Best states for health care

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February 18, 2020
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Best states for health care

The average American spends more than $10,000 on health coverage each year—but what you get for your money depends a lot on where you live. The types of coverage you can receive in each state changes based on how federal subsidies are used and which insurance companies are available. These differences affect what services you can access and what you will pay out-of-pocket. And with single-payer health care gaining steam as a viable idea, it's fairly safe to expect health care will be evolving significantly in the years to come. For now, it's anyone's guess whether the Affordable Care Act will be overturned or stay in place. The answer may end up being different state-by-state.

In order to take a closer look at which U.S. states offer the best health care, Stacker gathered data from a WalletHub analysis of health care that ranked each of the 50 states as well as the District of Columbia. The WalletHub rankings, using data from Aug. 5, 2019, were created by scoring various health-care factors related to cost, access, and outcomes in each state—as well as by surveying health-care experts about topics that included insurers, health-care reform, and expenditures.

Measuring cost included factors, such as average monthly premiums and the cost of a dental visit. Access rankings looked at the state's number of emergency responders, the number of insured adults, and average emergency room wait time. Ranking medical outcomes was a measure of life expectancy, infant mortality, and heart disease rate. How each state scored in terms of cost, access, and outcomes determined its total score.

WalletHub evaluated the results for each state across cost, access, and outcomes based on a 40-metric, weighted system with corresponding points based on a 100-point scale. A score of 100 indicated top-notch health care at the best value. The following 26 locations hit the top of the list. Keep reading to find out whether your state made the cut.

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#26. Illinois

- Healthcare score: 52.2
- Cost rank: #24
- Access rank: #23
- Outcomes rank: #32

Tens of thousands of Illinois residents are currently struggling without access to health care, thanks to a Medicaid backlog. The Chicago Sun-Times's Becky Z. Dernbach reported last year that more than 112,000 applications are still unprocessed past the government's 45-day limit. When that happens, applicants are supposed to get temporary medical coverage cards—but those are in a backlog, too.

#25. Ohio

- Healthcare score: 52.22
- Cost rank: #10
- Access rank: #22
- Outcomes rank: #37

Ohio ranks near the top of the list for states where most adults have seen a doctor in the last two years, in spite of the state facing a physician shortage. A bill was recently passed to help change that by allowing nurse practitioners to do more with patients than they're presently allowed.

#24. New York

- Healthcare score: 52.26
- Cost rank: #29
- Access rank: #24
- Outcomes rank: #29

Voters in New York had high hopes that 2019 would be the year of single-payer health care. But legislators "face an uphill climb" for 2020, according to Politico's Shannon Young, who cites several leaders, including Gov. Cuomo, who have yet to sign on to the some $200 billion price tag. Meanwhile, the state has some of the most physicians per capita—though comparatively little accept Medicare—and cancer rates are fairly high.

#23. New Jersey

- Healthcare score: 53.39
- Cost rank: #14
- Access rank: #30
- Outcomes rank: #28

New Jersey has both good and bad going for it. The state has one of the lowest infant mortality rates, but also one of the highest cancer rates. New Jersey is trying to engage younger people in their health, though, to set an example as they get older. Recently several hospitals came together to organize a social aimed at wellness for college students.

#22. Nebraska

- Healthcare score: 53.64
- Cost rank: #43
- Access rank: #10
- Outcomes rank: #17

Funding for health care continues to be an issue in Nebraska; however, the University of Nebraska Medical Center may receive $300 million in state funding for a new health-care project and campus complex in response to the coronavirus. Part of the idea is the creation of jobs as well as health-care training, which one senator called a potential "game-changer" for the state.

#21. Virginia

- Healthcare score: 54.63
- Cost rank: #25
- Access rank: #35
- Outcomes rank: #12

The governor of Virginia has helped to increase access to quality, affordable health care for everyone in the state. In October, Ralph Northam signed Executive Directive Five, which also strategizes ways "to reduce health insurance premiums statewide, and protect Virginians from federal uncertainty."

#20. Michigan

- Healthcare score: 55.09
- Cost rank: #6
- Access rank: #18
- Outcomes rank: #30

Although Michigan has fairly decent health care, the state is still facing problems from obesity, inactive adults, and lower death ages than other parts of the country. Part of the issue is that Michigan spends relatively little on education for health-care issues, like vaccinations and screenings.

