Health Care Varies Significantly Among States, Study Finds

A new Commonwealth Fund study shows wide disparities in health care across states. The Chicago Tribune reports: "Even as state and federal initiatives have extended a medical safety net beneath children in recent years, more and more adult Americans have been living without insurance coverage – compounding the already-serious problems of the healthcare system and fueling sharp disparities in the cost and quality of care across the country. ... The nation doesn't have one system and one reality, it has at least 50 – each with its own economic, social and demographic characteristics."

Such disparities present a major challenge to health care reform, according to the Tribune. In addition, conditions have most likely worsened with the recent economic downturn. The study notes historic trends as well as employer and economic factors. It also notes that "states that ranked high tended to have less poverty and higher median incomes than states at the bottom." But the report also offered exceptions to these trends. "Maine, ranks 35th in median household and 28th in percentage of residents living in poverty, but fifth on the Commonwealth scorecard in part because it is one of the few states that extends Medicaid coverage to childless adults and because it requires an unusual amount of information-sharing among health care providers and health officials within the state, according to the report" (Zajac, 10/7). 

USA Today reports that Karen Davis, president of the Commonwealth Fund, said the study lists "shockingly wide variations" among the states. "Overall, Vermont ranked No. 1 and Mississippi came in last, the same position it held when the Commonwealth Fund compiled its first scorecard in 2007," USA Today found. "Hawaii, which was second this year, ranked first, ahead of Vermont, in 2007. The same 13 states made up the top quarter in both 2007 and 2009, although their specific rankings shifted. And 10 of the 13 states in the lowest quarter in 2009 also ranked at the bottom in 2007" (Rubin, 10/8).

The Dallas Morning News: "Health care in Texas ranks among the worst in the nation, dragged down by large numbers of uninsured and by the nation's most porous safety net. ... Texas ranked 46th among the 50 states and the District of Columbia – slightly better than its showing of 48th two years ago, but still far behind high-performing states in New England and the upper Midwest. Texas was ranked last in access to health care, and in equity – a measure of how minorities and low-income patients fared in the state's medical system. Texas has some of the nation's strictest (eligibility) requirements for Medicaid insurance."

The study notes how Texas compares to other states in the analysis: "In Massachusetts, for example, 92.8 percent of working-age adults had health insurance. In Texas, just 68.5 percent of working adults were insured, down from 70.4 percent in the last scorecard. More than 35 percent of low-income Texas adults said they put off seeing a doctor for a medical problem because of the cost. In Maine, it was 16 percent" (Landers, 10/8).

The Day reports on Connecticut: "Despite having a health care system ranked among the top 10 performing states, Connecticut has seen a worsening of care for nursing home and home-care patients leading to more hospitalizations, and sharp increases in health insurance premiums, according to a new national report" (Benson, 10/8).

The Denver Business Journal reports that Colorado ranks "slightly better than average among the states, giving it a high rating on healthy living but low scores on access to care and the 'equity' of its system" (Harden, 10/7).