2017’s Best & Worst States for Health Care
1:57 AMPosted by: Richie Bernardo
More Americans have access to health care today, but cost and service quality can vary widely from state to state. The overall health of the population, more advanced medical equipment and a general lack of awareness regarding the best types of treatment, for instance, can all drive up costs. Today, the average American spends nearly $10,000 per year on personal health care, according to the most recent estimates from the Centers for Medicare & Medicaid Services, and that figure is expected to increase over time.
But higher costs don’t necessarily translate to better results. In its latest analysis of global health care quality, the Kaiser Family Foundation reported that the U.S. remains outperformed by several other wealthy nations on several measures, such as health coverage, life expectancy and disease burden, which measures longevity and quality of life. However, the U.S. has progressed in others, particularly “its ability to promote health and provide high-quality care, with some recent improvement in the accessibility of that care and a slowing of spending growth.”
To determine where Americans receive the best and worst health care in the U.S., WalletHub’s analysts compared the 50 states and the District of Columbia across 35 measures of cost, accessibility and outcome. Read on for our findings, expert insight on the future of American health care and a full description of our methodology.
Main FindingsEmbed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/23457/geochart-healthcare-access.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="http://ift.tt/2vGbVeL;
|
Overall Rank |
State |
Total Score |
‘Health Care Costs’ Rank |
‘Health Care Access’ Rank |
‘Health Outcomes’ Rank |
|---|---|---|---|---|---|
| 47 | Arkansas | 46.20 | 19 | 35 | 48 |
| 48 | Nevada | 45.86 | 41 | 45 | 39 |
| 49 | Mississippi | 43.98 | 32 | 28 | 50 |
| 50 | Louisiana | 42.05 | 37 | 34 | 51 |
| 51 | Alaska | 39.56 | 51 | 23 | 27 |
Ask the Experts
As Americans anticipate changes to their health care in both the short and long terms, we asked a panel of experts to weigh in with their thoughts on the following key questions:
- Major insurers, including Blue Cross, Aetna and Humana, have pulled out of many state-run insurance exchanges, leaving residents of some counties with few, if any, options for coverage. What does this signal about the future of the Affordable Care Act?
- If enacted, how would the health care reform proposals offered by congressional Republicans reshape state health care systems? How might it impact businesses and the provision of employer-sponsored plans?
- What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage?
- What are the most important steps Americans can take to minimize health-related expenditures?
- What are the most important metrics for evaluating state health care systems?
John E McDonough Professor of Practice in the Department of Health Policy & Management, and Director of the Center for Executive & Continuing Professional Education at Harvard T. H. Chan School of Public Health
David I. Kass Clinical Professor of Finance and Senior Fellow in the Center for Financial Policy at the University of Maryland, Robert H. Smith School of Business
Samuel Lingrosso Adjunct Associate Professor of Political Science at Los Angeles Valley College
Major insurers including Blue Cross, Aetna and Humana have recently announced they will no longer be offering plans in many state exchanges. What does this signal about the future of the ACA? Blue Cross plans are state plans, and BCBS is not pulling out of the exchanges in a significant way -- some such as the BC plan in Florida are doing quite well in the Exchanges. Aetna/Humana/United are national plans without much prior experience before 2014 in the non-group/individual health insurance market. Their relationships and negotiating influence with local provider systems is actually much more limited than the local and state players. Their withdrawals are certainly not good for the overall state of the marketplaces, though not as dire as long-time ACA critics suggest. Many of the critics have been predicting the crash of the ACA since the law was signed in 2010 and regularly use every bit of bad or confusing news to declare the ACA sky falling in. Numerous tweaks and changes to the law would, in fact, bolster the stability and competition in the marketplaces -- though the ACA's opponents want none of these because they are invested in the law's failure, not its success. Also, the notion of a "marketplace" is competition, which always results in winner and losers. The fact that some insurers are unable to succeed in a brand new and active marketplace is what should be expected with such a degree of competition. What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage?
- Seek out advice from knowledgeable enrollment assisters.
- Make sure you are fully aware of your eligibility for premium subsidies and, potentially based on household income, for cost sharing protections.
- If you are eligible for financial support, remember that the "silver" plan is the benchmark for you.
- Don't just look at premium costs -- also take into account a plan's cost sharing requirements such as co-pays, deductibles, and coinsurance. Your reaction to these will, in significant part, depend upon your own current health status and medical needs.
- If you are committed to a physician, hospital, or other medical provider and want to maintain that relationship, make sure that your preferred provider is included in a potential plan's provider network. And ask your provider -- don't just take the insurance company's response to the bank.
