bottom five.

Some key points from the report:

* Record number of deaths from suicide, alcohol, and drugs. The U.S. is seeing a rising number of “deaths of despair,” although there are strong regional variations. Opioid addiction is particularly destructive in New England and Appalachia, for example, while alcohol is a bigger killer in the western states.

* Improvements in access to health care have stalled. The number of people lacking health insurance fell sharply after the Affordable Care went into effect, but the numbers have stopped improving in most states. In 16 states, the percentage of uninsured adults rose by one point between 2016 and 2017.

* Medicaid expansion improves access. The 10 states with the lowest uninsured rates, led by Massachusetts at 4%, expanded their Medicaid programs as allowed by the Affordable Care Act, while the highest uninsured rates were found in states that have not expanded Medicaid. Texas has the highest uninsured rate, with 24% of adults lacking health care coverage. The next four states on that variable – Oklahoma, Georgia, Florida and Mississippi – have also not expanded Medicaid.  

* The financial burden of health care is rising everywhere. “Health care costs are the primary driving force behind rising premiums, which are an increasing financial burden to working families in all

States,” the report says. Rising costs mean that many families are “paying more for their insurance

but getting less.”

The report includes estimates of how well the health care system would be performing if all states achieved the top level of performance for each variable. Such an improvement would result, for example, in 18 million more children and adults with health insurance; 11 million more adults receiving cancer screenings; 808,000 more children receiving all recommended vaccines; 6.7 million fewer unnecessary emergency room visits; and 90,000 fewer deaths from treatable diseases for those under 75.

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