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Health Care Access Rankings

Measuring affordability and access of health care in the states


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A thick layer of fog rolls over the Mississippi River toward Dubuque, Iowa, Monday, Oct. 23, 2017. (Dave Kettering/Telegraph Herald via AP)

Iowa Is No. 1


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Health care access is worth one-third of the weight in ranking the Best States for health care. Six metrics contributed to the rankings: child wellness visits, health insurance enrollment, adult wellness visits, adult dental visits, child dental visits and health care affordability. While many Americans have access to quality health care, others face barriers, such as lack of insurance, that prevent them from receiving basic health services. The lack of access to quality health care increases the financial and public health burden on state residents as individuals and as a population.

The Best State for health care access is Massachusetts, which also ranks fifth for health care and is the No. 8 overall state. Hawaii, the No. 1 state for the health care category, places second in the health care access subcategory. Four other New England states also make the top 10: Connecticut, Vermont, Rhode Island and New Hampshire. The worst state for health care access, Alaska, ranks fourth for health care quality. Six of the bottom-10 states for health care access are in the Southeast or Southwest: Mississippi, Florida, Oklahoma, Texas, Georgia and Alabama.

Best States for Health Care Access

Health Care Access Rank State Adult Dental Visits Adult Wellness Visits Child Dental Visits Child Wellness Visits Health Care Affordability Health Insurance Enrollment
#1 Massachusetts MA 4 3 11 1 5 1
#2 Hawaii HI 7 23 6 9 1 2
#3 Connecticut CT 1 8 1 22 8 7
#4 Vermont VT 10 29 5 13 4 4
#5 Iowa IA 11 24 18 1 2 5
#6 Rhode Island RI 2 1 19 25 11 6
#7 Maryland MD 16 9 8 10 15 16
#8 New Hampshire NH 9 16 9 16 10 17
#9 Washington WA 18 43 4 12 9 18
#10 Minnesota MN 3 27 45 14 7 3
#11 Pennsylvania PA 25 19 35 1 17 10
#12 West Virginia WV 48 4 13 1 39 14
#13 New York NY 17 11 41 8 18 19
#14 Kentucky KY 39 7 24 20 27 8
#15 North Dakota ND 27 47 - - 3 15
#16 Delaware DE 26 5 28 26 21 13
#17 New Jersey NJ 5 2 22 24 32 25
#18 Wisconsin WI 8 26 49 1 12 9
#19 Michigan MI 14 17 40 30 31 11
#20 Virginia VA 12 12 21 28 35 31
#21 Illinois IL 29 28 38 31 19 21
#22 Maine ME 32 18 43 15 14 26
#23 Ohio OH 19 10 47 44 13 12
#24 New Mexico NM 37 45 7 21 30 35
#25 Montana MT 28 40 14 35 20 29
#26 Colorado CO 22 46 10 43 25 22
#27 Nebraska NE 15 41 12 37 26 30
#28 South Dakota SD 13 32 34 38 6 33
#29 Utah UT 6 48 31 29 24 28
#30 North Carolina NC 31 13 17 17 44 41
#31 Oregon OR 20 42 42 46 16 20
#32 Indiana IN 38 38 36 33 29 24
#33 Missouri MO 40 25 48 1 34 34
#34 Kansas KS 24 37 33 39 23 32
#35 Tennessee TN 45 30 20 32 28 36
#36 California CA 21 39 39 49 22 23
#37 Louisiana LA 50 22 26 1 48 43
#38 Arkansas AR 47 21 23 42 40 27
#39 Idaho ID 33 50 3 45 37 40
#40 South Carolina SC 43 35 25 23 42 39
#41 Alabama AL 36 20 27 40 45 38
#42 Nevada NV 42 31 44 11 43 44
#43 Arizona AZ 41 36 37 41 36 37
#44 Wyoming WY 23 44 32 36 38 42
#45 Georgia GA 34 15 16 34 47 47
#46 Texas TX 44 34 2 18 49 50
#47 Oklahoma OK 46 33 30 19 41 49
#48 Florida FL 35 6 46 27 46 48
#49 Mississippi MS 49 14 15 47 50 45
#50 Alaska AK 30 49 29 48 33 46

Adult Dental Visits

This metric measures the percentage of adults who did not visit a dental clinic for any reason, including to see a dentist, dental hygienist or dental specialist, within the past year. Data were collected by Centers for Disease Control and Prevention in a 2016 survey. Nationally, around 34 percent of adults did not make a dental visit, though the rate ranged from 26 percent in New England to 40 percent in the Southwest. New England states comprised three of the top five states for adult dental visits, and with 22 percent, No. 1 Connecticut had the smallest percentage of adults who did not visit a dental clinic in 2016. This was an improvement from more than 25 percent in 2014. Louisiana ranked No. 50 for adult dental visits, with 43 percent of adults saying they did not visit a dental clinic within the past year.

