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Commonwealth Fund Releases Scorecard On State Health System Performance

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A new report shows suicide, alcohol, and drug overdose deaths have reached near-crisis levels nationwide, and states are struggling to cope. 

When it comes to overall health system performance, Massachusetts, Connecticut, and Vermont are among the top-ranked states in 2019. That's according to the Commonwealth Fund's "2019 Scorecard on State Health System Performance," which assesses all 50 states and the District of Columbia on 47 measures of access to health care, quality of care, service use and costs of care, along with health outcomes, and income-based health care disparities. New York ranks 14th, Pennsylvania 21st.

Economist Sara Collins is vice president for health care coverage and access at The Commonwealth Fund. She notes the report highlights three key findings:   "First, death from suicide, alcohol and drug overdose are regional epidemics that are affecting states in dramatically different ways. Second, progress made in insurance coverage since the Affordable Care Act passed has stalled, and it's even reversing in several states.  And third, per capita spending growth in employer health plans which drive premium growth, outpaced spending and Medicare in a majority of states between 2013 and 2016."

David Radley, a senior scientist for The Commonwealth Fund's Tracking Health System Performance program, says deaths from substance abuse take the lead impacting national health.   "Drug overdose mortality is disproportionately impacting states in the eastern parts of the county and suicide and alcohol-related deaths are occurring at higher rates in the west."

According to Radley, states in the Great Lakes, New England, mid-Atlantic and Southeast regions have been particularly hard hit by the opioid crisis.  Pennsylvania is among the states with the highest death rates from drug overdoses.   "States that expanded Medicaid eligibility experienced improved access to the opioid reversal drug Naloxone."

The report found that between 2013 and 2017 in nearly all states, there were widespread reductions in uninsured rates following the Affordable Care Act’s implementation. Today, with health spending growing faster than median income, the pendulum is beginning to swing in the opposite direction.   "Some states are setting provider prices closer to those used in the Medicare program for their state employee benefits program and public plans offered in the marketplace. Ultimately, improvement will require that states and the federal government work together to co-ordinate efforts and resources to ensure that whatever progress is made is sustainable."

The report attributes the change to a lack of Medicaid expansion efforts by individual states.  New York, Massachusetts, Vermont, Connecticut and Pennsylvania all expanded Medicaid.

Here are the overall health system performance rankings for each state:

1. Hawaii

2. Massachusetts

3. Minnesota

4. Washington

5. Connecticut

5. Vermont

7. Rhode Island

8. Iowa

9. Colorado

10. New Hampshire

11. Utah

12. Maine

12. Wisconsin

14. California

14. New York

16. North Dakota

17. Oregon

18. Idaho

18. Maryland

20. New Jersey

21. Pennsylvania

22. Nebraska

23. District of Columbia

23. South Dakota

25. Michigan

26. Montana

27. Delaware

28. Illinois

29. Virginia

30. Alaska

30. Kansas

32. Arizona

33. Ohio

34. North Carolina

35. New Mexico

36. Indiana

37. Wyoming

38. Alabama

38. Tennessee

40. Kentucky

41. South Carolina

42. Georgia

43. Missouri

44. Florida

45. Louisiana

45. West Virginia

47. Arkansas

48. Nevada

49. Texas

50. Oklahoma

51. Mississippi

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