States Ranked by Health Care Outcomes
All 50 states scored on the Commonwealth Fund's 2025 State Scorecard, CDC life expectancy, and Census uninsured rates.
How this ranking works
This ranking blends three named measures into one composite. The anchor is the Commonwealth Fund's 2025 Scorecard on State Health System Performance, which grades all 50 states and the District of Columbia on 50 indicators across access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and equity, using data that generally reflect 2023 (Commonwealth Fund, 2025). The second input is life expectancy at birth from CDC National Center for Health Statistics mortality data. The third is the uninsured rate from the Census Bureau's American Community Survey (Census ACS, 2023). The District of Columbia is excluded because this is a ranking of states, so its presence in the Commonwealth Fund order is subtracted out.
The composite score runs 0 to 100 and is ordinal and analytical: no single official government ranking of state health systems exists, so positions here should be read as an ordering built from the named sources, with the Commonwealth Fund rank weighted most heavily and life expectancy and coverage used to break ties and confirm direction. Where a state's position comes directly from the Commonwealth Fund, that is attributed in the entry. Each of the top 15 states carries subscores, oriented so a fuller meter always means better: coverage, healthy lives measured by life expectancy, avoidable death inverted so fewer deaths reads higher, access and affordability, and avoidable hospital use and cost inverted the same way.
The framework pays no attention to party control, health policy rhetoric, or hospital marketing. It measures whether residents are insured, whether they can afford care, and how long they live. What is deliberately ignored: hospital prestige rankings, physician-per-capita counts, and any input measure that does not show up in outcomes. The same ruler is laid across every state. If that ordering produces discomfort for any region or any party, the discomfort belongs to the reader, not the data.
1MassachusettsNortheast, first ACA-style coverage state (2006)100.0
Ranked first overall on the Commonwealth Fund's 2025 Scorecard, first for affordability and access, with the nation's highest insurance coverage, highest childhood vaccination rates, lowest infant mortality, and fewest premature avoidable deaths (Commonwealth Fund, 2025; Mass.gov, 2025). Its uninsured rate, about 2.4 percent, is the lowest of any state (Census ACS, 2023).
The receipts: Massachusetts topped the 2025 Commonwealth Fund Scorecard and ranked first for health care affordability and access, the state that built the individual-mandate model the Affordable Care Act later copied nationally (Mass.gov, 2025). Its uninsured rate of about 2.4 percent is the lowest recorded for any state, and it posts the nation's lowest infant mortality and among its fewest avoidable premature deaths (Commonwealth Fund, 2025; Census ACS, 2023).
2HawaiiPacific97.9
Second overall in the 2025 Commonwealth Fund Scorecard, top five in access and affordability and in avoidable hospital use and cost (Commonwealth Fund, 2025; Hawaii Department of Health, 2025). Its life expectancy of roughly 81 years is the highest of any state (CDC NCHS, 2023).
The receipts: Hawaii ranked second overall on the 2025 Scorecard and posts the highest life expectancy of any state at about 81.1 years (Commonwealth Fund, 2025; CDC NCHS, 2023). Its 1974 Prepaid Health Care Act, which requires most employers to cover workers, helped hold its uninsured rate well below the national average for decades (Hawaii Department of Health, 2025).
3New HampshireNortheast96.4
Third overall among states on the Commonwealth Fund's 2025 Scorecard, with strong access and low avoidable mortality (Commonwealth Fund, 2025).
The receipts: New Hampshire placed third among states on the 2025 Scorecard, part of a New England tier that swept the top of the table (Commonwealth Fund, 2025). It pairs above-average life expectancy with one of the lower uninsured rates in the country following its 2014 Medicaid expansion (Census ACS, 2023).
4Rhode IslandNortheast95.6
Fourth among states in the 2025 Commonwealth Fund rankings, part of a top tier dominated by New England (Commonwealth Fund, 2025).
The receipts: Rhode Island ranked fourth among states on the 2025 Scorecard, scoring strongly on access and affordability after an early and aggressive marketplace and Medicaid expansion (Commonwealth Fund, 2025). Its uninsured rate sits well below the national average (Census ACS, 2023).
5VermontNortheast94.1
A perennial top-tier state on the Commonwealth Fund Scorecard, and a top-ranked state on the Fund's separate 2025 Medicare beneficiary scorecard (Commonwealth Fund, 2025).
The receipts: Vermont is a perennial top-tier Scorecard state and ranked among the best on the Commonwealth Fund's separate 2025 State Scorecard on Medicare Beneficiary Experiences (Commonwealth Fund, 2025). Its uninsured rate is among the lowest in the nation, the product of one of the earliest state coverage-expansion efforts (Census ACS, 2023).
6ConnecticutNortheast93.0
Consistently in the Commonwealth Fund's top ten, with life expectancy well above the national average of 78.4 years (Commonwealth Fund; CDC NCHS, 2023).
The receipts: Connecticut sits consistently in the Commonwealth Fund's top ten and posts life expectancy near 79 years, comfortably above the 78.4-year national figure (Commonwealth Fund, 2025; CDC NCHS, 2023). Its uninsured rate runs below the national average after an early Access Health CT marketplace and Medicaid expansion (Census ACS, 2023).
7MinnesotaMidwest92.2
A long-running top-ten Commonwealth Fund performer and a top-three state on the Fund's 2025 Medicare beneficiary scorecard (Commonwealth Fund, 2025).
The receipts: Minnesota is a long-running top-ten Scorecard performer and ranked among the top three on the Commonwealth Fund's 2025 Medicare Beneficiary Experiences scorecard (Commonwealth Fund, 2025). It combines a low uninsured rate with life expectancy well above the national average, the strongest health profile in the Midwest (CDC NCHS, 2023; Census ACS, 2023).
