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Best states for health care

  • Best states for health care

    The COVID-19 pandemic has put new pressure on the American health care system, revealing deep disparities among racial and ethnic groups, high costs that are often barriers to care, and shortages of doctors, nurses, and other professionals, often in rural areas. Further complicating care is that millions of Americans lost their jobs and their health care just when they needed it most.

    One way states have been able to get health care to more of their residents has been to expand their Medicaid programs using federal dollars as allowed under the Patient Protection and Affordable Care Act. People for whom health care was out of reach financially have been able to enroll. Some states embraced the change quickly, but others did not for ideological reasons and concerns over the funding in the long term.

    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 Washington D.C. The WalletHub rankings, released in August 2020, 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 the 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 44-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.

    Read on to find out if you live in one of the worst or best states for health care. 

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  • #51. Georgia

    - Health care score: 43.76
    - Cost rank: #26
    - Access rank: #51
    - Outcomes rank: #47

    Georgia will only partially expand Medicaid coverage in July 2021, adding a work requirement and foregoing the federal funds available with full expansions under the Affordable Care Act (ACA). The Kaiser Family Foundation estimates that there are 267,000 Georgia residents that fall into what’s called the Medicaid coverage gap—not eligible for either Medicaid or the subsidies available under the ACA. Work requirements have faced legal challenges.

  • #50. Louisiana

    - Health care score: 43.82
    - Cost rank: #37
    - Access rank: #18
    - Outcomes rank: #49

    New Orleans became an early hotspot in the coronavirus pandemic after Mardi Gras in the spring of 2020. As of the beginning of November 2020, there had been 5,951 deaths in the state, according to a New York Times case count.

  • #49. Alabama

    - Health care score: 43.84
    - Cost rank: #30
    - Access rank: #46
    - Outcomes rank: #48

    Alabama has not accepted federal funds available through the Affordable Care Act for Medicaid expansion. If it does expand Medicaid, it would see the largest drop in its uninsured rate among all of the states that have not done so, according to The Robert Wood Johnson Foundation. Its proposed work rules would be the strictest in the country.

  • #48. North Carolina

    - Health care score: 44.32
    - Cost rank: #50
    - Access rank: #45
    - Outcomes rank: #33

    About 257,000 people in the state lost health insurance when they lost their jobs during the first six months of the coronavirus pandemic, according to North Carolina Medical Journal.

    The pandemic sparked renewed debate over whether the state should expand its Medicaid program, but it did not in 2020. The governor, who favors expansion, estimates that an additional 624,000 residents would be eligible for coverage. North Carolina was one of the last states to adopt Medicaid in January 1970.

  • #47. Mississippi

    - Health care score: 44.36
    - Cost rank: #17
    - Access rank: #25
    - Outcomes rank: #51

    Mississippi is one of the 12 states that has not expanded Medicaid, and it has asked for permission from the Centers for Medicare and Medicaid Services. There are 99,000 residents who have no realistic expectation of health insurance with the Medicaid expansion. Nearly three times more residents died from COVID-19 at Mississippi’s for-profit nursing homes, according to the Mississippi Center for Investigative Reporting.


  • #46. Arkansas

    - Health care score: 45.61
    - Cost rank: #15
    - Access rank: #22
    - Outcomes rank: #50

    Arkansas implemented a work requirement when it expanded its Medicaid program, but it was halted by a federal judge in 2019. In September 2020, it was third in the country for new COVID-19 cases per capita, according to Johns Hopkins University, which has been closely tracking the pandemic.

  • #45. Tennessee

    - Health care score: 46.55
    - Cost rank: #35
    - Access rank: #34
    - Outcomes rank: #45

    Tennessee has not expanded Medicaid. It has asked for federal approval for a Medicaid work requirement and a transition to Medicaid block grant funding. There are about 113,000 residents in the so-called Medicaid gap—ineligible both for subsidies and for Medicaid.

  • #44. South Carolina

    - Health care score: 46.57
    - Cost rank: #43
    - Access rank: #37
    - Outcomes rank: #42

    South Carolina also has not expanded Medicaid, though it did receive federal approval for a work requirement. If the state did accept Medicaid, it would enable an additional 312,000 people to receive health care coverage.

  • #43. Texas

    - Health care score: 46.8
    - Cost rank: #34
    - Access rank: #48
    - Outcomes rank: #38

    Texas has not accepted federal Medicaid expansion, leaving 1,685,000 people uninsured who could be getting coverage. Texas gets some of the lowest overall scores in the federal government’s 2018 National Healthcare Quality and Disparities Report, the most recent available.

  • #42. Alaska

    - Health care score: 46.83
    - Cost rank: #51
    - Access rank: #30
    - Outcomes rank: #20

    Alaska did expand its Medicaid program and now covers more than 60,000 additional people, some of whom lost their jobs during the coronavirus pandemic. Alaska also had some of the lowest overall scores in the federal government’s 2018 National Healthcare Quality and Disparities Report, which showed a wide discrepancy between Native Alaskans and white residents as far as insurance coverage. Two regions of the state are showing widespread community transmission of COVID-19.