Best views, weather, etc. How to test them 👓 SC, Ala. sites look back Betty Ford honored
NEWS
Hospitals and Medical Centers

Rankings: More states improve than worsen on most health measures

Laura Ungar
USAToday

More states improved than worsened over time on most measures examined in new health rankings out Wednesday — the first since the Affordable Care Act’s coverage expansions took effect.

Former Kentucky governor Steve Beshear, D, led that state's expansion of Medicaid.

The Commonwealth Fund Scorecard on State Health System Performance looks at access to medical care, prevention and treatment of disease, avoidable hospital use and cost, healthy lives and health equity. Some of the 42 indicators on the scorecard are numbers of insured adults, people 50 and older who got recommended screenings, adults who went without care because of cost, breast cancer deaths and infant mortality.

This year’s scorecard, the fourth in a series, documents changes during 2013 and 2014 to assess the ACA’s health insurance expansions last year as well as payment reforms and incentives to reduce re-admissions to the hospital.

Physician David Blumenthal, president of The Commonwealth Fund, says he "can't with scientific precision" attribute all the gains the report found to the ACA, but says several positive trends do coincide with the implementation of the law.

Still, the report cautions, “the effects of the ACA are not yet fully reflected” in this year’s results, and “it may take many years to see the resulting changes.”

According to the scorecard:

• The top-ranked states overall are Minnesota, Vermont and Hawaii, and the bottom states are Mississippi, Oklahoma and Arkansas. There’s up to an eight-fold difference in performance between the top- and bottom-ranked states.

• Access to medical care improved from 2013 to 2014, with the percentage of uninsured working-age adults dropping in nearly every state — and by three or more points in 39 states. The percentage of adults going without care because of cost declined by two or more points in 21 states.

• While health care spending growth moderated for Medicare recipients, premiums for employer-sponsored health insurance plans kept rising.

• Louisiana, Kentucky, Oklahoma and Tennessee saw the greatest gains across health measures — improving on at least 13 indicators despite being among the bottom states overall.

For example, Kentucky ranked just 40th overall, but improved on 13 indicators and worsened on only three. The state led the nation in declines among uninsured adults, for example, and improved substantially in adults who went without care because of cost; infant mortality, and adults 50 and older who got recommended screenings and preventive care.

Kentucky expanded its Medicaid program under the ACA, although new Gov. Matt Bevin, who was inaugurated Tuesday, has pledged to scale back that expansion and dismantle the state’s online insurance-shopping site.

Louisiana, meanwhile, improved on 16 indicators, the most of any state, and worsened on three. Louisiana has not expanded Medicaid under the ACA, although the state’s governor-elect, Democrat John Bel Edwards, has announced support for adopting the expansion. The law expands Medicaid eligibility to adults with incomes at or below 138% of the federal poverty level, or $27,724 for a family of three in 2015.

Amelia Burns, press secretary in the Louisiana Department of Health and Hospitals, says her agency has focused on improving health with initiatives such as strengthening the state's Medicaid managed-care program, strengthening access to behavioral health, moving health care delivery from the state to local governing bodies, and using technology to improve health.

"One of our most notable programs is Well-Ahead Louisiana..." she says. "The program encourages making the healthy choices easier in environments where Louisiana’s residents live, work, learn and play."

Douglas McCarthy, senior research director for The Commonwealth Fund, says although Louisiana, Kentucky and other states at the bottom of the rankings have a long way to go, "they also have more to gain from improvement.”

And overall, he says, “there’s room for improvement in all states.”

More information: Visit the U.S. Health System Data Center at http://datacenter.commonwealthfund.org for interactive maps, state profiles, and comparisons of state performance.

Featured Weekly Ad