8New YorkNortheast90.8
Life expectancy of roughly 81 years, third highest in the nation, and coverage rates well above the national average following aggressive Medicaid and marketplace enrollment (CDC NCHS, 2023; Census ACS, 2023).
The receipts: New York posts life expectancy of about 81.0 years, third highest of any state, and holds coverage well above the national average after aggressive Medicaid and marketplace enrollment (CDC NCHS, 2023; Census ACS, 2023). Its Essential Plan basic health program covers more than a million lower-income residents outside standard Medicaid (Commonwealth Fund, 2025).
9New JerseyNortheast90.1
Life expectancy of about 81 years, second highest of any state (CDC NCHS, 2023).
The receipts: New Jersey posts life expectancy of about 81.1 years, second highest of any state and nearly tied with Hawaii (CDC NCHS, 2023). It pairs that longevity with a below-average uninsured rate after expanding Medicaid and running its own marketplace, Get Covered NJ (Census ACS, 2023).
10WashingtonPacific Northwest89.3
A consistent upper-tier Commonwealth Fund state with above-average life expectancy and below-average uninsured rates (Commonwealth Fund; Census ACS, 2023).
The receipts: Washington is a consistent upper-tier Scorecard state with above-average life expectancy and a below-average uninsured rate after an early Medicaid expansion and the Washington Healthplanfinder marketplace (Commonwealth Fund, 2025; Census ACS, 2023). It ranks among the better states for avoidable hospital use (Commonwealth Fund, 2025).
11ColoradoMountain West88.4
Among the nation's lowest rates of premature death and obesity, with life expectancy above the national average (CDC NCHS; Commonwealth Fund).
The receipts: Colorado records among the nation's lowest rates of obesity and premature death and posts life expectancy above the national average (CDC NCHS, 2023). It combines that with a below-average uninsured rate after expanding Medicaid and running Connect for Health Colorado (Census ACS, 2023; Commonwealth Fund, 2025).
12MaineNortheast87.2
The oldest state by median age still posts above-average coverage and access, a harder feat than it sounds (Census ACS, 2023; Commonwealth Fund).
The receipts: Maine, the oldest state by median age, still posts above-average coverage and access, which is harder for an older population that uses more care (Census ACS, 2023; Commonwealth Fund, 2025). Its uninsured rate fell after voters expanded Medicaid by ballot initiative in 2017 (Commonwealth Fund, 2025).
13MarylandSouth Atlantic86.5
Above-average coverage and access, supported by the nation's only all-payer hospital rate-setting system (Census ACS, 2023; Commonwealth Fund).
The receipts: Maryland runs the nation's only all-payer hospital rate-setting system, which sets uniform hospital prices across payers and is credited with restraining avoidable hospital cost growth (Commonwealth Fund, 2025). It posts above-average coverage and access with a below-average uninsured rate (Census ACS, 2023).
14CaliforniaPacific85.9
Life expectancy among the highest in the nation and an uninsured rate below the national average after the largest Medicaid expansion in the country (CDC NCHS, 2023; Census ACS, 2023).
The receipts: California posts life expectancy among the highest in the nation and a below-average uninsured rate after mounting the largest Medicaid expansion in the country through Medi-Cal (CDC NCHS, 2023; Census ACS, 2023). Covered California, its state marketplace, is among the largest in the nation (Commonwealth Fund, 2025).
15UtahMountain West85.2
Among the nation's lowest rates of smoking and premature death, and a top-three state on the Commonwealth Fund's 2025 Medicare beneficiary scorecard (CDC; Commonwealth Fund, 2025).
The receipts: Utah records among the nation's lowest smoking rates and lowest rates of premature death, driving strong healthy-lives scores (CDC NCHS, 2023). It ranked among the top three on the Commonwealth Fund's 2025 Medicare Beneficiary Experiences scorecard, showing more than one route into the upper tier (Commonwealth Fund, 2025).
16OregonPacific Northwest84.4
Ranked 12th on the Commonwealth Fund's 2025 Scorecard including the District of Columbia, with a below-average uninsured rate after an early Medicaid expansion (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Oregon ranked 12th on the 2025 Scorecard when the District of Columbia is included, holding a below-average uninsured rate after one of the earliest Medicaid expansions and the Oregon Health Plan (Commonwealth Fund, 2025; Census ACS, 2023). Its life expectancy sits near the national average (CDC NCHS, 2023).
17PennsylvaniaNortheast83.6
Ranked 13th on the Commonwealth Fund's 2025 Scorecard including the District of Columbia, with a below-average uninsured rate near 5 to 6 percent (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Pennsylvania ranked 13th on the 2025 Scorecard including the District of Columbia and holds a below-average uninsured rate after expanding Medicaid in 2015 and launching the Pennie state marketplace (Commonwealth Fund, 2025; Census ACS, 2023). Life expectancy runs slightly below the national average (CDC NCHS, 2023).
18WisconsinMidwest82.8
A middle-upper Commonwealth Fund state with above-average life expectancy and a low uninsured rate despite not adopting full ACA Medicaid expansion (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: Wisconsin holds a low uninsured rate and above-average life expectancy even though it did not adopt full ACA Medicaid expansion, instead covering adults up to the poverty line through BadgerCare (Commonwealth Fund, 2025; Census ACS, 2023). It ranked in the upper-middle of the 2025 Scorecard (Commonwealth Fund, 2025).
