States made little progress in improving healthcare access, quality and outcomes and lowering costs in 2007-12, the five years preceding implementation of the major coverage provisions of the Affordable Care Act, according to the Commonwealth Funds third state health system scorecard.
The majority of states declined or failed to improve on two-thirds of the 34 scorecard indicators that could be tracked over time.
Wide gaps among states persisted since the last scorecard, with top states sometimes performing two to eight times better than the lowest-performing states. For example, the rates of elderly receiving high-risk medications, children hospitalized for asthma, Medicare hospital readmissions and potentially preventable deaths before age 75 were more than twice as high in states near the bottom of the scorecard compared with states that had the best performance.
The report, Aiming Higher: Results from a Scorecard on State Health System Performance, 2014, ranks the health systems of every state and Washington, D.C., based on 42 healthcare measures, 34 of which were used to reveal trends between 2007 and 2011-12. All states made meaningful improvement on at least seven of the 34 trend measures. However, more than half of states lost ground on at least nine indicators.
Indicators for which performance improved in a majority of states were often the targets of concerted federal and state efforts. Gains in safe prescribing for the elderly, reductions in avoidable hospital admissions and readmissions, higher childhood vaccination rates and fewer cancer-related deaths chiefly resulted from initiatives at both the national and state levels, including investment to promote better health outcomes, according to the report.
For example, Vermont has been a national leader in guaranteeing access to care and investing in primary care. In states such as Vermont, Massachusetts, Minnesota and New Hampshire, between 5% and 17% of working-age adults were uninsured in 2011-12.
In contrast, the states at the bottom of the scorecard Mississippi, Arkansas, Oklahoma and Louisiana had adult uninsured rates between 22% and 28% in 2011-12.
This state scorecard underscores the importance of national and state actions to ensure that no matter where a person lives, they have access to an affordable, high-quality health system, Cathy Schoen, a Commonwealth Fund vice president, said in a news release. In the five years before the Affordable Care Acts major insurance expansions, access to healthcare declined and, too often, states declined or failed to improve, with only pockets of progress.
Leading states raised the bar on some measures, and most states improved on key areas for the elderly. But the overall pace of change was slow and less than we should expect given how much we pay for healthcare.
Coverage and access
According to the scorecard, in the five years before full ACA implementation, uninsured rates for adults grew and healthcare became less affordable.
In 2011-12, the uninsured rate for working-age adults ranged from a low of 5% in Massachusetts to 25% or more in Arkansas, California, Florida, Georgia, Louisiana, Montana, Nevada, New Mexico, Oklahoma and Texas.
Between 2007-08 and 2011-12 the uninsured rate for working-age adults rose from 19% to 21% nationally, increasing in 20 states.
The percentage of adults going without healthcare because of costs increased in 42 states over the five years that included the Great Recession. By 2012, it ranged from a low of 9% in Hawaii, Massachusetts and North Dakota to highs of 21% to 22% in Arkansas, Florida, Mississippi, South Carolina and Texas.
And 16% of individuals under age 65 came from homes with high medical costs relative to their household incomes in 2011, ranging from 10% in Minnesota and D.C.to 22% in Idaho and Utah.
In the United States, where you live has long determined the kind of healthcare you receive, and it shouldnt, Commonwealth Fund President David Blumenthal, MD, said in the news release. The Affordable Care Act has the potential to level the playing field, as all states have the opportunity to make substantial improvements to their healthcare systems if they take full advantage of the law, including Medicaid expansion.
Substantial benefits would take place across the country if all states elevated their performance and reached the benchmarks set by the leading states, according to the report.
For example, if all states could do as well as the top-performing states, more than 35 million children and adults would gain health insurance; an additional 10 million older adults would receive preventive care; more than 1 million fewer Medicare enrollees would be exposed to an unsafe prescription drug; and 84,000 fewer people would die prematurely each year from conditions that could have been prevented with timely and effective care.
The authors note that while improvements among low-performing states would have some of the most substantial effects, all states have room for improvement, given that none scored near the top on all 42 measures.