The scorecard measured 42 health indicators, including insurance coverage, vaccination rates, preventable hospital visits, obesity, suicide rates, smoking rates and cancer deaths from 2007 to 2012 — just before the major provisions of the Affordable Care Act (ACA) began to be implemented.
That’s not to say that Minnesota scored well on all 42 indicators. We ranked 37th, for example, in the category “children ages 19 to 35 months who received all recommended seven doses of vaccines” and 48th in the category “home health patients whose wounds improved or healed after an operation.”
Some of Minnesota’s scores also worsened during the five years covered by the study. Those categories included “adults who went without care because of cost in the past year,” “the risk-adjusted 30-day mortality among Medicare beneficiaries hospitalized for heart attack, heart failure or pneumonia,” and “children ages 10-17 who are overweight or obese.”
But, overall, we did better than any other state — including neighboring Wisconsin, which ranked seventh overall on the scorecard.
In fact, most states either failed to improve or did worse on 34 of the indicators (the ones for which long-term data is available).
“No state is making widespread progress toward the achievable outcomes that all individuals should expect considering the substantial and increasing resources devoted to health care in the United States,” note Douglas McCarthy, a senior research director for the Commonwealth Fund, and two colleagues in a commentary about the scorecard report that appears in the Journal of the American Medical Association (JAMA).
Indeed, as the report itself points out, annual health-care spending in the United States increased by $491 billion to $2.8 trillion during the scorecard’s five-year time frame — a period that included the Great Recession.
“Spending increased in all states on both a per-capita basis and as a share of total state income. And still, the Scorecard points to deteriorating access to care for adults, stagnant or worsening performance on other key measures such as preventive care for adults, and widespread disparities in peoples’ health care experience across and within states,” the report notes. “These findings together suggest that the return on our nation’s health care investment is falling woefully short.”
Big regional differences
The report’s finding of a wide geographical disparity among state health systems is particularly troubling — and glaring.
The states ranked in the bottom quartile of states are located almost exclusively in the Deep South, from Texas across to Florida. The only non-Southern states in that quartile are Indiana and Nevada.
The top-ranking quartile of states came from the Upper Midwest (Wisconsin, Iowa and South Dakota, along with Minnesota) and New England, as well as two “outlier” states, Colorado and Hawaii.
Tellingly, 16 of the states ranked in the bottom half of overall performance are among the 23 states that have not yet decided to accept additional Medicaid funds under the ACA.
“If all states participate in Medicaid expansions, the geographic divide documented by the scorecard might narrow; however, if many states do not, the divide could widen in the future,” writes McCarthy and his JAMA co-authors.