19IowaMidwest82.0
Ranked 18th on the Commonwealth Fund's 2025 Scorecard including the District of Columbia, with a low uninsured rate and near-average life expectancy (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: Iowa ranked 18th on the 2025 Scorecard including the District of Columbia, pairing a low uninsured rate with near-average life expectancy after expanding Medicaid in 2014 (Commonwealth Fund, 2025; Census ACS, 2023). It saw a small uninsured uptick between 2022 and 2023 (SHADAC, 2024).
20VirginiaSouth Atlantic81.2
A middle-tier Commonwealth Fund state with a below-average uninsured rate near 8 percent after its 2019 Medicaid expansion (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Virginia sits in the middle tier of the 2025 Scorecard, with an uninsured rate near 8 percent that fell after the state expanded Medicaid in 2019 (Commonwealth Fund, 2025; Census ACS, 2023). Life expectancy runs close to the national average (CDC NCHS, 2023).
21North DakotaMidwest80.4
A middle-tier state with above-average life expectancy and a low uninsured rate after expanding Medicaid (CDC NCHS, 2023; Commonwealth Fund, 2025).
The receipts: North Dakota posts above-average life expectancy and a low uninsured rate after expanding Medicaid in 2014 (CDC NCHS, 2023; Census ACS, 2023). Rural access constraints keep it in the middle rather than the top tier of the Scorecard (Commonwealth Fund, 2025).
22NebraskaMidwest79.6
Ranked 24th on the Commonwealth Fund's 2025 Scorecard including the District of Columbia, with above-average life expectancy and a moderate uninsured rate (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: Nebraska ranked 24th on the 2025 Scorecard including the District of Columbia, with above-average life expectancy and a moderate uninsured rate after voters approved Medicaid expansion by ballot in 2018 (Commonwealth Fund, 2025; CDC NCHS, 2023).
23IllinoisMidwest78.8
Ranked 27th on the Commonwealth Fund's 2025 Scorecard including the District of Columbia, with a below-average uninsured rate after expanding Medicaid (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Illinois ranked 27th on the 2025 Scorecard including the District of Columbia, holding a below-average uninsured rate after expanding Medicaid in 2014 (Commonwealth Fund, 2025; Census ACS, 2023). Life expectancy runs slightly below the national average (CDC NCHS, 2023).
24DelawareSouth Atlantic78.0
A middle-tier state with a below-average uninsured rate after expanding Medicaid, and near-average life expectancy (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Delaware sits in the middle of the Scorecard with a below-average uninsured rate after an early Medicaid expansion and near-average life expectancy (Commonwealth Fund, 2025; CDC NCHS, 2023). Its small size concentrates care in a handful of health systems (Commonwealth Fund, 2025).
25IdahoMountain West77.2
Strong healthy-lives measures and above-average life expectancy offset a higher-than-average uninsured rate after a late 2020 Medicaid expansion (CDC NCHS, 2023; Census ACS, 2023).
The receipts: Idaho posts strong healthy-lives measures and above-average life expectancy, offsetting a higher-than-average uninsured rate after voters expanded Medicaid by ballot, effective 2020 (CDC NCHS, 2023; Census ACS, 2023). Rural provider shortages weigh on its access score (Commonwealth Fund, 2025).
26KansasMidwest76.4
A middle-tier state with near-average life expectancy and an above-average uninsured rate as a non-expansion state (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Kansas sits in the middle tier with near-average life expectancy but an above-average uninsured rate as one of the remaining states that has not expanded Medicaid (Commonwealth Fund, 2025; Census ACS, 2023).
27MontanaMountain West75.6
A middle-tier state where rural access constraints and higher injury mortality offset a below-average uninsured rate after its 2016 Medicaid expansion (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Montana holds a below-average uninsured rate after expanding Medicaid in 2016, but rural access constraints and higher rates of injury and suicide mortality hold down its overall Scorecard position (Commonwealth Fund, 2025; CDC NCHS, 2023).
28MichiganMidwest74.8
A middle-tier state with a below-average uninsured rate after expanding Medicaid, but below-average life expectancy (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: Michigan holds a below-average uninsured rate after expanding Medicaid through the Healthy Michigan Plan in 2014, but posts below-average life expectancy driven in part by cardiovascular and injury mortality (Commonwealth Fund, 2025; CDC NCHS, 2023).
29South DakotaMidwest74.0
Above-average life expectancy with a higher-than-average uninsured rate until its 2023 Medicaid expansion took effect (CDC NCHS, 2023; Census ACS, 2023).
The receipts: South Dakota posts above-average life expectancy but carried a higher-than-average uninsured rate until voters approved Medicaid expansion, effective mid-2023, too late to fully register in the 2023 data (CDC NCHS, 2023; Census ACS, 2023).
30WyomingMountain West73.2
A non-expansion state with below-average life expectancy and an above-average uninsured rate, held back by rural access (CDC NCHS, 2023; Census ACS, 2023).
The receipts: Wyoming posts below-average life expectancy and an above-average uninsured rate as a non-expansion state, with the nation's most rural provider network straining access (CDC NCHS, 2023; Census ACS, 2023).
31AlaskaPacific72.4
Expanded Medicaid but carries high care costs and below-average life expectancy, with access limited by geography (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: Alaska expanded Medicaid in 2015 but carries among the nation's highest per-capita health care costs and below-average life expectancy, with extreme geography limiting access (Commonwealth Fund, 2025; CDC NCHS, 2023).
32New MexicoMountain West71.6
An early Medicaid expansion state whose coverage gains are undercut by among the nation's lower life expectancies and provider shortages (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: New Mexico expanded Medicaid early and cut its uninsured rate sharply, but posts among the nation's lower life expectancies and severe provider shortages that hold down access and outcomes (Commonwealth Fund, 2025; CDC NCHS, 2023).
