They used a ranking system of "42 different metrics that gauged everything from insurance coverage to avoidable hospital stays to vaccination rates, at the systemic level; and from obesity rates to how many adults have lost six or more teeth, at the individual level." The states at the top: Minnesota comes in at Number 1, and Massachusetts, Vermont and New Hampshire are tied for second. At the bottom: Mississippi is worst, with Louisiana, Oklahoma and Arkansas not much better.
Demographically, Mississippi is already at a disadvantage. A black man in Mississippi has a shorter life expectancy than the average American did in 1960. The state has an obesity rate of 35 percent, one of the highest poverty rates in the country, and just one abortion clinic.Not to pick on the Mississippi Medicaid program too much—in Alabama, which is stingiest, that cut-off for Medicaid families is $3,221 a year and in Texas it's $3,737. Alabama is ranked 46 out of 51 by Commonwealth, and Texas is 44. Mississippi, however, has the largest percentage of adults who didn't seek medical care when they needed it because they couldn't afford it. There's plenty of misery to go around, however. In West Virginia, almost a quarter of the population has lost six or more teeth. (You can see how your state is doing with this interactive map.)
Healthcare in Mississippi and in other Southern states is unlikely to become more equitable anytime soon, however. As the study authors note, 16 of the states in the bottom half of the ranking have opted not to expand Medicaid under the Affordable Care Act to adults making up to 138 percent of the federal poverty level.
In Mississippi, for example, "Medicaid eligibility for non-disabled adults is limited to parents with incomes below 29 percent of poverty, or about $6,800 a year for a family of four, and adults without dependent children remain ineligible regardless of their income," as the Kaiser Family Foundation points out.
Like KFF, the Commonwealth Fund foresees a "widening rather than a narrowing of health outcomes and quality of care" among the states unless southern states follow the lead of the better-performing states to expand access to health care. That includes Medicaid expansion.