How does your state rank for health care?

Folks living in Massachusetts, Hawaii and New Hampshire may be among the nation's healthiest, according to a new scorecard that ranks how well the health care system in each U.S. state is working.

By contrast, people in Mississippi, West Virginia and Oklahoma fare the worst when it comes to access to quality care and overall health and well-being.

Released each year by the Commonwealth Fund, a nonprofit group focused on health policy reform, the report card grades all 50 states and Washington, D.C., on 58 measures. They include access to health care, quality of care, cost, health outcomes and disparities in care. This year's report drew on 2021 data, and it also looked at the state-by-state landscape for women's health, including reproductive health, for the first time.

The report noted there was an unprecedented spike in preventable deaths across the country from 2019 to 2021, largely due to the COVID-19 pandemic.

"We saw a large increase in death early in life from preventable and treatable causes due to COVID-19 including drug overdose and alcohol-induced deaths, suicide, firearm deaths [and death from] chronic illnesses that were worsened by COVID-19 health care disruptions," said senior scientist David Radley.

Rates of preventable disease due to COVID were highest in Louisiana, Mississippi, Texas and New Mexico, surging more than 35%. Arizona's rate rose by 45%, the largest increase in preventable deaths during this period.

Black and American Indian/Alaska Native people experienced some of the highest rates of avoidable death in many states, the new report card found.

"The pandemic cut deep," Radley said during a media briefing. "The effect on the health care workforce and the ability of hospitals and health care providers to meet demand are real impacts that extend beyond daily awareness of the virus and will be felt for a long time."

Access to women's and reproductive health care was a mixed bag across states. The report card graded states on 12 measures, including access to prenatal and postpartum care and reproductive cancer screenings and other preventive services, as well as women's overall health outcomes.

Overall, women of childbearing age died at increasing rates from preventable causes, including pregnancy and childbirth as well as COVID and substance use during the pandemic.

Massachusetts, Rhode Island and New Hampshire ranked best for reproductive and women's health.

There were pronounced disparities by state in terms of access to prenatal care. In Vermont, 11% of women giving birth in 2021 didn't receive prenatal care during the first trimester. By contrast, 29% of women in Texas and Florida didn't have access to such care. Most U.S. women do receive postpartum checkup visits after birth, but there is still room for improvement.

Dr. Laurie Zephyrin is the senior vice president of advancing health equity. She said the new report card doesn't reflect the Dobbs decision by the U.S. Supreme Court that ended a nationwide right to abortion last year.

"The Dobbs [ruling] just recently happened so the data do not currently tell us the impact of the Dobbs decision," Zephyrin said.

The report also noted there is a mental health care crisis taking place in the United States, with demand for behavioral health services overwhelming supply. Sixty percent of adolescents aged 12 to 17 who had a major depressive episode could not get the treatment they needed, with a high of nearly 80% in South Carolina.

Despite historic health insurance coverage gains during the pandemic, millions of people still struggled with medical debt, especially in the South.

There's lots to do to reverse some of these troubling trends, said Sara Collins, a senior scholar and vice president.

This starts with ramping up efforts to make health care insurance more affordable and accessible for all and ensuring that those who lose coverage can quickly regain it, she said.

"Primary care physicians are essential to reducing avoidable deaths, and policymakers and stake holders can strengthen the primary care workforce by investing in training programs," Collins said.

It's also a good idea to take steps to integrate behavioral health care with primary care services, she said.

Meanwhile, Collins said increasing access to overdose prevention methods and addiction treatment can help curb the high raises of overdose deaths.

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