The lowest-ranked states overall are Mississippi, Texas, Oklahoma, Arkansas and West Virginia. But in specific areas, each of these states outperformed many of their peers. Mississippi, for example, ranks in the top quartile of state spending on primary care.

The scorecard includes 50 measures of health care access and affordability; prevention and treatment; avoidable hospital use and costs; health outcomes and healthy behaviors; and equity. Among the other significant findings:

• Uninsured rates fell to record lows in all states by 2023, and differences in health coverage and access to care narrowed among states. These improvements in all likelihood were due to the Affordable Care Act’s coverage expansions, recent state expansions of Medicaid eligibility and more affordable marketplace plan premiums.
• The number of children receiving all doses of seven recommended early childhood vaccines fell in most states between 2019 and 2023. In five states, including Nebraska and Minnesota, the decline exceeded 10%.
• The infant mortality rate (deaths within the first year of life) worsened in 20 states between 2018 and 2022, with considerable variation across states.
• Premature, avoidable deaths vary considerably across states; the rate in West Virginia is more than twice as high as the rate in Massachusetts. Not only are avoidable mortality rates higher in the United States than in other high-income countries, but they also are on the rise, even as they fall elsewhere.
• Wide racial disparities in premature deaths are the norm in most states. In 42 states and the District of Columbia, avoidable mortality for Black people is at least twice the rate for the group with the lowest rate.
• Targeted, coordinated federal and state policies are needed to raise health system performance across the nation.

“By enabling states to see how they compare with their peers, we hope to inform and inspire action at the federal, state and local levels to ensure all Americans have affordable access to high-quality health care and the opportunity to live a healthy life,” the report said. “In many cases, the wide variations in health and health care we see come down to the policy choices that state leaders make.”