Using metrics including health care access and affordability, preventive care and treatment, potentially avoidable hospital use and cost, healthy lives, reproductive care and women’s health, income disparity, and racial and ethnic health equity, the Commonwealth Fund ranked all 50 states and Washington, D.C. using a scorecard based on their overall quality of health care.
The top five states were Massachusetts, Hawaii, New Hampshire, Rhode Island, and Vermont, while the bottom five states included Mississippi, Oklahoma, West Virginia, Texas, and Arkansas.
Among the bottom 10 states, six are among those that have yet to adopt the Medicaid expansion, which greatly improved access and affordability to health care.
Non-expansion states also have notably higher rates of uninsured residents: Texas, one of those states, has the highest uninsured rate in the country at 18%.
The pandemic-era state of emergency enabled states to enroll Medicaid recipients on a continuous basis, but that came to an end on March 21. Consequently, an estimated 15 million individuals are expected to lose coverage.
"Losses are looming as states redetermine eligibility for Medicaid enrollees," Commonwealth Fund vice president for health care coverage and access and tracking health system performance Sara Collins said in a call with reporters. "To maintain and build on the gains realized during the pandemic, we need to closely monitor the Medicaid unwinding and ensure those who lose coverage can quickly regain it."
Maternal mortality and health equity
Reproductive care and women’s health also played a significant role in how states were ranked. (The fallout of the overturn of Roe v. Wade occurred in 2022, while the scorecard data ends at 2021.)
The scorecard measured health outcomes for women and infants, including maternal and infant mortality, and access to health services like checkups and prenatal and postpartum care. Racial and ethnic disparities were also factored in.
Jesse Baumgartner, a senior research associate at the Commonwealth Fund, noted that the national maternal mortality rate increased by almost 40% between 2019 and 2021. In that time, maternal mortality rates have also risen across nearly every racial and ethnic group.
Overall, the maternal mortality rate per 100,000 live births in 2021 was 32.9, but the numbers vary widely by demographic. Among Black women, the rate is 69.9 while for American Indian/Alaskan Native, the number jumps to 118.7.
The rates also fluctuate depending on location — between 2019-2021, the maternal mortality rate in California was 9.6 while in Mississippi, it hit 50.3. Other states with high rates include Tennessee, Louisiana, and Alabama.
"Many of these deaths could have been avoided through better, more equitable access to comprehensive health care, along with greater efforts to eliminate inequities in the quality of care received," Baumgartner said on the media call. "This includes health services during and after pregnancy. State variations in care become apparent when looking at specific services."
For example, he said, nearly 30% of women in Texas and Florida didn’t receive early prenatal care in their first trimester of pregnancy in 2021 while Vermont, the best-performing state, only saw 11% of its women not receiving early prenatal care.
'Another epidemic that deserves our urgent attention'
As a result of the coronavirus pandemic’s devastating impact on mental health, the number of combined deaths from drug overdoses, alcohol, and suicide — so-called "deaths of despair" reached record levels in 2021.
Part of it is due to individuals not being able to access mental health care, whether as a result of COVID restrictions, availability of providers, or other factors such as cost.
"We know the ways COVID-19 reverberated across all aspects of state health systems, and we still see its effect," David Radley, senior scientist at the Commonwealth Fund, said on the call. "We found large increases in deaths early in life from preventable and treatable causes in all states. These increases were driven by deaths attributable to COVID-19, but also included increases in deaths from drug overdose, suicide and firearms, and even from certain chronic illnesses that have been exacerbated by COVID-related health care disruptions."
The numbers are troubling for both adolescents and adults. A 2020 federal survey from Mental Health America found that 60% of adolescents between the ages of 12-17 who had a major depressive episode did not get any treatment, while 55% of adults with mental illness reported the same. Cost was cited as the primary barrier among adults not receiving care.
Drug overdoses are also still a significant problem in the US. More than 106,000 individuals died from a drug overdose in 2021, a 16.2% uptick from 2020.
"There’s no doubt that mental health has been underfunded for decades," Dr. Joseph Betancourt, president at the Commonwealth Fund, explained on the call. "The impact of the pandemic on mental health has created what I’d argue is another epidemic that deserves our urgent attention."
And "as we think about mental health challenges," he added, "this will only get worse until we make real investments in the behavioral health workforce, behavioral health integration in primary care, and treatment for substance use disorders at the national level."
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Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambells and reach her at [email protected].