Major insurers including Blue Cross, Aetna and Humana have recently announced they will no longer be offering plans in many state exchanges. What does this signal about the future of the ACA? As major insurers no longer offer plans in many state exchanges, the future of ACA is more precarious as a result of less competition. What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage? For each person, the right balance between the cost of premium and level of coverage depends on how risk averse he/she is and how much he/she can afford. What are the most important steps Americans can take to minimize health related expenditures? The most important steps Americans can take to minimize health care expenditures are primarily related to lifestyle -- diet, exercise, proper amount of sleep, and regular check-ups with their physicians. Samuel Lingrosso Adjunct Associate Professor of Political Science at Los Angeles Valley College 
Major insurers including Blue Cross, Aetna and Humana have recently announced they will no longer be offering plans in many state exchanges. What does this signal about the future of the ACA? The ACA as it was conceived in 2010, relies upon the compelled participation of healthy individuals in the health insurance market. The problem is that healthy individuals do not see a value in purchasing insurance that covers them for presently nonexistent health problems. This rational choice view of the system is preventing the revenue stream of healthy people from offsetting the high overhead of the sick and elderly who are eager for lower cost coverage. The exit of many major insurance providers is a signal that the system is not adequately incentivizing healthy people into the market, and placing the future of the ACA in jeopardy. What tips do you have for a person looking to find the right balance between the cost of premium and level of coverage? The future of the ACA depends on the participation of healthy policy owners. So the easy answer is to make the penalties of not participating higher, so that participating makes more financial sense, this the ‘stick” incentive. Additionally, allowing for “value added features” to policies would be the “carrot” incentive for healthy people to see a value in an otherwise low value product. If a healthy person’s gym membership, vitamin supplements, or even equipment such as running shoes could be covered as a preventative care benefit, it might get more healthy people to participate sooner which would help make financial sense for the insurers to spread the risk to the greater population in the individuals states. In short, make the penalty higher for not having insurance, and make the insurers cover more preventative costs. What are the most important steps Americans can take to minimize health related expenditures? The NAHU article presents many leading causes for the rising healthcare costs and the aging population, pharmaceutical costs, new technologies and lifestyle are listed in the top 5. Americans can directly impact these costs by paying more attention to our sedentary lifestyles and poor diet (myself included). If we move ourselves from the sick column to the healthy column, it reduces the strain on the entire system, for a longer period of time, and reduces our out of pocket expenses used on healthcare related costs. What measures can state and local authorities undertake in order to improve local healthcare systems? State and local authorities should focus on fine tuning the regulations that cause unneeded overhead and cost in the administrative structure. Arthur Okun refers to the “leaky bucket model” of policy and process where for each dollar spent on programs like healthcare, the amount spent on administrative costs is a leak in the bucket, meaning it is less money that is dedicated to addressing healthcare needs. Healthcare is an information asymmetry problem between provider and purchaser, and the government’s main focus should be to bridge that gap. Government should be improving the exchange websites to provide the most efficient, organized and clearly worded information possible. For instance, when this program first began, I was pointing my students to Health Sherpa because it was doing a better job at servicing potential insureds than the state exchange sites. Who has the best plan for improving the American healthcare system: Hillary Clinton or Donald Trump? This, in my opinion, is a false choice. Candidates for president have too many competing interests to offer any real viability in a program as extensive and complicated as “nationalized” healthcare. The problem to solve, in my opinion, is how to balance the innovative engine that generates the highest quality of healthcare, which depends upon the promise of profit, with the demand of access to these high quality medications, procedures and technologies; while at the same time keeping the costs affordable to all, regardless of the ability to pay. The answer is: healthy people need to help pay for the system. The argument that is commonly heard from the conservative voice is “I shouldn’t have to pay for a service I don’t need.” However, it’s not that they are being asked to pay for services they don’t need, its helping to pay to keep a system running so it is there for them when they do need it. For instance, I don’t particularly need the fire department at the moment, but I am willing to pay taxes to ensure that they are there for me when I need them in the future, regardless of who they might happen to be helping in the meantime. What are the most important metrics for evaluating state healthcare systems? I would measure a healthy healthcare system by how many healthy people are participating in the exchanges in each state. If only the sick people are in the pool, the risk cannot be spread wide enough for insurance companies to make a profit and they will therefore exit the individual state market, leaving the poor to fend for themselves, while the persons of means pay cash for medical services.
Methodology
In order to determine the best and worst states for health care, WalletHub’s analysts compared the 50 states and the District of Columbia across three key dimensions: 1) Cost, 2) Access and 3) Outcomes.
We evaluated those dimensions using 35 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the best health care at the most reasonable cost.
Finally, we determined each state and the District’s weighted average across all metrics to calculate its total score and used the resulting scores to rank-order our sample.
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