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The Commonwealth Fund, a New York-based nonprofit and independent health care research firm, evaluated 58 health care indicators, as well as income, race and ethnicity-based differences within states, to make this year’s scorecard. Each indicator was weighted equally, and findings are based on an analysis of publicly available data from 2021 and earlier published by the U.S. Census Bureau, the Centers for Disease Control & Prevention, the Centers for Medicare & Medicaid Services and other federal agencies.
The best-performing states overall across all 58 metrics were Massachusetts, Hawaii, New Hampshire and Rhode Island and Vermont, according to the Commonwealth Fund’s assessment.
“These rankings reflect state residents having better access to care, being most likely to receive high-quality care, experiencing better health outcomes and generally having lower, within-state disparities across racial and ethnic groups and across income stratifications,” David Radley, a senior scientist at the Commonwealth Fund, said during a briefing with reporters.
The lowest-ranking states were Arkansas, Texas, Oklahoma, West Virginia and Mississippi, driven by higher uninsured rates, poorer health outcomes and larger inequities, Radley said.
Compared to all other states, Illinois performed especially well in certain categories, such as reproductive and women’s health, coming in at No. 14. Commonwealth officials said in the briefing with reporters that states scoring high on this metric often have expanded Medicaid coverage to their residents and also good availability of gynecology care.
While Illinois has moved in recent years to preserve access to abortions and require Medicaid plans to pay for them, Commonwealth says the scorecard data was collected before the overturning of Roe v. Wade, meaning scores don’t reflect post-Roe laws. However, the researchers noted that states scoring the worst on reproductive and women’s care are also implementing and considering further restrictions on abortion access.
Illinois also scored high on areas related to residents living healthy lives, with fewer overdoses and suicides (No. 16), more racial and ethnic health equity (No. 17) and more access and affordability (No. 19).
But Illinois struggles when it comes to avoidable hospital use and cost measurements, coming in at No. 46 nationwide and No. 3 among Great Lakes states. According to the study, 14% of every 1,000 insured Illinois residents age 18 to 64 endured potentially avoidable emergency department visits. And nearly 15% of every 1,000 Medicare beneficiaries age 65 and older were considered to have had potentially avoidable emergency department visits.
Radley said during the briefing that the reason Illinois struggles with avoidable hospital use is in part because the state does a poor job of managing chronic diseases, a reflection of Illinois’ primary care infrastructure.
“You could intervene with good primary care, even good specialty care in the cases of some of these chronic conditions to help manage the diseases well and keep people out of the hospital,” Radley said.
However, the researchers acknowledge the well-documented shortage of primary care physicians and low reimbursements rates from public and private insurers, which make the profession less appealing and primary care harder to find.
Across the board, states grappled with a surge in preventable deaths and unaddressed health needs as the COVID-19 pandemic ushered in new challenges for Americans and the health system. Each state saw large increases in avoidable deaths from 2019 to 2021, Commonwealth’s research shows. Arizona saw the largest increase, at 45%. Other states — such as Louisiana, Mississippi, Texas and New Mexico — saw preventable deaths surge more than 35%.
In Illinois, 212 of every 100,000 residents died prematurely from preventable causes, up from 155 from 2018 to 2019.
Black people and American Indian/Alaska Native people were the two groups most affected by COVID-19 nationwide and experienced some of the highest rates of avoidable death in many states.
“We also know that pandemic-era disruptions led to people with chronic illnesses delaying or completely forgoing routine care and disease management activities, contributing further to the trends we see here,” Radley said.
Preventable deaths were also caused by an increase in suicide, firearms and drug overdoses, according to the research.
In the study, Commonwealth researchers suggest policy strategies they say could help alleviate some of the health system issues highlighted in the report. They urge policymakers to lower insurance and administrative barriers for addiction treatment, invest in primary care workers and practices and continue to expand Medicaid coverage to more residents.
Commonwealth Fund senior scholar and Vice President Sara Collins pointed out during the briefing that the end of pandemic-era Medicaid expansion could threaten care accessibility going forward, as about 6.2 million Americans stand to become uninsured this year. In Illinois alone, about 700,000 people here will lose access to Medicaid beginning July 1, a phenomenon that could also have significant consequences for Chicago’s safety-net hospitals.
“To maintain and build on the gains realized during the pandemic, we need to closely monitor the Medicaid unwinding and ensure those who lose coverage can quickly regain it,” Collins said.
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