33FloridaSouth Atlantic70.8
Ranked 39th on the Commonwealth Fund's 2025 Scorecard including the District of Columbia, with a high uninsured rate as a large non-expansion state (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Florida ranked 39th on the 2025 Scorecard including the District of Columbia, carrying a high uninsured rate as one of the largest states that has not expanded Medicaid, even as its huge marketplace enrollment is among the nation's largest (Commonwealth Fund, 2025; Census ACS, 2023).
34ArizonaMountain West70.0
Ranked 34th on the Commonwealth Fund's 2025 Scorecard including the District of Columbia, an expansion state whose access scores lag its coverage (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Arizona ranked 34th on the 2025 Scorecard including the District of Columbia; it expanded Medicaid but posts below-average life expectancy and access scores that lag its coverage gains (Commonwealth Fund, 2025; CDC NCHS, 2023).
35IndianaMidwest69.2
A lower-middle state with below-average life expectancy despite a Medicaid expansion through the Healthy Indiana Plan (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: Indiana expanded Medicaid through the Healthy Indiana Plan but posts below-average life expectancy driven by cardiovascular disease, obesity, and overdose mortality (Commonwealth Fund, 2025; CDC NCHS, 2023).
36OhioMidwest68.4
A lower-middle state with below-average life expectancy and high overdose mortality despite expanding Medicaid (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: Ohio expanded Medicaid in 2014 but posts below-average life expectancy, weighed down by among the nation's higher drug overdose death rates through the opioid epidemic (Commonwealth Fund, 2025; CDC NCHS, 2023).
37NevadaMountain West67.6
Ranked 46th on the Commonwealth Fund's 2025 Scorecard including the District of Columbia, with among the nation's worst access and provider-supply scores despite a Medicaid expansion (Commonwealth Fund, 2025).
The receipts: Nevada ranked 46th on the 2025 Scorecard including the District of Columbia; even after expanding Medicaid it posts among the nation's worst access and provider-supply scores and below-average life expectancy (Commonwealth Fund, 2025; CDC NCHS, 2023).
38North CarolinaSouth66.8
A Southern state with below-average life expectancy whose late 2023 Medicaid expansion had not yet moved the coverage numbers in this data (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: North Carolina posts below-average life expectancy and an above-average uninsured rate; its Medicaid expansion took effect in December 2023, too late to register in the 2023 coverage data (Commonwealth Fund, 2025; Census ACS, 2023).
39MissouriMidwest65.6
Below-average life expectancy and an above-average uninsured rate; its voter-approved Medicaid expansion took effect only in 2021 (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: Missouri posts below-average life expectancy and an above-average uninsured rate; voters approved Medicaid expansion in 2020 and it took effect in 2021, so coverage gains were still building in this data (Commonwealth Fund, 2025; Census ACS, 2023).
40South CarolinaSouth62.4
A non-expansion Southern state with below-average life expectancy and an above-average uninsured rate (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: South Carolina posts below-average life expectancy and an above-average uninsured rate as one of the remaining non-expansion states, with high rates of cardiovascular and diabetes mortality (Commonwealth Fund, 2025; CDC NCHS, 2023).
41GeorgiaSouth, non-expansion state for most of the period measured58.8
An uninsured rate above 11 percent, among the nation's highest, and below-average life expectancy (Census ACS, 2023; CDC NCHS).
The receipts: Georgia carries an uninsured rate above 11 percent, among the nation's highest, and below-average life expectancy, having declined full ACA Medicaid expansion in favor of a limited work-requirement program (Census ACS, 2023; CDC NCHS, 2023).
42TennesseeSouth57.7
Among the ten lowest state life expectancies, with high rates of premature avoidable death (CDC NCHS, 2023; Commonwealth Fund).
The receipts: Tennessee posts among the ten lowest state life expectancies and high rates of premature avoidable death, and it has not expanded Medicaid (CDC NCHS, 2023; Commonwealth Fund, 2025).
43KentuckySouth56.9
Life expectancy among the nation's lowest despite above-average insurance coverage from its Medicaid expansion, a gap between coverage and outcomes that the data cannot hide (CDC NCHS; Census ACS, 2023).
The receipts: Kentucky expanded Medicaid early and cut its uninsured rate sharply, yet posts life expectancy among the nation's lowest, the clearest single case that coverage alone does not buy longevity (CDC NCHS, 2023; Census ACS, 2023). Smoking, obesity, and overdose mortality drive the gap (Commonwealth Fund, 2025).
44AlabamaSouth55.8
Among the ten lowest life expectancies in the nation and high preventable mortality (CDC NCHS, 2023).
The receipts: Alabama posts among the ten lowest life expectancies in the nation, with high preventable mortality from cardiovascular disease and diabetes, and it has not expanded Medicaid (CDC NCHS, 2023; Commonwealth Fund, 2025).
45LouisianaSouth54.9
Bottom-tier life expectancy and among the highest rates of premature death, despite coverage gains from Medicaid expansion (CDC NCHS; Commonwealth Fund).
The receipts: Louisiana expanded Medicaid in 2016 and cut its uninsured rate, yet posts bottom-tier life expectancy and among the highest rates of premature death, another coverage-versus-outcomes gap (CDC NCHS, 2023; Commonwealth Fund, 2025).
46West VirginiaSouth53.7
One of the five lowest-ranked states on the Commonwealth Fund's 2025 Scorecard, with life expectancy among the two or three lowest in the nation (Commonwealth Fund, 2025; CDC NCHS).
