Why states are losing ground on key health measures

February 3, 2020

A report card of healthcare indicators shows troubling developments.

The Commonwealth Fund recently issued its 2019 “Scorecard on State Health Performance,” measuring states on 47 healthcare indicators in the categories of access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives.

The scorecard finds areas of progress along with a number of troubling developments, most notably substantial increases in deaths from drug overdoses, alcohol and suicide. Together, these “deaths of despair” significantly contributed to the recent decline in average life expectancy at birth.

Read on for other key takeaways from the scorecard:

Death rates

Deaths from suicide, drug overdoses and alcohol reached all-time highs in 2017

Deaths from drug overdoses increased by 115 percent between 2005 and 2017, with West Virginia, Ohio and Pennsylvania experiencing the highest rates of increase

Deaths from alcohol-related causes were up by 37 percent during the 2005-2017 period. The Dakotas, Mountain States and Pacific Northwest saw the largest increases

Suicide rates were up by 28 percent during the 2005-2017 period, with a particularly sharp increase between 2016 and 2017. Rates were highest in the Mountain States and the Dakotas.

Insurance coverage

After several years of declining uninsured rates following passage of the Affordable Care Act, progress has stalled

From 2016 to 2017, 16 states saw increases in their numbers of uninsured adults

At the end of 2018, 30 million adults were uninsured and about 44 million others had deductibles and out-of-pocket expenses that were large enough relative to their incomes as to be considered underinsured

Medicaid expansion is a major determinant of adult uninsurance rates. The five highest uninsurance rates in 2017 were in states that had not expanded Medicaid eligibility: Texas, Oklahoma, Georgia, Florida and Mississippi

Cost of care

Healthcare costs are rising more quickly than median incomes, which in turn has contributed to stalled progress in reducing the number of un- and underinsured Americans and escalating premiums, deductibles and copays for the approximately 158 million Americans who get coverage through their employer

In 2017, employee premium contributions as a share of median income was 7 percent nationally, with families in southern and southwestern states spending the largest amount of their incomes on employer premiums

Between 2013 and 2017, per-enrollee spending growth in employer health plans outpaced that of Medicare spending in 31 states.

How states are responding

The scorecard finds that states are responding to coverage shortfalls and rising costs in a variety of ways:

As of June, 33 states and the District of Columbia had expanded access to Medicaid as allowed under the Affordable Care Act

Seven states are operating their own reinsurance programs, helping to strengthen and stabilize their markets for individual insurance

Washington State will begin offering a public-plan option to its residents in 2021 that will cap provider payments at 160 percent of Medicare rates

Several states are seeking to strengthen primary care in underserved areas by offering tuition assistance and increasing reimbursements for primary care services