New State Health System Scorecard Reveals Unprecedented Spike in Preventable Deaths, Unaddressed Mental Health Needs, and Millions Mired in Medical Debt Across States

Scorecard Includes First-Ever Rankings for Reproductive Care and Women’s Health; Bleak Picture in Many States

from Commonwealth Fund, June 22, 2023 

States across the country are grappling with a widespread surge in preventable deaths and unaddressed mental health needs — particularly in adolescents — according to the Commonwealth Fund’s 2023 Scorecard on State Health System Performance.

All states experienced large increases in avoidable deaths from 2019 to 2021, due mostly to the COVID-19 pandemic. Several states, however, stood out: Rates in Louisiana, Mississippi, Texas, and New Mexico surged more than 35 percent, while Arizona’s rate rose by 45 percent, the largest increase. Black and American Indian/Alaska Native people, two of the groups most affected by COVID-19, experienced some of the highest rates of avoidable mortality in many states.

For the first time, the scorecard, which annually ranks states’ health care systems based on how well they provide high-quality, accessible, and equitable health care, also includes measures to evaluate their performance on reproductive care and women’s health. The 12 measures assess prenatal and postpartum care access, reproductive cancer screenings and other preventive services, and women’s overall health outcomes and mortality rates.

During the pandemic, women of reproductive age died at increasing rates from preventable causes, including pregnancy and childbirth as well as COVID-19 and substance use.

Drawing from 2021 data — the most recent available — the scorecard examined other health issues that states are confronting. Highlights from these findings include:

• The five top-ranked states for overall health system performance were Massachusetts, Hawaii, New Hampshire, Rhode Island, and Vermont. Arkansas, Texas, Oklahoma, West Virginia, and Mississippi were the lowest-ranked states.

• Many women struggle to get needed health care, and states varied significantly in their performance on reproductive care and women’s health. For example, in Vermont, only 11 percent of women giving birth in 2021 did not receive prenatal care during the first trimester, compared to 29 percent in Texas and Florida. Deaths from all causes per 100,000 women of reproductive age ranged from 78.9 in Hawaii to 238.6 in West Virginia.

• Rates of medical debt are especially high in the South; in West Virginia, nearly one-quarter of residents are struggling to pay off medical debt. Despite historic coverage gains during the pandemic, millions of people, both uninsured and insured, are struggling to pay off debt related to medical bills.

• Adolescents and adults with mental health needs cannot get the care they need. Nationally, 60 percent of adolescents ages 12 to 17 who had a major depressive episode could not get the treatment they needed, with a high of nearly 80 percent in South Carolina. The Commonwealth Fund’s 2023 Scorecard on State Health System Performance allows users to explore key findings, access data on individual states and topics, and view customized tables, graphs, and maps. IMPLICATIONS The study authors point to several policy strategies for improving health system performance, among them:

• Reducing the number of deaths from preventable causes. Policymakers can lower insurance and administrative barriers for addiction treatment, as well as boost investment in good primary care — the foundation for a high-performing health care system — by expanding the primary care workforce and fully integrating behavioral health care with primary and pediatric care services.

• Continuing to make coverage more affordable and care more accessible. Congress can close the Medicaid coverage gap by creating a federal insurance option for people with low income in states that have not expanded Medicaid eligibility. It also can make the American Rescue Plan Act’s marketplace premium subsidy enhancements permanent and allow longer continuous Medicaid eligibility.

• Strengthening reproductive and women’s health care. Steps include: extending postpartum coverage in Medicaid to 12 months; supporting policies that advance reproductive care at all stages, from family planning, abortion services, and maternity care to postpartum and well-woman care; funding community-based organizations that improve maternal health outcomes and racial equity; and growing and diversifying the maternal health workforce.

HOW WE CONDUCTED THIS STUDY

The Commonwealth Fund’s 2023 Scorecard on State Health System Performance evaluates 58 health care indicators as well as income- and race- and ethnicitybased differences in performance within states. Findings are based on the authors’ analysis of the most recent publicly available data from federal agencies including the U.S. Census Bureau, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services, as well as other data sources. For more detail, see “Scorecard Methods” in the report.

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Link: Full Report

PDF: Hawaii Statistics

SA: Hawaii, along with Texas, Florida, Arkansas and New Mexico, is among the worst states in terms of women receiving early prenatal care. About 28% of women in Hawaii did not initiate prenatal care within the first trimester of their pregnancy.