The 10 states with the best health care, according to patients

Americans face record levels of cost pressure

Nearly half of U.S. adults (47%) say they worry they will not be able to afford necessary health care in the coming year, the highest level recorded since West Health and Gallup began tracking the measure in 2021.

One in five Americans report that they or someone in their household could not pay for prescription medications in the past three months — also a record high.

Those findings come from the "State of the States (SOS) Study: Insights on Healthcare in America," a new analysis from the West Health-Gallup Center for Healthcare in America.

The report evaluates health care experiences in all 50 states and the District of Columbia based on nearly 20,000 survey responses from patients covering cost, quality and access.

Unlike other rankings that focus on health outcomes or system performance, the study examines what people say they encounter in their daily lives.

Top-ranked states lead on affordability, preventive engagement

Iowa, Massachusetts, Washington, D.C., and Rhode Island top the national rankings for overall health care experience. In the West Health–Gallup analysis, residents in these states report better overall experiences, particularly in their ability to afford, access and receive quality care when and where they need it.

Cost barriers are notably lower in the highest-ranked states. About 15% of residents in the top 10 say they were unable to pay for prescriptions in the past three months, compared with 29% in the bottom 10.

Massachusetts reports the lowest share of adults skipping a recommended medical test or procedure due to cost (18%), while Mississippi reports the highest (46%).

Preventive care indicators also help distinguish the strongest performers.

Nationally, 71% of adults say their physicians ensure they receive recommended screenings and evaluations. That figure rises as high as 78% in Massachusetts and Rhode Island.

Lifestyle guidance shows similar patterns: 76% of adults in top-ranked states say clinicians discuss healthy lifestyle choices, compared with lower rates in states at the bottom of the rankings.

Quality and access indicators

Quality perceptions vary significantly from state to state. Nationally, 68% of adults say their medical professionals provide high-quality care, ranging from 79% in Massachusetts to 56% in Texas. Only 59% of adults across the country believe their medical professionals understand their health needs.

Access divides are even sharper.

Sixty-six percent of Nebraskans say it's easy to get necessary health care services, compared with just 30% in New Mexico and 31% in Nevada.

Lack of information remains a major barrier, as 25% of adults nationwide say they did not know how to find a health care provider at some point when they needed care.

Transportation challenges affect another 15% of adults, and appointment wait times are the most commonly reported barrier — preventing or delaying care for 53% of U.S. adults.

Even strong states show signs of strain

Despite their high rankings, the top 10 states are not free of systemic pressure.

One in four adults in top-ranked states still skip recommended care due to cost, and more than 20% report that accessing the health care services they need is either difficult or very difficult.

Shelley Lyford, CEO and chair of the West Health Institute and the Gary and Mary West Foundation, said the findings underscore the unevenness of care across the country. "While no state is without room for improvement, ZIP code should not determine whether you can afford to see a doctor or fill a prescription — but in America today, it often does."

Joe Daly, global managing partner at Gallup, said the report "arrives at a moment of intense strain for the U.S. health care system," as workforce shortages, rising costs and polarized policy debates continue to shape patient experiences.