A new national analysis offers a nuanced view of how healthcare access, affordability, treatment quality and hospital use intersect across the United States.
The “2025 Scorecard on State Health System Performance” from Commonwealth Fund evaluates all 50 states and the District of Columbia using 50 indicators spanning healthcare access and affordability, prevention and treatment, avoidable hospital use and costs, health outcomes, healthy behaviors, and equity. Most of the data reflects performance in 2023.
The findings underscore a persistent reality: Americans’ ability to access affordable healthcare, receive quality treatment, and live a healthy life still largely depends on where they live. This holds true even as uninsured rates fell to record lows in all states by 2023, proving insurance coverage is only one piece of the puzzle.
The report also highlights tradeoffs within health systems at the state level, revealing that gains in one area can coincide with setbacks in another.
Take Massachusetts, for example. It ranks first overall based on the scorecard’s 50 measures. The state leads in access and affordability and ranks second in prevention and treatment. Yet it comes in 35th for avoidable hospital use and cost. That discrepancy points to challenges in care coordination and efficiency. Massachusetts performs worst on metrics such as hospital readmissions among skilled nursing facility patients, preventable hospitalizations for adults 65 and older, and 30-day readmission rates for Medicare beneficiaries. It is one example of how even high-performing states face operational strains beneath their top-line rankings.
On the other hand, the lowest overall performers were Mississippi, Texas, Oklahoma, Arkansas, and West Virginia. Yet each of these states showed strengths in specific areas. Mississippi, for instance, ranks in the top quartile for state spending on primary care — outpacing many of its higher-ranked peers on that measure.
Below, states are listed by their overall scorecard ranking, along with a snapshot of three key dimensions: access and affordability, prevention and treatment, and avoidable hospital use and cost.
- Access and affordability measures include rates of insurance coverage for adults and children, out-of-pocket expenses for care, cost-related barriers, medical debt, and dental care utilization.
- Prevention and treatment measures capture access to preventive and mental health care, along with quality measures in ambulatory, hospital, post-acute and long-term care settings.
- Avoidable hospital use and cost measures reflect emergency department and hospital use that could be reduced with timely outpatient care, success in discharging patients from skilled nursing facilities, and spending patterns among Medicare beneficiaries and working-age adults with employer-sponsored insurance, including how much is directed toward primary care.
The complete report from Commonwealth Fund, along with individual snapshots of each state, can be found here. Here is a snapshot of how each state ranks overall and across three select dimensions, starting with the top overall performers.
1. Massachusetts
Access and affordability: 1
Prevention and treatment: 2
Avoidable hospital use and cost: 35
2. Hawaii
Access and affordability: 2
Prevention and treatment: 45
Avoidable hospital use and cost: 3
3. New Hampshire
Access and affordability: 3
Prevention and treatment: 9
Avoidable hospital use and cost: 21
4. Rhode Island
Access and affordability: 6
Prevention and treatment: 16
Avoidable hospital use and cost: 33
5. District of Columbia
Access and affordability: 4
Prevention and treatment: 1
Avoidable hospital use and cost: 16
6. New York
Access and affordability: 16
Prevention and treatment: 26
Avoidable hospital use and cost: 31
7. Maryland
Access and affordability: 17
Prevention and treatment: 4
Avoidable hospital use and cost: 12
8. Vermont
Access and affordability: 5
Prevention and treatment: 11
Avoidable hospital use and cost: 26
9. Washington
Access and affordability: 15
Prevention and treatment: 23
Avoidable hospital use and cost: 5
10. Colorado
Access and affordability: 23
Prevention and treatment: 7
Avoidable hospital use and cost: 1
11. Connecticut
Access and affordability: 9
Prevention and treatment: 5