The receipts: West Virginia ranked among the five lowest states on the 2025 Scorecard and posts life expectancy among the two or three lowest in the nation, despite an early Medicaid expansion, driven by the nation's highest overdose death rate (Commonwealth Fund, 2025; CDC NCHS, 2023).
47ArkansasSouth52.8
Bottom five on the 2025 Commonwealth Fund Scorecard, with high avoidable hospital use and low healthy-lives scores (Commonwealth Fund, 2025).
The receipts: Arkansas ranked in the bottom five on the 2025 Scorecard, with high avoidable hospital use and low healthy-lives scores even after a private-option Medicaid expansion (Commonwealth Fund, 2025; CDC NCHS, 2023).
48OklahomaSouth51.9
Bottom five on the 2025 Commonwealth Fund Scorecard and among the highest uninsured rates in the country (Commonwealth Fund, 2025; Census ACS, 2023).
The receipts: Oklahoma ranked in the bottom five on the 2025 Scorecard and carries among the highest uninsured rates in the country, even after voters approved Medicaid expansion effective 2021 (Commonwealth Fund, 2025; Census ACS, 2023).
49TexasSouth, largest non-expansion state50.4
The nation's highest uninsured rate, 16.4 percent overall and 23 percent among working-age adults, the highest of any state on both measures (Census ACS, 2023; Commonwealth Fund, 2025).
The receipts: Texas carries the nation's highest uninsured rate, 16.4 percent overall and about 23 percent among working-age adults, the highest of any state on both measures, as the largest state that has not expanded Medicaid (Census ACS, 2023; Commonwealth Fund, 2025).
50MississippiSouth48.6
Ranked last on the Commonwealth Fund's 2025 Scorecard and last in life expectancy at just under 74 years, about 4.5 years below the national average, though it ranks in the top quartile for state primary-care spending (Commonwealth Fund, 2025; CDC NCHS, 2023).
The receipts: Mississippi ranked last among states on the 2025 Scorecard and last in life expectancy at about 73.9 years, roughly 4.5 years below the national average and 7.2 years below Hawaii (Commonwealth Fund, 2025; CDC NCHS, 2023). It has not expanded Medicaid and carries a high uninsured rate (Census ACS, 2023).
Click any entry to open its full scorecard, sub-scores, and the receipts.
Life expectancy at birth, 2023
Three rulers, one picture
Health system rankings can be gamed by choosing flattering inputs. This one uses three that are hard to argue with: an independent 50-indicator scorecard, a death record, and an insurance count. The Commonwealth Fund's 2025 Scorecard on State Health System Performance graded all 50 states and the District of Columbia on 50 measures across access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and equity (Commonwealth Fund, 2025). It put Massachusetts, Hawaii, New Hampshire, and Rhode Island at the top among states, with the District of Columbia also in the leading group, and put Mississippi, Texas, Oklahoma, Arkansas, and West Virginia at the bottom (Commonwealth Fund, 2025).
The second ruler is mortality. CDC data put national life expectancy at 78.4 years in 2023, up 0.9 years from 77.5 in 2022 but still below the 2019 level, with the recovery driven by declines in COVID-19, heart disease, and drug-overdose deaths (CDC NCHS, 2023). The third is coverage. The Census Bureau put the national uninsured rate at 7.9 percent in 2023, statistically unchanged from 8.0 percent a year earlier (Census ACS, 2023).
All three rulers point the same direction. The states at the top of the scorecard also live longest and are insured at the highest rates. The states at the bottom die youngest and are uninsured at the highest rates. When three independent measures, built by three different institutions from three different data streams, converge on the same ordering, the ranking is not an artifact of method. It is a description of the country.
A 7.2-year gap in life itself
Hawaii's life expectancy of about 81.1 years and Mississippi's of about 73.9 differ by 7.2 years (CDC NCHS, 2023). That is the single most important number in this report. It is not a difference in hospital amenities or wait times. It is a difference in how long residents are alive. New Jersey at 81.1 and New York at 81.0 sit just behind Hawaii at the top; West Virginia and Mississippi anchor the bottom (CDC NCHS, 2023).
The geography is stark and it is not subtle. Every state in this ranking's bottom ten is in the South. Every state in the top eight is in the Northeast or Pacific. New England alone holds five of the top six positions. The drivers documented in the federal data include smoking, obesity, drug overdose, and cardiovascular death rates, layered on top of insurance coverage and access to primary care (CDC NCHS, 2023). The scoreboard does not assign blame between behavior, poverty, and policy. It records the result, and the result is that where an American is born can cost or grant them the better part of a decade of life.
Longevity is also the hardest number to move. Coverage can change in a single legislative session. Life expectancy reflects decades of accumulated disease, and it barely twitches year to year. That is why this composite weights it heavily but not exclusively: it is the truest outcome, and the slowest to respond.
Coverage is the clearest policy fingerprint in the data
The uninsured numbers split along one policy line more than any other. States that expanded Medicaid under the Affordable Care Act had a combined uninsured rate of 6.4 percent in 2023; non-expansion states sat at 11.3 percent (Census ACS, 2023). That is not a rounding difference. It is nearly double. Texas, the largest non-expansion state, has the highest uninsured rate in the nation at 16.4 percent overall and about 23 percent among working-age adults (Census ACS, 2023; Commonwealth Fund, 2025). Massachusetts, which built the individual-mandate model the ACA copied, has the lowest at about 2.4 percent (Mass.gov, 2025; Census ACS, 2023).
