New Ranking Reveals Health Gaps Between and Among States

Hawaii has the best health care access and quality, Mississippi the worst.

Commonwealth Fund Health Care Scorecard 2013
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Wealthy people in states with lower health care access and quality are worse off than poor people in states with higher health care access and quality, reveals a new ranking published Wednesday by the Commonwealth Fund.

The report showed wide gaps within and among states and the District of Columbia. Connecticut, Hawaii, Massachusetts, Minnesota, Vermont and Wisconsin performed best for low-income populations and had among the lowest rates of uninsured adults. Southern and South Central states performed the worst, with high levels of uninsurance, low rates of preventive care, high rates of potentially avoidable hospital use from complications of disease, and significantly worse health outcomes.

Leaders from the Commonwealth Fund, a private foundation that specializes in health care research, say the implementation of the Affordable Care Act will curb this divide, given its focus on preventive care, its expansion of Medicaid, and its health insurance requirements.

The report, titled "Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations," examines the health care experiences of low-income Americans across 30 performance measures, including factors such as percentage of uninsured adults, medical and dental preventive care, number of avoidable emergency department visits, and infant mortality.

"This shows that in the United States high income is not a guarantee of good health and low income does not condemn you to worse health," says David Blumenthal, Commonwealth Fund president.

The scorecard looks at how each state's health care system is working for low-income families, meaning those earning less than $47,000 a year for a family of four. Low-income individuals comprise 39 percent of the U.S. population, and in the states with the lowest health care access and quality nearly half of their residents live in poverty. The report compares their health care experiences to families with higher incomes, or those making more than $94,000 for a family of four, and finds disparities by income within each state.

Differences from state to state in health care for low-income populations are particularly pronounced in areas of affordable access to care, preventive care, dental disease, prescription drug safety, potentially preventable hospitalization and premature death.

Most states have areas where they do well, and every state has areas to improve, says Cathy Schoen, Commonwealth Fund senior vice president for policy, research and evaluation. The District of Columbia, Illinois and Maryland, for instance, have the lowest mortality rates among Medicare beneficiaries hospitalized for heart attack, heart failure or pneumonia, even though they fall within the bottom half in their overall ranking.

Texas is in the top quartile for healthy living factors, such as low rates of infant mortality, premature deaths before age 75, and smoking, but is in the bottom quartile for health access, affordability, prevention and treatment.

The report attributes lack of access to primary care as responsible for insufficient health outcomes and high medical costs. If everyone received the same level of care that the wealthiest residents in top-performing states receive, the report states, then an estimated 86,000 fewer people would die prematurely, 33,000 more infants born to low-income mothers would survive to see their first birthday, and more than 33 million more low-income adults and children would have health insurance.

Shoen says she hopes the report will provide states with health care benchmarks and give them a way to track their progress over time.

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