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A new report by the Commonwealth Fund has revealed the states with the best and worst health care systems, based on 50 different measures.

Massachusetts, Hawaii, New Hampshire and Rhode Island were at the top of the leader board for having the best health care systems in the country, meanwhile, Mississippi was ranked the state with the worst health care system.

Why It Matters

Access and affordability of health care is a pressing problem in the U.S.—with many Americans struggling to cover expensive costs, while finding it difficult to get medical help.

Key factors affecting how well each state ranked included whether they had expanded Medicaid eligibility under the Affordable Care Act (ACA)—with states that had not done so being among the worst performing.

President Donald Trump’s “Big Beautiful Bill” did not include mention of renewing enhanced ACA tax credits, which are set to expire this year, while proposing major cuts to the Medicaid health program and new requirements for eligibility.

Many critics of the tax bill have warned of its impact on health outcomes, while a report recently found that the ACA’s Medicaid expansion significantly reduced mortality among adults with low incomes, saving an estimated 27,000 lives, according to the Commonwealth Fund.

What To Know

“When it comes to having affordable health coverage, access to good-quality care, and the ability to lead a healthy life, where you live matters,” the Commonwealth Fund report said.

For example, premature, avoidable deaths varied widely across states—in West Virginia, the rate was more than twice as high as the rate in Massachusetts.

The rankings were obtained based on 50 measures of health care access and affordability, prevention and treatment, avoidable hospital use and costs, health outcomes and healthy behaviors, income disparity, and equity.

The overall rankings were as follows:

Massachusetts Hawaii New Hampshire Rhode Island District of Columbia New York Maryland Vermont Washington Colorado Connecticut Oregon Pennsylvania Virginia Minnesota New Jersey Utah Iowa Idaho California Maine North Dakota Michigan Nebraska Delaware Wisconsin Illinois Montana North Carolina Ohio New Mexico South Dakota Kansas Arizona Indiana South Carolina Kentucky Alaska Florida Wyoming Louisiana Alabama Missouri Tennessee Georgia Nevada West Virginia Arkansas Oklahoma Texas Mississippi

Explaining the reasons states like Massachusetts and Rhode Island performed so well in the rankings, Vivian Ho, chair in health economics at Rice University, Texas, told Newsweek that these states expanded Medicaid under the ACA.

This “contributed to improved affordability of health care and health insurance,” she said.

She added that Massachusetts and Rhode Island have been “particularly proactive in monitoring and controlling the costs of hospital care, which is the most significant component of rising costs.”

“These states also aggressively support their state public health systems, which leads to better prevention of debilitating diseases,” she said.

Arkansas, West Virginia and Mississippi are in the highest Federal Medical Assistance Percentage category under Medicaid, according to KFF data, indicating that “household income is the lowest in the country,” Ho said.

“Therefore, a larger portion of their populations need financial assistance to access healthcare which they are too poor to afford,” she added.

However, even top ranking states did not do well across every measure, the Commonwealth Fund report noted.

In the case of Massachusetts, while it was ranked the best state for health care, it ranked near the bottom on several measures of care for elderly patients—such as preventable hospitalizations and hospital readmissions.

The reverse can be said about Mississippi, as while it ranked the lowest overall, it came in the top quartile of state spending on primary care.

The report also noted that the disparity in the quality of health care overall varied in states because of policy choices made by state leaders, such as whether to expand Medicaid eligibility, whether to ensure women can access the full range of reproductive care services, or whether to boost investment in primary care.

The report also revealed wider issues in the country—that avoidable mortality rates are higher in America than in other high-income countries, and rather than declining, the rates are increasing.

Ho said that some of the reasons for this could be because the “opioid crisis is unique to America; vaccine misinformation seems more widespread in this country; and our lack of health insurance is unique among developed countries.”

There is also a significant racial disparity—as in 42 states avoidable mortality for Black people was found to be at least two times the rate for the group with the lowest rate.

The Intensive Care unit at a California hospital is seen in this file photo. The Intensive Care unit at a California hospital is seen in this file photo. Damian Dovarganes/AP

What People Are Saying

Vivian Ho, chair in health economics at Rice University, Texas, told Newsweek: “The American public doesn’t understand that consolidated healthcare systems are charging prices that earn them extraordinary profits, which raises the costs of employer-provided health insurance. That’s why so many Americans have to rely on Obamacare or Medicaid for health insurance, or go without coverage at all. Shopping for healthcare has become extremely complicated, and I blame employers for not being more aggressive in designing benefits for their workers that exercise better price sensitivity.”

Nicole Maestas, a professor of economics and health care policy and chair in the Department of Health Care Policy at Harvard Medical School, told Newsweek: “I think policy choices are the main explanation for the differences across states, and Medicaid policy is probably the most important policy choice, though not the only choice. States that chose to expand Medicaid under the ACA have had access to federal funds that enabled them to drive improvements in access, affordability, and health. The trends in avoidable mortality are worrying, and merit policy attention so that the U.S. doesn’t lose further ground.”

What Happens Next

As the report highlighted the major impact policymakers can have on the health care services in states, Trump’s new bill proposing major changes to health programs could see the provision and access to care in states begin to change in coming months.