Adult Wellness Visits

Regular health checkups help doctors prevent and treat problems early on, which can lead to a longer, healthier life. This metric evaluates the percentage of adults who reported that they went without a routine checkup in the past year in a 2016 survey by the Centers for Disease Control and Prevention. Given the CDC definition of a routine checkup as “a general physical exam, not an exam for a specific injury, illness, or condition,” survey participants were then asked the following question: “About how long has it been since you last visited a doctor for a routine checkup?” In the U.S., about 29 percent of adults went without a routine checkup, and in the Rocky Mountain region about 38 percent of adults did not see a doctor for a routine visit. States with a lower percentage of missed checkups earned a higher ranking for this metric. In No. 1 Rhode Island, 18 percent of adults went without a routine checkup, while in No. 50 Idaho, 4 percent of adults did not see a doctor for a routine visit within the past year.

Child Dental Visits

This evaluates how many children did not visit a dental clinic over the past year. In 2016, the Centers for Medicaid & Medicare measured the percentage of children eligible for EPSDT, the child health component of Medicaid, who did not receive any dental services in the past year. A lower percentage of missed dental visits indicated a higher ranking for this metric. In the U.S., 54 percent of children eligible for EPSDT had not seen a dentist in the past year, while in the Southwest, 44 percent of eligible children had not visited a dental clinic. In No. 1 Connecticut, 38 percent of children eligible for EPSDT did not receive any dental services in 2016, while in Wisconsin, which ranked last for this metric, 71 percent of children went without a visit to a dental clinic. North Dakota did not have any data and was unranked.

Child Wellness Visits

This metric monitors compliance with preventative care under the child health component of Medicaid. In 2016, the Centers for Medicaid & Medicare measured the total number of routine screenings received above the expected number received by a state’s population under 20 years old in the past year. Because the percentages were capped at 100, seven states tied for first in this metric: Iowa, Louisiana, Massachusetts, Missouri, Pennsylvania, West Virginia and Wisconsin. With 50 percent of expected screens completed in 2016, California ranked last for child wellness visits. North Dakota did not have data and was unranked. Nationally, about 76 percent of expected child screenings were completed. In three regions – the Mid-Atlantic, New England and the Great Plains – at least 90 percent of children received their expected routine screens, while in the Far West just 57 percent did.

Health Care Affordability

This metric measures the percentage of adults who responded positively to the question, “Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?” in a 2016 Centers for Disease Control and Prevention survey. Participants who did not know or refused to answer were not counted for this metric. In Hawaii, which ranked first for health care affordability, 7 percent of adults reported that they could not see a doctor because of cost. Two Plains states –Iowa and North Dakota – and two from New England – Vermont and Massachusetts – rounded out the top five. Each of the bottom-10 states for health care affordability fell in the Southeast or Southwest, topped by No. 50 Mississippi, where 19 percent of respondents said they did not see a doctor in the past year due to cost. Nationally, 13 percent of Americans could not see a doctor because it was too expensive in the past year.

Health Insurance Enrollment

This metric is weighted the most in this subcategory. It measures the percentage of adults age 18 to 64 without health insurance, according to 2016 U.S. Census data. On average, 12 percent of American adults lacked health coverage. Massachusetts, where less than 4 percent of adults lacked health insurance, ranked first for this metric, and three other New England states – Vermont, Rhode Island and Connecticut – also made the top 10. In No. 50 Texas, less than 23 percent of adults did not have health insurance, and Southeast and Southwest states made up another seven of the worst 10 states for health insurance enrollment.

Nationally, about 10 percent of females age 18 to 64 lacked health insurance, while nearly 14 percent of males did not have coverage. In the U.S., people ages 18 to 34 also lacked health coverage more often than those ages 35 to 64. About 8 percent of non-Hispanic whites did not have health insurance, but 20 percent of American Indians and nearly 10 percent of black Americans lacked coverage.