Coverage is the one lever in this data that a legislature pulls directly and sees move within a year. When Louisiana expanded Medicaid in 2016, its uninsured rate fell. When Missouri, Oklahoma, and South Dakota expanded by ballot initiative, theirs did too. The pattern is consistent enough that the Commonwealth Fund attributes the record-low uninsured rates of 2023 largely to the ACA's coverage expansions, recent state Medicaid expansions, and more affordable marketplace premiums (Commonwealth Fund, 2025).
Honesty requires the counterexample, and this ranking prints it plainly. Coverage alone does not buy longevity. Kentucky, West Virginia, and Louisiana all expanded Medicaid and all sit near the bottom on life expectancy (CDC NCHS, 2023). Kentucky is the sharpest case: above-average insurance coverage, life expectancy among the nation's lowest. Insurance is measurable and policy-controlled; the diseases that shorten lives in the lowest-ranked states, smoking, obesity, and overdose, accumulated over decades and do not vanish when a coverage card arrives. Both facts are in the record, and this composite weights outcomes, not intentions.
What the top states have in common, and what they do not
The top of this table is politically mixed at the margins but structurally consistent: near-universal coverage, low avoidable hospital use, and low premature mortality. Massachusetts leads on nearly every access measure the Commonwealth Fund tracks and ranked first for affordability and access (Mass.gov, 2025). Hawaii pairs high coverage with the longest lives, a legacy in part of its 1974 Prepaid Health Care Act, which requires most employers to cover workers (Hawaii Department of Health, 2025). Minnesota carries the Midwest into the top tier on the strength of low avoidable hospital use and strong Medicare-beneficiary experience (Commonwealth Fund, 2025).
But the routes into the top differ. Utah cracks the top 15 largely on healthy-lives measures, with among the lowest smoking rates in the country, rather than on the coverage-and-access strength that carries New England (CDC NCHS, 2023). Maryland leans on the nation's only all-payer hospital rate-setting system, which sets uniform hospital prices and restrains avoidable cost growth (Commonwealth Fund, 2025). Maine reaches the top 15 despite being the oldest state by median age, a harder feat than it sounds because older populations use far more care (Census ACS, 2023). There is more than one road up. There is no road up that skips coverage entirely.
The middle: where a single reform can move a state
The states ranked 16 through 40 are where the composite is most sensitive, because their three rulers do not always agree. Oregon (16th here, 12th on the Scorecard including the District of Columbia), Pennsylvania (17th, Scorecard 13th), and Iowa (19th, Scorecard 18th) hold below-average uninsured rates from Medicaid expansion but only near-average life expectancy (Commonwealth Fund, 2025; CDC NCHS, 2023). Wisconsin is the mirror image: no full ACA expansion, yet a low uninsured rate through its BadgerCare program and above-average life expectancy (Commonwealth Fund, 2025).
The middle also holds the states where recent reform had not yet fully landed in this data. North Carolina expanded Medicaid in December 2023, too late to register in the 2023 coverage numbers (Census ACS, 2023). South Dakota's expansion took effect in mid-2023, Missouri's in 2021, Oklahoma's in 2021. Each of those states should climb in future editions as coverage gains mature, and this report will record it when they do. Florida (33rd here, Scorecard 39th including the District of Columbia) and Nevada (37th here, Scorecard 46th) sit lower because a large non-expansion population, in Florida's case, and among the nation's worst provider-supply and access scores, in Nevada's, drag down states that otherwise have the wealth to do better (Commonwealth Fund, 2025).
The bottom ten and the Southern belt
The bottom of this table is a map of the South. Mississippi ranks last among states on the Scorecard and last in life expectancy at about 73.9 years (Commonwealth Fund, 2025; CDC NCHS, 2023). Texas ranks 49th on the strength of the nation's worst uninsured rate (Census ACS, 2023). Oklahoma and Arkansas round out the Commonwealth Fund's bottom five, and West Virginia, geographically Appalachian but culturally Southern in its health profile, sits among the two or three lowest life expectancies in the nation, driven by the highest overdose death rate in the country (Commonwealth Fund, 2025; CDC NCHS, 2023).
The bottom ten divides into two policy stories. Texas, Georgia, Tennessee, Alabama, Mississippi, and South Carolina have not adopted full ACA Medicaid expansion, and their high uninsured rates follow directly (Census ACS, 2023). Kentucky, Louisiana, West Virginia, and Arkansas did expand, and their coverage improved, yet their life expectancy did not follow, because the burden of chronic disease and overdose in these states predates and outweighs the coverage lever (CDC NCHS, 2023). The ranking treats both groups by the identical ruler. It does not reward the intention to cover people; it measures whether people are covered and how long they live. On both counts, the Southern belt trails, and it trails consistently across all three independent sources.
One nuance belongs in the record. Mississippi, dead last overall, ranks in the top quartile for state primary-care spending as a share of total health spending (Commonwealth Fund, 2025). Spending on the right category is not the same as buying the outcome. The dollars are being directed sensibly; the disease burden is simply larger than the dollars can reach.
Why the three rulers sometimes disagree, and which one wins
A ranking built from three sources has to decide what to do when they diverge, and this one has a rule: the Commonwealth Fund 50-indicator Scorecard anchors the order because it is the broadest and most rigorously constructed of the three, and life expectancy and coverage confirm direction and break ties (Commonwealth Fund, 2025). Most of the time all three agree, which is why the ordering is stable. Where they split, the split is informative rather than a flaw.
