Worst states for health care
The average American spends more than $10,000 on health care each year, according to the Center for Medicare and Medicaid Services. But that money isn't necessarily going toward high-quality care. There are stories of patients going in for routine appointments or procedures, only to receive bills later for thousands of dollars; horror stories of surgeries gone wrong; and even a recent spate of violence against health care workers, with shootings inside hospitals and assaults on nurses.
The state of health care in the United States is in constant flux, making it difficult to know just where the country—or individual states—stand. Meanwhile, health care costs are prohibitive for many people; which can lead to undiagnosed and unaddressed illnesses or injuries that only get worse.
To take a closer look at how individual states compare when it comes to health care, Stacker gathered data from a WalletHub analysis (data from Aug. 5, 2019). The WalletHub rankings were created by scoring various health care factors related to cost, access, and outcomes in each state—as well as surveying health care experts about topics that included insurers, health care reform, and expenditures. Measuring cost included factors such as the cost of visiting a doctor and average monthly premiums, while access rankings looked at the quality of the public hospital system, the number of doctors per person, and Medicare acceptance rates. Ranking medical outcomes was a measure of mortality, cancer rate, and non-immunized children. 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 25 states hit the bottom of the list and are ranked in this gallery from bad to most severe. Does your home state fall on this list?
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#25. Wyoming
- Health care score: 52.14
- Cost rank: #36
- Access rank: #37
- Outcomes rank: #16
Bryce Habel is a former Shopko pharmacist in Wyoming. Every day, he drives an 80-mile loop around his county, delivering medication to those who lost the only nearby pharmacy when Shopko went out of business. It's bad news for the state, which already has the second-least amount of physicians per capita.
#24. Idaho
- Health care score: 52.02
- Cost rank: #30
- Access rank: #43
- Outcomes rank: #19
There's a problem with uncompensated care in Idaho, costs not paid back by the state when uninsured people are treated at the emergency room. In 2017 alone, hospitals in the state lost $294 million due to this, according to the Idaho State Journal. Medicaid expansion may help; but whether it will also help increase the low amount of hospital beds, physicians, and dentists in the state is yet to be seen.
#23. Delaware
- Health care score: 51.79
- Cost rank: #42
- Access rank: #27
- Outcomes rank: #21
Despite most adult Delawareans keeping up with regular doctor visits, the state still battles with high cancer and infant mortality rates. One issue Delaware is currently facing is "clawbacks," where insurance companies are allowed to charge patients a higher copay at the pharmacy than the cost of their prescriptions.
#22. California
- Health care score: 51.19
- Cost rank: #39
- Access rank: #42
- Outcomes rank: #20
Although California has one of the lowest heart disease rates and one of the highest amounts of dentists per capita, the state is still in the midst of a health care crisis. It's said to be expensive and difficult to get, which isn't surprising—about 7 million residents live in official Health Professional Shortage Areas.
#21. New Mexico
- Health care score: 50.95
- Cost rank: #19
- Access rank: #31
- Outcomes rank: #36
New Mexico has some of the lowest average monthly insurance premiums in the country—but don't let the ranking there fool you. The state is also struggling with incredibly high deductibles, forcing people to skip critical care. New Mexico is also expected to be in the top 10 states with doctor shortages by 2030.
#20. Washington
- Health care score: 49.85
- Cost rank: #48
- Access rank: #44
- Outcomes rank: #11
If you think nature is the best cure, head to Washington State; health care providers there are teaming up with Washington State Parks and the nonprofit Park Rx America to prescribe time in nature as part of a care plan. The state's Veterans Affairs office is partaking, noting that time outdoors helps PTSD. This initiative will hopefully bring more people to the doctor—Washington has the second-highest percentage of at-risk adults who haven't seen a doctor in the last two years.
#19. Oregon
- Health care score: 49.43
- Cost rank: #49
- Access rank: #29
- Outcomes rank: #15
For trans people, Oregon is one of the best states for health. The low-income Oregon Health Plan covers hormone therapy and surgeries, and Oregon Health & Science University has a Transgender Health Program for those not on the state plan. The state faces some challenges, though: costs are rising, leadership is in flux, and the state is among those with the fewest hospital beds per capita in the country.
#18. Indiana
- Health care score: 49.29
- Cost rank: #9
- Access rank: #38
- Outcomes rank: #40
Amid the national measles outbreak, Indiana is taking a stand and offering vaccinations without a prescription. Health officials released the order after just one confirmed case of measles in the state.
#17. Kentucky
- Health care score: 49.11
- Cost rank: #16
- Access rank: #14
- Outcomes rank: #47
Kentucky is facing a trifecta of health ailments. The state has the highest cancer rate in the country, the second-highest heart disease rate, and one of the highest rates of stroke-related deaths. It's also one of the top 10 states for opioid deaths—something the medical community there is coming together to help solve.
#16. Tennessee
- Health care score: 48.05
- Cost rank: #18
- Access rank: #32
- Outcomes rank: #42
Residents in Tennessee are dealing with some unfortunate revelations in their health care system recently. The state is set to be the first to request a Medicaid block grant, which could impact coverage for low-income people. Also, eight health care providers were recently busted for opioid trafficking.