#19. Utah

- Healthcare score: 55.12
- Cost rank: #32
- Access rank: #41
- Outcomes rank: #8

Utah's relatively high ranking on this list might come as a surprise, given that the state has few hospital beds per capita and few physicians per capita. According to a study by Altarum Healthcare Value Hub, over half of Utah residents have difficulty affording health care. "The most commonly reported burden, by 47% of Utah adults, was having to change their prescribed medications because of the cost," per the report.

#18. South Dakota

- Healthcare score: 55.15
- Cost rank: #17
- Access rank: #15
- Outcomes rank: #24

In 2016, South Dakota ranked in the top five states for the usage of telemedicine for health concerns. But by the next year, it sank to the lowest five, with patients opting to use in-person clinics. According to MoneyRates, despite the state receiving some of the worst marks for health insurance affordability, it is buoyed by high marks in hospital affordability. 

#17. Montana

- Healthcare score: 55.44
- Cost rank: #21
- Access rank: #19
- Outcomes rank: #18

Montana ranks high for states with the most dentists per capita, but that doesn't relieve other issues like a lack of resources for mental health care and substance abuse treatment. In February, however, Greg Gianforte, the state's member in the House of Representatives, introduced the National Telehealth Strategy and Data Advancement Act to expand telehealth services, while in December he introduced a bill to help lower drug prices and hold pharmacy benefit managers accountable.

#16. Wisconsin

- Healthcare score: 55.46
- Cost rank: #45
- Access rank: #6
- Outcomes rank: #10

Wisconsin is a deeply divided state, especially on topics like health care. A recent poll by Third Way asked nearly 1,000 Wisconsin voters to choose a priority between lowering the cost of health care and prescription drugs or guaranteeing health care to all; 60% supported the first, while 30% chose the latter. The rural nature of the state makes it difficult for the majority of the residents to get easy access to quality care. But Ascension Wisconsin is an example of one response: The organization just opened a $42 million health center as part of a $100 million plan to expand access and resources to the Racine area.

#15. Pennsylvania

- Healthcare score: 55.7
- Cost rank: #13
- Access rank: #13
- Outcomes rank: #25

Pennsylvania has one of the highest cancer rates in the country, and those patients are worried. They're falling smack into the middle of a duel between two large health-care systems in the state. The ongoing battle began in 2011 and puts patients in danger of paying out-of-pocket for costly medical procedures. However, Gov. Tom Wolf this month signed Act 6 to ensure patients have access to the most advanced and beneficial therapies, barring insurance companies from choosing a potentially worse treatment option, and thus leaving the doctors to decide the best life-saving measures.

#14. Kansas

- Healthcare score: 56.05
- Cost rank: #7
- Access rank: #16
- Outcomes rank: #27

Kansas recently had a big change to its health care offerings. The state decided to bypass the Affordable Care Act, allowing insurers to offer health plans that don't cover pre-existing conditions. In January, Gov. Laura Kelly and Sen. Jim Denning came to an agreement to expand Medicaid to low-income adults. The program likely won't begin until 2021, but it will provide coverage to over 100,000 Kansans.

#13. Connecticut

- Healthcare score: 56.44
- Cost rank: #44
- Access rank: #11
- Outcomes rank: #7

Connecticut's residents definitely care about their teeth: The state ranks #5 for best dental care and #3 for dental habits. But the state and its legislators also care deeply about mental health as well: In July, Gov. Ned Lamont signed the Mental Health Parity Act so that those suffering from substance use and mental health disorders are covered to the same extent as those with other illnesses. According to his office's announcement, "The bill requires that insurance companies not place more stringent limits on mental health and substance use disorder benefits than for medical and surgical benefit."

#12. Maryland

- Healthcare score: 56.71
- Cost rank: #4
- Access rank: #21
- Outcomes rank: #23

Maryland may have some of the fewest hospital beds per capita, but the state recently made health-care history. In the 2019 Maryland General Assembly, lawmakers established the country's first Prescription Drug Affordability Board and also made strides toward easy enrollment for health insurance through a checkbox on taxes.

#11. Colorado

- Healthcare score: 56.77
- Cost rank: #47
- Access rank: #12
- Outcomes rank: #3

Low cancer and heart disease rates are a boon for Colorado, and state lawmakers are continuing to implement ways to improve health care. In 2019 the General Assembly "enacted several bills focused on making health insurance more affordable and increasing coverage protections for consumers." One of those tasked the Division of Insurance and Department of Health Care Policy and Financing to create a proposal for a public option, and in November, the two agencies concluded the state should "require certain insurers to offer the public option on the individual market — where Coloradans buy their own health insurance — when it goes live in 2022." However, at the start of 2020 there remains firms opposition before it becomes law.