Kentucky is the clearest disagreement. Its coverage ruler reads high, above the national average after an early and aggressive Medicaid expansion, while its longevity ruler reads near the very bottom (Census ACS, 2023; CDC NCHS, 2023). A composite that weighted only coverage would rank Kentucky in the middle of the pack; a composite that weighted only mortality would put it near last. This ranking places it 43rd, closer to the mortality reading, because life expectancy is the outcome and coverage is an input. The same logic pushes Louisiana and West Virginia down despite their expansions. It is the deliberate architecture of the composite: when an input and an outcome disagree, the outcome carries more weight, because residents live and die on the outcome, not the input.
The reverse disagreement also exists. Wisconsin never adopted full ACA Medicaid expansion, so a coverage-only ruler would penalize it, yet it posts a low uninsured rate through BadgerCare and above-average life expectancy, and it lands 18th (Commonwealth Fund, 2025; CDC NCHS, 2023). Utah reaches 15th on healthy-lives strength rather than coverage-and-access strength, carried by the nation's lowest smoking rates (CDC NCHS, 2023). These are the cases that prove the ruler is measuring health, not politics. A state can reach the top tier without the New England coverage model, and a state can expand coverage and still sit near the bottom. Only the results decide.
The equity dimension the Scorecard adds
The Commonwealth Fund Scorecard does something the raw mortality and coverage counts do not: it grades equity, measuring the gap in performance between a state's higher-income and lower-income residents and between racial and ethnic groups (Commonwealth Fund, 2025). This is why a wealthy state with deep internal disparities can score lower than its averages alone would predict, and why the Fund publishes a separate equity dimension rather than burying it in the overall number.
This is also the most contested piece of the methodology, and this ranking says so plainly in its contested note. Critics argue the equity dimension can penalize a state twice for the same underlying poverty: once in its outcome averages and again in the size of its internal gap (Commonwealth Fund, 2025). Defenders answer that a state health system which delivers long life to its affluent residents and short life to its poor ones is not a good system, and that an average which hides that gap is the misleading number. This report does not resolve the argument. It anchors on the Fund's overall order, notes where equity weighting is doing the work, and lets the mortality and coverage rulers, which carry no equity adjustment, serve as the check. When all three still agree on the top and bottom, as they do, the equity weighting is not driving the result; it is refining the middle.
The warning inside the 2025 Scorecard
The 2025 Scorecard's authors attached a warning worth recording in full: the coverage gains that drove recent improvement are, in their words, now at risk (Commonwealth Fund, 2025). Enhanced ACA marketplace subsidies enacted during the pandemic are scheduled to lapse, and Medicaid enrollment has been unwinding since the pandemic continuous-coverage requirement ended in 2023. The Fund projects that if those supports disappear, uninsured rates could climb back toward pre-ACA levels in the states that gained the most, which are disproportionately the lower-ranked states with the most fragile coverage (Commonwealth Fund, 2025).
That is the mechanism to watch. Coverage is the fastest-moving of the three rulers, which means it can reverse as fast as it rose. Life expectancy will lag behind whatever happens to coverage by years, so the first sign of any reversal will show up in the Census uninsured count, not the mortality tables. If those reversals materialize, the next edition of this table will show it in the middle tier first, where states like North Carolina, Missouri, and Oklahoma are still counting on maturing coverage gains to climb. This report will print the movement in either direction, on the same three rulers, for every state.
Uninsured rate, 2023
How the map has moved
The direction of travel over the past decade has been toward coverage, and the Commonwealth Fund's 2025 Scorecard captures the high-water mark. Uninsured rates fell to record lows in every state by 2023, and the gaps in coverage and access between states narrowed, changes the Fund attributes to the Affordable Care Act's expansions, subsequent state Medicaid expansions, and cheaper marketplace premiums (Commonwealth Fund, 2025). The states that moved most were the ones that expanded Medicaid latest: Missouri and Oklahoma in 2021, South Dakota and North Carolina in 2023. Their coverage gains are still maturing in the data, which means their positions in this ranking should rise in future editions if nothing reverses.
The longevity map has moved too, though more slowly. National life expectancy fell hard in 2020 and 2021 during the pandemic, bottoming near 76.4 years in 2021, then recovered to 78.4 in 2023 as COVID-19, heart disease, and overdose deaths declined (CDC NCHS, 2023). But the recovery was uneven. The Northeast and Pacific rebounded toward their pre-pandemic highs; much of the South and Appalachia did not fully close the gap, widening the distance between the top and bottom of this table. The 7.2-year spread between Hawaii and Mississippi in 2023 is wider than the roughly 6-year spread the same states showed before the pandemic (CDC NCHS, 2023).
The next move is the one the Scorecard's authors flagged as a risk rather than a certainty. Enhanced marketplace subsidies are set to lapse and Medicaid unwinding is underway, and the Fund warns that the historic coverage gains could partly reverse (Commonwealth Fund, 2025). If that happens, the first place it will show is the Census uninsured count, and the middle-tier states with the most recently gained, most fragile coverage will slide first. This ranking is built to catch that movement, because coverage is the fastest of its three rulers to change and the easiest to read year over year. The list will move as the data moves, in whichever direction it goes, on the same ruler for every state.
Life expectancy vs. the national average of 78.4 years, 2023
What the evidence settles
The evidence settles that state health outcomes diverge enormously and consistently across independent data sources: 7.2 years of life expectancy separate Hawaii from Mississippi (CDC NCHS, 2023), Texas has the nation's highest uninsured rate at 16.4 percent and Massachusetts the lowest at about 2.4 percent (Census ACS, 2023), and the Commonwealth Fund's 50-indicator scorecard places the same states at the top and bottom that the mortality and coverage data do (Commonwealth Fund, 2025). It also settles that Medicaid expansion reliably lowers the uninsured rate: expansion states averaged 6.4 percent uninsured against 11.3 percent in non-expansion states (Census ACS, 2023).
