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WalletHub Ranks Best, Worst States for Healthcare

Mary Caffrey
States that ranked poorly are those with high rates of diabetes and obesity; those with high rankings have long-term commitments to getting people insured.
Southeastern states with high rates of diabetes and obesity fared poorly, while Vermont and Massachusetts—2 states that kept an individual mandate scrapped in the new tax law—ranked highly in a report that looked at how well states fare in offering healthcare.

The WalletHub 2018 Best & Worst States for Health Care measured things such as what people pay in healthcare premiums, the numbers of doctors and hospital beds per capita, and whether people with chronic disease have seen a physician in the past 2 years. To some degree, the results line up with long-term underlying health trends, but some individual measures appear to reflect state-level health policy decisions, such as whether to expand Medicaid.

The 5 best states for healthcare, in order, were Vermont, Massachusetts, New Hampshire, Minnesota, and Hawaii; the worst were North Carolina, Arkansas, Alaska, Mississippi, and Louisiana, which came in dead last despite expanding Medicaid in 2016.

By region, healthcare was best in New England and the upper Midwest; it was average in the Western and Mid-Atlantic states, and it was subpar in the Southeast.

A common connection among the low-ranking states? Setting aside Alaska, which has some unique cost and delivery challenges (it ranked in the top half of states in outcomes), states that ranked poorly have high costs and poor outcomes given what people spend. Four of the bottom 5 states are at least partly within the CDC's “diabetes belt,” with Mississippi entirely within it. North Carolina ranked next-to-last in cost and in the bottom 5 states in access, despite being home to some of the nation’s top medical schools.

The access criteria may be key to Louisiana’s poor ranking, as these items include the quality of the public hospital system, hospital beds per capita, response times for emergency medical services, emergency room wait times, presence of urgent care, retail clinics, presence of medical paraprofessionals, and transfer times. For generations, healthcare for the poor in Louisiana was delivered through a unique public charity hospital system that was dismantled under former Governor Bobby Jindal, and several emergency rooms closed. While a system of community health centers arose in New Orleans to replace Charity Hospital after Hurricane Katrina, access for the poor outside the city remains limited and underfunded.

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