Avoidable hospital use and cost: 48
12. Oregon
Access and affordability: 13
Prevention and treatment: 20
Avoidable hospital use and cost: 13
13. Pennsylvania
Access and affordability: 14
Prevention and treatment: 14
Avoidable hospital use and cost: 32
14. Virginia
Access and affordability: 21
Prevention and treatment: 12
Avoidable hospital use and cost: 20
15. Minnesota
Access and affordability: 7
Prevention and treatment: 18
Avoidable hospital use and cost: 9
16. New Jersey
Access and affordability: 19
Prevention and treatment: 19
Avoidable hospital use and cost: 37
17. Utah
Access and affordability: 28
Prevention and treatment: 3
Avoidable hospital use and cost: 2
18. Iowa
Access and affordability: 11
Prevention and treatment: 15
Avoidable hospital use and cost: 17
19. Idaho
Access and affordability: 30
Prevention and treatment: 34
Avoidable hospital use and cost: 8
20. California
Access and affordability: 25
Prevention and treatment: 49
Avoidable hospital use and cost: 24
21. Maine
Access and affordability: 18
Prevention and treatment: 6
Avoidable hospital use and cost: 29
22. North Dakota
Access and affordability: 8
Prevention and treatment: 30
Avoidable hospital use and cost: 15
23. Michigan
Access and affordability: 10
Prevention and treatment: 24
Avoidable hospital use and cost: 30
24. Nebraska
Access and affordability: 24
Prevention and treatment: 36
Avoidable hospital use and cost: 19
25. Delaware
Access and affordability: 27
Prevention and treatment: 22
Avoidable hospital use and cost: 28
26. Wisconsin
Access and affordability: 12
Prevention and treatment: 13
Avoidable hospital use and cost: 34
27. Illinois
Access and affordability: 20
Prevention and treatment: 31
Avoidable hospital use and cost: 43
28. Montana
Access and affordability: 31
Prevention and treatment: 39
Avoidable hospital use and cost: 7
29. North Carolina
Access and affordability: 38
Prevention and treatment: 8
Avoidable hospital use and cost: 11
30. Ohio
Access and affordability: 22
Prevention and treatment: 10
Avoidable hospital use and cost: 47
31. New Mexico
Access and affordability: 45
Prevention and treatment: 47
Avoidable hospital use and cost: 23
32. South Dakota
Access and affordability: 26
Prevention and treatment: 28
Avoidable hospital use and cost: 6
33. Kansas
Access and affordability: 35
Prevention and treatment: 25
Avoidable hospital use and cost: 38
34. Arizona
Access and affordability: 43
Prevention and treatment: 43
Avoidable hospital use and cost: 10
35. Indiana
Access and affordability: 29
Prevention and treatment: 21
Avoidable hospital use and cost: 42
36. South Carolina
Access and affordability: 39
Prevention and treatment: 27
Avoidable hospital use and cost: 14
37. Kentucky
Access and affordability: 32
Prevention and treatment: 17
Avoidable hospital use and cost: 41
38. Alaska
Access and affordability: 33
Prevention and treatment: 50
Avoidable hospital use and cost: 18
39. Florida
Access and affordability: 44
Prevention and treatment: 37
Avoidable hospital use and cost: 49
40. Wyoming
Access and affordability: 46
Prevention and treatment: 42
Avoidable hospital use and cost: 4
41. Louisiana
Access and affordability: 37
Prevention and treatment: 35
Avoidable hospital use and cost: 46
42. Alabama
Access and affordability: 40
Prevention and treatment: 32
Avoidable hospital use and cost: 25
43. Missouri
Access and affordability: 36
Prevention and treatment: 40
Avoidable hospital use and cost: 50
44. Tennessee
Access and affordability: 41
Prevention and treatment: 29
Avoidable hospital use and cost: 22
45. Georgia
Access and affordability: 47
Prevention and treatment: 38
Avoidable hospital use and cost: 39
46. Nevada
Access and affordability: 49
Prevention and treatment: 51
Avoidable hospital use and cost: 27
47. West Virginia
Access and affordability: 34
Prevention and treatment: 33
Avoidable hospital use and cost: 51
48. Arkansas
Access and affordability: 42
Prevention and treatment: 41
Avoidable hospital use and cost: 36
49. Oklahoma
Access and affordability: 48
Prevention and treatment: 46
Avoidable hospital use and cost: 44
50. Texas
Access and affordability: 51
Prevention and treatment: 44
Avoidable hospital use and cost: 45
51. Mississippi
Access and affordability: 50
Prevention and treatment: 48
Avoidable hospital use and cost: 40