#15. Missouri
- Health care score: 47.5
- Cost rank: #31
- Access rank: #25
- Outcomes rank: #41
Children in Missouri are quickly becoming one of the largest groups of those affected by subpar health care in the state. In the last year, child suicide rates have grown, along with rates of children being pushed out of Medicaid thanks to an unnecessarily difficult re-enrollment process.
#14. Nevada
- Health care score: 47.37
- Cost rank: #22
- Access rank: #47
- Outcomes rank: #39
Nevada has the lowest cancer rate of all the states, which is notable. Unfortunately, the state is a problem area for health care workplace violence. A bill introduced in March works to combat the issue.
#13. Florida
- Health care score: 47.37
- Cost rank: #34
- Access rank: #46
- Outcomes rank: #35
Since the 1970s, Florida has been facing low rates of insured patients—and it still does, ranking in the bottom five for both children and adults. But that may change with a new bill currently on its way through the governor's desk. The bill overturns Certificate of Need regulations, which meant new services or expansion by outpatient facilities had to get state approval first, something that often reduced access to care and inflated prices.
#12. West Virginia
- Health care score: 47.35
- Cost rank: #41
- Access rank: #7
- Outcomes rank: #45
West Virginia has some of the highest insurance premiums, but also ranks as having some of the most hospital beds per capita—but it also has a major opioid problem and high expenses. To that end, a group of hospitals in the state are suing opioid firms, blaming false marketing for fueling the problems.
#11. Arizona
- Health care score: 46.74
- Cost rank: #37
- Access rank: #48
- Outcomes rank: #34
Arizona may be nearing the bottom of the good health care list, but it's also considered a great place for nurses. Prospective nurses are won over by high levels of opportunity and competition, a high salary, and high rates of job growth. But there aren't many job openings, likely due to a lack of health care facilities overall per capita.
#10. Alabama
- Health care score: 46.59
- Cost rank: #12
- Access rank: #45
- Outcomes rank: #46
Alabama has some of the highest heart disease rates in the country and some of the fewest dentists—but the state has at least one thing going for it: There hasn't been a single confirmed case of measles all year. And that's after someone confirmed to have the illness traveled there in April.
#9. Texas
- Health care score: 45.94
- Cost rank: #28
- Access rank: #51
- Outcomes rank: #38
Texas has some of the lowest rates of insured people—the lowest overall for adults age 18 to 64, and almost last for children from birth to age 17. The state legislature is working to improve health care in Texas, though, introducing bills covering everything from raising the minimum age to buy cigarettes to extending the length of covered behavioral health services after someone gives birth.
#8. Louisiana
- Health care score: 44.5
- Cost rank: #33
- Access rank: #20
- Outcomes rank: #49
Louisiana is facing numerous health care issues: the least amount of people seeing a dentist, high infant mortality rates, and overall the worst health care ratings in the country. To raise that ranking, the state is hoping to raise the smoking age to 21 and also recently broke ground on a new biomedical research facility.
#7. Oklahoma
- Health care score: 44.47
- Cost rank: #26
- Access rank: #39
- Outcomes rank: #48
With one of the highest percentages of adults who haven't seen a dentist, one of the lowest percentages of insured adults, and some of the highest monthly insurance premiums, Oklahoma has a long way to go to secure proper health care for its residents. The state is making strides in the right direction, though, by recommending a measles vaccine.
#6. Georgia
- Health care score: 44.45
- Cost rank: #23
- Access rank: #49
- Outcomes rank: #44
In April, Georgia lawmakers signed the Patients First Act, a bill that's designed to make it easier for uninsured and underinsured residents to get access to health care. It's a good time for it, too—Georgia ranks as one of the states with the lowest numbers of insured adults.
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#5. Arkansas
- Health care score: 43.48
- Cost rank: #20
- Access rank: #33
- Outcomes rank: #50
Arkansas unfortunately beats all other states for risk of heart disease, as well as having some of the most adults who haven't been to the dentist and a high infant mortality rate. The state does, though, have a high rate of available hospital beds. A new mobile health unit now travels throughout Arkansas offering free health screenings.
#4. South Carolina
- Health care score: 42.96
- Cost rank: #46
- Access rank: #40
- Outcomes rank: #43
A recent Winthrop University survey offers some insight on South Carolina's poor state of health care. Most residents report they would support a government-owned national health plan—as long as they had the option to keep their regular insurance plans.
#3. Mississippi
- Health care score: 42.76
- Cost rank: #27
- Access rank: #28
- Outcomes rank: #51
Even though Mississippi has the second-most hospital beds per capita, the state ranks low on the amount of available physicians and dentists, insured adults, and people who see a dentist regularly. Coupled with high infant death rates and high heart disease rates, that leaves the state of health care in a bad situation. Many of the state's rural hospitals are at risk of closing, as well.
#2. North Carolina
- Health care score: 42.63
- Cost rank: #50
- Access rank: #50
- Outcomes rank: #33
Low insurance premiums, but low access rates plague North Carolina's health care system, but lawmakers are trying to change that. The NC Health Care for Working Families Act would increase access for low-income residents. The proposal would cover more than 540,000 people who lacked insurance before.
#1. Alaska
- Health care score: 42.21
- Cost rank: #51
- Access rank: #26
- Outcomes rank: #31
Among other states, Alaska is vying to be one of the first to get the Medicaid block grant. It could hurt the state's health care environment, though, with cuts to some services people use. Insurance premiums in the state are already low (and so is heart disease risk), but Alaska also has the least amount of covered children.
