The NCSL Blog


By Kate Blackman

Rising death rates from suicide, alcohol and drug overdose, growth in health care spending among those with employer coverage, and a slowdown in earlier health insurance coverage gains are among the trends highlighted in a new report from the Commonwealth Fund.

Stethescope on top of dollar billsReflecting state policymakers’ attention on these key issues, the Commonwealth Fund’s 2019 Scorecard on State Health System Performance examines state-level data on access and quality of health care, use and costs of care, health outcomes, and income-based health care disparities to reveal that all states experience challenges and have opportunities for improvement.

As the opioid epidemic continues to dominate headlines, the Scorecard affirmed several regions and states, such as Delaware, the District of Columbia, Kentucky, New Hampshire, Ohio, Pennsylvania, West Virginia, are among those hit the hardest.

In other states, alcohol and suicide were responsible for a larger contribution to premature death. In 2017, Montana, Nebraska, North Dakota, Oregon, South Dakota and Wyoming saw higher rates of death from suicide and alcohol than from drug overdoses.

States experienced overall increases in rates of individuals with health insurance between 2013 and 2017 but, since 2015, progress has leveled off in most states, according to the Scorecard.

Among working-age adults, more than half of the states held earlier coverage gains with level uninsured rates between 2016 and 2017. Another 16 states, regardless of whether they expanded Medicaid or not, saw a slight increase of 1% in their working-age adult uninsured rate. Among states that did not expand Medicaid, adult uninsured rates continue to be relatively high for most, with five experiencing the highest rates in 2017, ranging from 18 to 24%.

Along with coverage, the Scorecard examined health care costs—another significant policy issue for state lawmakers. According to the Scorecard, 31 states saw faster growth in per-enrollee costs in employer plans than in Medicare between 2013 and 2016. Plans offered by employers are the most common way Americans younger than age 65 receive health insurance. The report found costs vary significantly across states and are among the largest drivers of health insurance premiums, which can affect whether consumers choose to enroll in insurance plans.

The report features a number of policy recommendations to address coverage, costs, access and premature death. State lawmakers across the country are pursuing many of these options as they seek to make progress in addressing these challenges. 

To learn more about your state, visit the Commonwealth Fund’s online interactive report as well as a data center that allows users to explore the data by state, region or topic with graphics and maps.

Kate Blackman is the director of NCSL's Health Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.