Although nearly half of U.S. adults worry that they won’t be able to afford necessary health care in the coming year, their overall health care experience varies significantly by where they live.
The State of the States 2025: Insights on Healthcare in America report from the West Health-Gallup Center for Healthcare in America ranked states for health care cost, quality and access.
Residents in the 10 top-ranked states are less likely than those in the 10 bottom-ranked ones to forgo recommended care (25% vs. 40%) or prescriptions (15% vs. 29%) because of cost. Americans in the top-ranked states also are more likely to report receiving high-quality, proactive care from their providers and to experience fewer barriers to accessing health care services, including challenges related to finding providers, transportation and personal health or mobility limitations.
However, despite the clear differences between top- and bottom-ranking states, survey responses show that in every state, thousands -- if not millions -- of residents are struggling to get the care they need. Ranking states on cost, quality and access separately also reveals that strong performance in one area doesn’t always translate to strength across the board. Although some states perform well overall, they also reveal gaps in specific areas. Their uneven performance highlights inconsistencies that can affect residents’ ability to navigate and afford the care they need, despite strengths in other areas of the system.
Among the other findings:
- High performers minimize financial strain. Nationally, about 1 in 5 adults report that someone in their household was unable to afford a prescription in the past three months. In Mississippi, this number is 36%, three times the rate in Iowa (12%). Thirty percent of U.S. adults say a household member skipped medical treatment because of cost.
- Top states deliver more proactive care Nationwide, 71% of adults say their health care provider ensures they receive all recommended screenings and evaluations. This rate climbs to 78% in Massachusetts and Rhode Island but drops to 59% in Oregon and Wyoming. Three-quarters of U.S. adults report that their providers offer guidance on healthy lifestyle choices.
- Top-ranked states have fewer access barriers. One-quarter of U.S. adults say not knowing how to find a provider has delayed or prevented care. This number is 14% in Iowa but as high as 36% in New Mexico. Long wait times for appointments were the most commonly reported barrier nationwide, preventing or delaying health care access for 53% of Americans overall.
“This analysis shows the common struggle, that all states -- even those at the top -- have room for improvement,” the report concluded. “Yet high-performing states demonstrate ways to better deliver on their promise, offering models for others to follow.”
While the study did not include the rankings of all 50 states, and Washington D.C., the bottom 10 states include Montana (#42), Arkansas (#43), Mississippi (#44), Arizona (#45), Delaware (#46), Vermont (#47), Texas (#48), New Mexico (#49), Nevada (#50), and Alaska (#51).
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