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New State Health Care Scorecard Finds Surge in ‘Deaths of Despair’; Premature Deaths Also on the Rise

Despite Progress in Overall Health System Performance, States Lose Ground on Key Measures Affecting Life Expectancy


  This scorecard shows us that all states have the opportunity to improve, including those at the top. Moving forward, we should continue to evaluate states’ progress and support effective policies that are making it easier for people to get and afford the health care they need. David Blumenthal, M.D. Commonwealth Fund President

David Blumenthal, M.D.
Commonwealth Fund President


The authors note that some lower-ranked states still perform better on certain indicators and that all states can learn from each other. They calculate that if every state achieved top rates of health system performance: 18 million more children and adults would have health insurance; 14 million more would be able to see a doctor when needed; and 89,000 fewer premature deaths from medically preventable causes would occur.

The gains in access to care brought about by Medicaid expansion and the ACA’s insurance marketplace subsidies highlight the role the federal government can play in helping to equalize opportunity across and within states. However, recent gains in access to care may be challenged by the repeal of the ACA’s individual mandate penalties and regulatory changes to state insurance markets currently under way. Additional challenges include high health care costs and eroding affordability for consumers.

Insurance coverage is a necessary but not sufficient condition for improving health care and outcomes. Reversing the disconcerting rise in mortality rates, the authors say, will require tighter integration of services across sectors, as well as better coordination of federal and state efforts to rein in opioid abuse.

With states assuming greater responsibility for the direction of health policy, it will be more important than ever, they say, to continue tracking the performance of state health systems.

2018 Scorecard on State Health System Performance Teleconference

Additional Pertinent Research

Health System Scorecards

Publication Details

Publication Date: May 3, 2018
Contact: Mary Mahon, Vice President, Public Information, Communications, The Commonwealth Fund