20 Worst States in America for Healthcare

In late June, the Commonwealth Fund, a nonpartisan healthcare foundation, ranked healthcare quality in all 50 states and Washington, D.C. For its annual scorecard, the agency looked at seven major metrics for each state—including healthcare access and affordability, preventive care and treatment, potentially avoidable hospital use and cost, reproductive care and women's health, racial and ethnic health equity—and many other secondary factors. Notably, the researchers considered reproductive care by looking at infant deaths and maternal mortality by state (though the report was issued before Roe v. Wade was overturned, limiting abortion access for millions). The states that ranked best were Massachusetts (at #1), Hawaii, New Hampshire, Rhode Island, and Vermont. These are the 20 worst states for healthcare, with the most severely ailing listed last.

Among U.S. states and the District of Columbia, New Mexico ranked 51st—dead last—in reproductive and women's health, 42nd in access and affordability, and 47th in healthy lives. Among its worst performances: all-cause mortality among women age 15 to 44 and alcohol-related deaths. 

Ranking 33rd among states overall, North Carolina scored among the bottom 10 in the areas of income disparity (46th) and reproductive and women's health (41st). Its worst metrics included the number of people burdened by medical debt, and the rate of drug overdose deaths stood out as one of the most concerning factors.

The report showed that "Arizona, Louisiana, Mississippi, New Mexico, and Texas had the largest increases in the rate of avoidable death from 2019 to 2021, with each of those states experiencing a more than 35% rise over that period" U.S. News and World Report said on June 22. "Arizona had the biggest increase of all states, rising 45% from 249.3 deaths per 100,000 population in 2019 to 362.6 per 100,000 in 2021."

Coming in 34th among all states, Indiana ranked 47th in avoidable hospital use and cost. Among its areas of worst performance: potentially avoidable emergency department visits by the elderly and spending on primary care. 

For the second year in a row, the Commonwealth Fund found Florida had the 16th-worst healthcare in the nation. In March, Time magazine commented on the state's performance on the 2022 scorecard. "Florida ranks below the northern blue states in life expectancy and rates of cancer death, diabetes, fatal overdoses, teen birth rates, and infant mortality," the news outlet said.

"South Carolina ranks 37th in the U.S. in overall healthcare performance and among the bottom tier in several key metrics," the State newspaper reported on June 22, noting South Carolina ranked 42nd in reproductive and women's health, 39th in access and affordability, 34th in prevention and treatment, 42nd in healthy lives, 41st in income disparity, and 46th in racial and ethnic health equity.

Missouri ranked dead-last among the seven Plains states in six out of seven major metrics; nationwide, it was mired in the 30s in the areas such as reproductive and women's health (34th), access and affordability (35th), and prevention and treatment (36th). 

Alaska ranked near the bottom of the list in prevention and treatment (50th) and reproductive and women's health (48th). It also occupied the bottom 10 in healthy lives, coming in 41st.

Coming in 40th overall, Kentucky's areas of worst performance were in healthy lives (where it ranked 49th out of 51), adults who report fair or poor health, adults who have lost six or more teeth, and adults without a dental visit. 

Ranked 41st overall, in the past year, Nevada saw 21 healthcare indicators improve, but 14 worsen and 14 stay the same. Among the factors that worsened most: Severe maternal morbidity and premature deaths from preventable causes. 

"Alabama is far behind on maternal and infant mortality, as well as overall mortality for women aged 15-44," the Alabama Political Reporter said of the Commonwealth Fund analysis. "The national average for maternal mortality is 25.6 deaths per 100,000 live births. In Alabama, 43 women die in every 100,000 births. Meanwhile, seven in every 1,000 infants die in Alabama births, compared to 5.4 nationally."

"Louisiana, which ranked 38th out of the 50 states and the District of Columbia, saw an increase in its maternal morbidity rate between 2018 and 2020, and it did not improve in any of the key areas researchers examined," reported MPBOnline.

The analysis found that Wyoming ranked in the bottom five nationwide in three of seven major metrics: access and affordability, prevention and treatment, and racial and ethnic health equity. It placed the state at 43rd overall. 

Bottom-ten finishes in several major metrics including reproductive and women's health (45th), access and affordability (48th) and income disparity (46th) were enough to put Georgia at 45th in the nation overall. 

The Commonwealth Fund found Tennessee ranked 40th in reproductive and women's health care. On July 6, local station WTVF reported that a new CDC study found that more women are dying during childbirth in the state. Pregnancy-related deaths for white and Hispanic women more than doubled in Tennessee in the last ten years, and Black women are three times more likely to die from childbirth than White women.

"Low rates of adult dental care and high rates of premature deaths from treatable causes push Arkansas near the bottom of the states," the Arkansas Center for Health Improvement said of the report. It noted that the state ranked 51st in the percentage of adults without dental visits, 50th in the number of adults who have lost six or more teeth, and 50th in premature deaths from treatable causes (ranked 50th). Arkansas also ranks below the national average in nine of 12 measures related to reproductive and women's health, including infant mortality, prenatal care and preterm births. 

"Texas is the hardest place in the nation to obtain health care and ranks among the most expensive places if you don't have coverage," Houston Chronicle columnist Chris Tomlinson said of the report. "After decades of competing with Mississippi and West Virginia for the worst ranking in health care access and affordability, Texas ranked 51st out of the 50 states and the District of Columbia in the latest data."

"The state has the highest uninsured rate at 24.3 percent, double the national average, and catastrophic compared to top-performer Massachusetts at 3.4 percent," he added.  The Dallas Morning News noted the report found that "reproductive care and women's health are worse in Texas than in nearly every other U.S. state."

Oklahoma is not looking OK when it comes to healthcare, the survey found. Only two states ranked lower overall. In access and affordability of healthcare, it ranked 50th. 

Only one state had worse healthcare than West Virginia, the Commonwealth Fund found. The state was particularly hard-hit by drug overdoses and ranked dead-last in healthy lives and 50th (out of 51) in avoidable hospital use and cost. 

Mississippi came in last overall in the report, "with marked increases in preventable deaths, high uninsured rates and more preterm births," said MPBOnline. "Mississippi ranked second to last in reproductive and women's health, with worsening rates of death for women of reproductive age, postpartum medical visits, and deaths from preventable and treatable causes. Mississippi also continues to have the highest rate of infant mortality in the country."