Why states are losing ground on key health measures

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