#10. Iowa

- Healthcare score: 57.27
- Cost rank: #15
- Access rank: #17
- Outcomes rank: #14

Iowa's governor in May of 2019 signed a law that flies in the face of an Iowa Supreme Court ruling from March. The new law says that public health programs will no longer pay for, or will limit funds for, trans and intersex health care. The Supreme Court ruled this unconstitutional, but the governor signed the law anyway.

#9. North Dakota

- Healthcare score: 58.21
- Cost rank: #3
- Access rank: #9
- Outcomes rank: #22

In North Dakota, one in every 13 adults are covered by Medicaid, which was expanded under the Affordable Care Act in 2014. Twenty percent of children, 50% of nursing home residents, 25% of people living with disabilities, and 11% of Medicare beneficiaries are also covered by Medicaid. 

#8. Maine

- Healthcare score: 58.44
- Cost rank: #38
- Access rank: #1
- Outcomes rank: #13

Health care costs in Maine continue to rise, something that in the past has driven the consolidation of hospital systems and health care facilities. But it's caused a secondary problem as urban hospital systems continue to grow while rural facilities have to cut back. Workers' costs for employer-based insurance exploded by 69% between 2008 and 2018.


#7. Hawaii

- Healthcare score: 59.64
- Cost rank: #8
- Access rank: #36
- Outcomes rank: #5

Micronesians, who often relocate to Hawaii, struggle with high rates of tuberculosis and Hansen's disease. Lawmakers in Hawaii are working to improve health care for the population, as many have trouble navigating the health system in the state. And the health system is a good one: Straub Medical Center in Honolulu in 2020 was ranked in the top 5% of U.S. hospitals.

#6. New Hampshire

- Healthcare score: 59.8
- Cost rank: #40
- Access rank: #8
- Outcomes rank: #2

About 12% of New Hampshire's residents were estimated to be uninsured in 2019—well above the national average of 8.5% uninsured. In New Hampshire, fewer enrollees may correlate to high costs of health care in the state, as residents pay on average $9,589 annually on health care

#5. Vermont

- Healthcare score: 60.13
- Cost rank: #5
- Access rank: #34
- Outcomes rank: #4

Health care reform experts in January 2020 claimed improvements to Vermont's health care are on track, including progress by the state's OneCare service toward becoming a non-profit. Gov. Phil Scott's budget allocates $5.5 million to a new, all-payer model considered among the most efficient health care revamps being undertaken in the U.S. 

#4. District of Columbia

- Healthcare score: 61.38
- Cost rank: #1
- Access rank: #3
- Outcomes rank: #26

Washington D.C. is known as having some of the best health care in the country. Yet the maternal mortality rate in our nation's capital is higher than that of Syria, which has led some experts to decry a lack of abortion access in the metropolis. Home health care will run the average person about $22,000 a year.

#3. Rhode Island

- Healthcare score: 62.12
- Cost rank: #11
- Access rank: #5
- Outcomes rank: #6

Rhode Island is pushing for additional funding for behavioral health and addiction programs, and ranks in the top three states for health care overall. It has some of the highest rates of insured people in the country and some of the lowest uninsured rates.

#2. Massachusetts

- Healthcare score: 62.33
- Cost rank: #35
- Access rank: #2
- Outcomes rank: #1

A record number of Massachusetts residents signed up for the state's Health Connector program, the marketplace through which people can sign up for health care, during the 2019-2020 enrollment period that ran from Nov. 1 to Jan. 23. There are now 312,000 people in the state with affordable health care.

#1. Minnesota

- Healthcare score: 63.79
- Cost rank: #2
- Access rank: #4
- Outcomes rank: #9

Part of what makes health care in Minnesota so great is a high level of doctors accepting Medicare, high rates of insured adults, and a lot of patients seeking regular dental care. There is, however, a poor distribution and overall shortage of health care workers—so much so that an entire summit in 2019 was dedicated to the issue, held by the Minnesota Department of Employment and Economic Development, North East Minnesota Office of Job Training, and the City of Duluth Workforce Development.

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