'The two Americas': The states with the biggest—and smallest—coverage gaps

State health care quality levels affect residents at all income levels

New rankings from the Commonwealth Fund suggest that healthy residents of states with limited access to providers and poor quality fared worse than poor residents in states with the best access and quality.

The report found wide gaps in health care quality and access among U.S. states that affect residents at all income levels, but researchers predict that the Affordable Care Act (ACA) will bridge those gaps by focusing on preventive health and expanding coverage for low-income residents.

For the report, researchers assessed the health care quality and access of residents in all 50 states and the District of Columbia by examining 30 data points, including uninsured rates, avoidable ED visits per year, infant mortality, and number of preventive care services provided.

'Health care in the two Americas'

Overall, the report found that there often are "two Americas when it comes to health care—divided by geography and income." There were wide state differences in health care access and quality for low-income residents. However, there was significantly less variation in access and quality for residents with higher incomes.

Researchers found that the states with the best health care access and quality for low-income residents were:

1. Hawaii;
2. Wisconsin;
3. Vermont;
4. Minnesota; and
5. Massachusetts.

Meanwhile, the states with the poorest health care access and quality for low-income residents were:

1. Mississippi;
2. Oklahoma;
3. Louisiana;
4. Alabama; and
5. Arkansas.

State access, quality gaps affect residents at all income levels

For the report, researchers compared health care access for families of four earning less than $47,000 a year—about 39% of the U.S. population—and families of four making more than $94,000 a year. They found that low-income families living in states with high health care quality and access are better off than wealthier families in states with poor health care quality and access.

"This shows that in the United States high income is not a guarantee of good health and low income does not condemn you to worse health," Commonwealth President David Blumenthal said.

The researchers concluded that, if every U.S. resident received the health care that wealthy residents do in states with high health care access and quality, there would be an estimated 86,000 fewer premature deaths, and 33,000 more infants would live at least one year.

Lead author Cathy Schoen said she hopes that the report will provide states with benchmarks that can help them track their health care progress in the future (Schoen et al., Commonwealth Fund report, 9/18; Leonard, U.S. News & World Report, 9/18).

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