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

Americans’ worries about paying for health care are at their highest level 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 U.S. adults say they are worried they will be unable to afford necessary health care in the next year. One in five Americans report 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 say 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 report 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 say 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 care their clinicians recommend.

Across the top 10 states as a group, 15% of residents say they were unable to pay for prescriptions in the past three months, and 25% say 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 say their medical professionals provide high-quality care, but that figure ranges from 79% in Massachusetts to 56% in Texas, the lowest level cited in the analysis. Only 59% of adults across the country believe their medical professionals understand their health needs.

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

Residents in top-ranked states also report more proactive engagement overall. In the release, West Health and Gallup note that 76% of adults in the top 10 states say clinicians discuss healthy lifestyle choices, and 69% say 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 are pronounced. The report finds that 66% of Nebraskans say it is easy to get the health care they need, compared with just 30% of residents in New Mexico and 31% in Nevada. Lack of information remains a major barrier: 25% of adults nationwide say they did not know how to find a provider at some point when they needed care. That figure is as low as 14% in Iowa, but rises to 36% in New Mexico, the highest rate cited.

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

States at the bottom of the rankings such as Texas, New Mexico, Nevada and Alaska are 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 lanscape

Tim Lash, 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 policymakers 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 show the most severe challenges, the report emphasizes that no state delivers consistently strong results on cost, quality and access. With nearly half of U.S. adults 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 say 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