More states have improved on most health indicators, according to an annual study that's releasing results for the first time since the Affordable Care Act expanded coverage throughout the country.
The Commonwealth Fund Scorecard on State Health System Performance analyzes access and affordability, prevention and treatment and avoidable hospital use and cost. There are also 42 indicators, including rates of children or adults who are uninsured; hospital admissions for children with asthma; breast and colorectal cancer deaths; and hospital patients who receive information about how to handle their recovery at home.
Overall, the top-ranked states are Minnesota, Vermont and Hawaii, all Medicaid expansion states. The lowest-ranked states included two states that didn't expand Medicaid—Mississippi and Oklahoma— as well as Arkansas, which has expanded Medicaid under a waiver. There are wide variations in performance, according to the study, and up to an eightfold difference exists between the top- and bottom-ranked states.
The newest scorecard tracked differences from 2013 in relation to the ACA's expansions. It also tracked mortality and hospital readmission rates.
Access to healthcare fared better in 2014. The scorecard revealed a sharp decline in the percentage of uninsured working-age adults. Almost every state saw a decline, and 10 states had a decline of 6 to 9 percentage points.
The vast improvement is unprecedented and clearly a result of the ACA, said Sara Collins, vice president of healthcare coverage and access at the Commonwealth Fund. But Collins cautioned that states that didn't expand Medicaid didn't improve as much as states that did expand. Still, the “general trend toward improvement is encouraging,” she said.
There was a stark difference between how much states improved and where they ranked overall. For example, Louisiana improved on 16 indicators, the most of any state. But Louisiana, a non-Medicaid expansion state, only ranked 48th overall. Oklahoma, which improved on 14 indicators, came in last. Kentucky and Tennessee both improved on 13 indicators, but Kentucky, which expanded Medicaid, only ranked at No. 40 overall, and Tennessee only reached No. 43. Tennessee, which has not expanded Medicaid, was also the only state in the nation not to worsen in any of the 42 indicators.
Collins said the next trend to watch is what effect improved access to care is having on the population's health overall.