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

Related: 10 states with the best health care, according to patients

Affordability concerns reach new highs

Worries about paying for health care are at their highest level in the U.S. since West Health and Gallup began tracking them in 2021.

According to the State of the States 2025 report from the West Health–Gallup Center for Healthcare in America, 47% of adults in the U.S. said they are worried they will be unable to afford necessary health care in the next year. One in five reported that they or someone in their household could not pay for prescription medications in the past three months, another record high.

Those findings come from a survey of 19,535 adults across all 50 states and the District of Columbia that asked 27 detailed questions about how they experience the health system in three areas: cost, quality and access.

The responses were combined into state-level rankings and grades, producing what West Health and Gallup describe as a patient-centered view of how people interact with health care where they live.

Where cost pressures hit hardest

The new rankings show that cost problems are not distributed evenly across the country. Bottom-ranked states such as Mississippi, Texas, Montana, New Mexico, Nevada and Alaska report some of the highest levels of cost-driven care avoidance.

Mississippi stands out as a clear outlier.

Thirty-six percent of adults there said they or someone in their household could not afford a prescription in the past three months, compared with 12% in Iowa. When it comes to care itself, 46% of Mississippi residents reported skipping a recommended medical test or procedure in the past year because of cost, more than double the 18% reported in Massachusetts.

Nationally, 30% of adults said someone in their household skipped medical treatment due to cost.

The report notes that rates of skipped recommended tests or procedures climb above 40% in states such as Texas and Montana as well, compared with fewer than 21% in Iowa and Massachusetts. Those state-level differences illustrate how much location can influence whether people follow through on the care their clinicians recommend.

Across the top 10 states as a group, 15% of residents said they were unable to pay for prescriptions in the past three months, and 25% said they skipped recommended care because of cost. In the bottom 10, those averages rise to 29% and 40%, respectively.

Quality and preventive care lag behind in low-ranking states

Quality perceptions also vary widely. Nationally, 68% of adults said their medical professionals provide high-quality care, but that figure ranged from 79% in Massachusetts to 56% in Texas, the lowest level cited in the analysis. Only 59% of adults nationwide said they believe their medical professionals understand their health needs.

Preventive and lifestyle-oriented care show similar gaps. In the report, 71% of adults nationally said their physicians ensure they receive recommended screenings and evaluations. That share rose to 78% in Massachusetts and Rhode Island. When it comes to lifestyle guidance, 72% of adults overall stated that their clinicians discuss healthy choices such as diet and exercise; the rate reached 80% in Rhode Island but dropped to 63% in Texas.

Residents in top-ranked states also reported more proactive engagement overall. In a news release, West Health and Gallup noted that 76% of adults in the top 10 states said clinicians discuss healthy lifestyle choices, and 69% said they are asked about their mental health, with significantly lower levels reported in the bottom 10 states. Those patterns suggest that strong provider-patient relationships and consistent preventive care are part of what separates higher-performing states from the rest.

Access problems define the bottom tier

Access to care is another area where state differences were pronounced. In the report, 66% of Nebraskans said it is easy to get the health care they need, compared with 30% of residents in New Mexico and 31% in Nevada. Lack of information remains a major barrier: 25% of adults nationwide said they did not know how to find a provider at some point when they needed care. That figure was as low as 14% in Iowa, but rose to 36% in New Mexico, the highest rate cited.

Transportation is also a factor, with 15% of adults nationally stating it has limited their ability to get care. Long wait times for appointments were the most commonly reported barrier overall, preventing or delaying access for 53% of adults in the U.S. Vermont had the highest level of reported delays from wait times, at 72%, whereas Nebraska had the lowest, at 46%.

States at the bottom of the rankings, such as Texas, New Mexico, Nevada and Alaska, were described in the report as facing “widespread challenges,” with residents more likely to delay or forgo care because of affordability, report difficulty accessing services and express lower confidence in the quality of care available to them.

A fragmented landscape

Tim Lash, MBA, president of the West Health Policy Center, said the findings show how rising costs and uneven access are shaping daily life for Americans.

“Spiking insurance premiums, rising costs and issues with quality and access have dramatically increased the struggle millions face at the hands of a high-priced health care system,” Lash said in the news release. He added that the study “captures this struggle directly from the mouths of residents in each state” and is meant to help policy makers and other stakeholders develop more effective, targeted policies that improve outcomes, expand access and lower costs.

The survey was conducted online in mid-2025, using the Gallup Panel and address-based sampling.

Even as the bottom-tier states showed the most severe challenges, the report emphasized that no state delivers consistently strong results in cost, quality and access. With nearly half of adults in the U.S. saying they were worried about affording care and one in five unable to pay for prescriptions in the past three months, the data point to a health care system under sustained strain.

West Health and Gallup said they plan to continue tracking state-level experiences as debates over Medicaid expansion, prescription drug pricing and broader health system financing play out in Washington and in state capitals across the country.

Related: 10 states with the best health care, according to patients