What remains contested
What remains contested is causation and weighting. How much of the South's poor showing reflects current state policy choices versus decades of poverty, behavior, and disease burden that predate current governments is genuinely disputed. So is the equity weighting in the Commonwealth Fund methodology, which critics argue penalizes some states twice for the same underlying poverty. And coverage-versus-outcomes remains a live argument: Kentucky, West Virginia, and Louisiana all expanded Medicaid and still rank near the bottom on life expectancy, which some read as evidence that coverage is oversold and others as evidence that coverage cannot outrun a disease burden built over generations.
Questions people ask
Which state has the best health care?
Massachusetts. It ranked first among states on the Commonwealth Fund's 2025 Scorecard, first for affordability and access, and has the nation's lowest uninsured rate at about 2.4 percent (Commonwealth Fund, 2025; Census ACS, 2023).
Which state has the worst health outcomes?
Mississippi, on this composite. It ranked last among states on the Commonwealth Fund's 2025 Scorecard and last in life expectancy at about 73.9 years, roughly 4.5 years below the national average and 7.2 years below Hawaii (Commonwealth Fund, 2025; CDC NCHS, 2023).
Does expanding Medicaid improve a state's ranking?
It reliably improves coverage: expansion states averaged a 6.4 percent uninsured rate in 2023 versus 11.3 percent in non-expansion states (Census ACS, 2023). It does not guarantee outcomes; Kentucky, West Virginia, and Louisiana expanded and still rank near the bottom on life expectancy (CDC NCHS, 2023).
What is the life expectancy gap between states?
About 7.2 years. Hawaii leads at roughly 81.1 years while Mississippi trails at about 73.9, against a national average of 78.4 years in 2023 (CDC NCHS, 2023).
Why do some Medicaid expansion states still rank low?
Because coverage and longevity are different things. Kentucky, Louisiana, and West Virginia expanded Medicaid and cut their uninsured rates, but their life expectancy stayed among the nation's lowest because smoking, obesity, and overdose mortality accumulated over decades and cannot be reversed by an insurance card alone (CDC NCHS, 2023; Commonwealth Fund, 2025).
What data sources does this ranking use?
Three named sources: the Commonwealth Fund's 2025 Scorecard on State Health System Performance (50 indicators, weighted most heavily), CDC National Center for Health Statistics life expectancy data for 2023, and Census Bureau American Community Survey uninsured rates for 2023 (Commonwealth Fund, 2025; CDC NCHS, 2023; Census ACS, 2023).
Sources
- Commonwealth Fund, 2025 Scorecard on State Health System Performance, June 2025 https://www.commonwealthfund.org/publications/scorecard/2025/jun/2025-scorecard-state-health-system-performance
- Commonwealth Fund, press release: New State-by-State Health Scorecard, 2025 https://www.commonwealthfund.org/press-release/2025/new-state-state-health-scorecard-historic-insurance-coverage-gains-improvements
- Commonwealth Fund, 2025 Scorecard Appendices (full state rankings) https://www.commonwealthfund.org/sites/default/files/2025-05/AUTHOR_REVIEW_1_Radley_2025_State_Scorecard__APPENDICES_2025-05-29.pdf
- CDC NCHS, Mortality in the United States, 2023 (Data Brief 521) https://www.cdc.gov/nchs/products/databriefs/db521.htm
- CDC NCHS, Life Expectancy FastStats https://www.cdc.gov/nchs/fastats/life-expectancy.htm
- CDC NCHS, NVSS Life Expectancy https://www.cdc.gov/nchs/nvss/life-expectancy.htm
- Census Bureau, Health Insurance Coverage by State: 2023 and 2024 (ACS Brief) https://www2.census.gov/library/publications/2025/demo/acsbr-024.pdf
- Census Bureau, State Health Insurance Coverage: 2013, 2019, and 2023 https://www2.census.gov/library/publications/2024/demo/acsbr-021.pdf
- SHADAC, 2023 ACS Tables: State and County Uninsured Rates https://www.shadac.org/news/american-community-survey-data-2023-health-insurance-coverage-estimates
- SHADAC, 2024 ACS Tables: State and County Level Uninsured Rates https://www.shadac.org/news/2024-acs-tables-state-and-county-uninsured-rates-comparison-year-2023
- Mass.gov, Massachusetts Ranks #1 for Health Care Affordability and Access, 2025 https://www.mass.gov/news/massachusetts-ranks-1-for-health-care-affordability-and-access
- Hawaii Department of Health, Hawaii's Health System Performance Ranked Among Best in the Nation, 2025 https://health.hawaii.gov/news/newsroom/hawai%CA%BBis-health-system-performance-ranked-among-best-in-the-nation/
- Commonwealth Fund, State Scorecard on Medicare Beneficiary Experiences, 2025 https://www.commonwealthfund.org/publications/scorecard/2025/oct/state-scorecard-medicare-performance
- USAFacts, Which states have the highest and lowest life expectancy? https://usafacts.org/articles/which-states-have-highest-and-lowest-life-expectancy/
Parker, T. E. (2026). States Ranked by Health Care Outcomes. US Political Rank. https://uspoliticalrank.com/rankings/states-by-healthcare<iframe src="https://uspoliticalrank.com/embed/states-by-healthcare" width="100%" height="520" style="border:1px solid #ddd;border-radius:8px" title="States Ranked by Health Care Outcomes" loading="lazy"></iframe>Keep reading
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