States have made historic progress in expanding health coverage and improving access to care over the past decade, according to the Commonwealth Fund’s 2025 Scorecard on State Health System Performance. Uninsured rates have fallen in every state since 2013, and fewer adults skip needed care because of the cost, a reflection of the Affordable Care Act’s (ACA) Medicaid expansion, subsidized marketplace coverage, and various consumer protections, such as banning insurers from excluding preexisting health conditions from coverage.
However, several proposed federal policy changes — including Medicaid funding cuts and work requirements, cuts and added red tape in the marketplaces, and the expiration of extra ACA premium subsidies enacted during the pandemic — may reverse those gains. At the same time, early childhood vaccination rates have declined in most states, and there remain significant gaps in health and health care — especially between geographic regions and between racial and ethnic groups.
The 2025 Scorecard on State Health System Performance is part of the Commonwealth Fund’s ongoing series of reports tracking how each state’s health system is working. Using data from 2023 — the most recent available — the report measures health care access, affordability, quality, outcomes, and equity in all 50 states and the District of Columbia.