The Worst States for Your Health, 2012

What do South Carolina, Texas, Louisiana, and Mississippi have in common?

They all find themselves among the worst states for your health.  And they all have governors who have already declared that they don’t want to expand Medicaid to uninsured adults in their states.

South Carolina ranks 40^th, Texas is 41^st, Louisiana is 44^th, and Mississippi is 47^th in the 2012 Our Health Policy Matters rankings of the states.

The worst state for your health this year is Oklahoma, which dropped from 47^th a year ago. 

New Mexico came in just ahead of Oklahoma, and just below Nevada, Mississippi, and Arkansas.  Rounding out the bottom ten were Alabama, Louisiana, West Virginia, Texas, and Montana.

Led by middle-of-the-pack Medicare and Medicaid community spending, West Virginia escaped the bottom of the rankings this year.  Its 43^rd place finish represents an improvement of seven places over last year’s worst-in-the-nation finish. 

On the other hand, Texas had a comparable fall into the bottom ten, plunging five places to a tie for 41^st from its finish last year, on the heels of bottom ten Healthy State and KidsCount Health rankings. 

Kentucky made the biggest jump out of the bottom ten during the past year, from 45^th in 2011 to 35^th in 2012.

The states with governors who have said that they will reject the Medicaid expansion are among those states whose citizens probably need it the most.

In addition to South Carolina, Texas, Louisiana, and Mississippi, three other states have governors who declared that they would refuse to expand the Medicaid program in 2014 – despite the federal government’s offer to pick up 100% of the cost in the first three years and at least 90% ever after.  Florida landed at the cusp of the bottom third, finishing in 33^rd place overall.  Georgia just managed to stay out of the bottom ten.  Only Iowa, which ranked 19^th, escaped from the bottom half of the rankings.

But what is most interesting about the rejecting states is that they all do a relatively poor job of directing their current Medicaid money toward home and community-based services.

• Georgia ranks last in that category, Florida ranks 43^rd, Mississippi ranks 42^nd, Louisiana ranks 35^th, South Carolina ranks 34^th, Texas ranks 32^nd, and Iowa ranks 25^th.

And as a group, their Healthy State rankings – a measure of how effectively the states support public health – aren’t any better.

• Mississippi ranks 50^th (last), Louisiana ranks 49^th, South Carolina ranks 45^th, Texas ranks 44^th, Georgia ranks 37th, Florida ranks 33^rd, and Iowa ranks 17^th on that measure.

The states at or near the bottom of the rankings should also be nervous about the changes Paul Ryan has proposed for the Medicare program.

• Medicare spending on community services is the one area in which many of these states shine.  Community per capita Medicare spending in Oklahoma, for example, is 13^th in the nation.  In Nevada it is 16^th. In Mississippi it is 10^th.  In Alabama it is 8^th.  And in Louisiana it is 3rd.  (Florida is first in this category.)

Ryan’s proposed transition of Medicare to a voucher program, with a cap on the value of the voucher, could turn out to be the first step in a long process that undermines these community-based Medicare services. 

Medicare recipients down the road might want to use their voucher money to continue to pay for these, but they might have to use it to cover hospital stays instead.

The full rankings are available here.

The OHPM rankings are a modest attempt to average rankings from several independent sources to provide an overall picture, relative to the other states, of both the health of a state’s population and the overall quality and accessibility of the state’s health care services. 

The rankings factor in:

• Public health and prevention
• Access to primary care services
• Access to home and community-based health services, especially for low income and elderly people
• Access to quality hospital care, including general and specialty hospital programs (including mental health)
• Private insurance coverage of the population

This year’s rankings incorporated three recently-released independent rankings.  These were the 2012 KidsCount Health Rankings, the 2011 Healthy State Rankings, and the 2012 U.S. News and World Report Hospital Ratings.  They also factored in the most recent CMS data on state per capita community (non-hospital and non-nursing home) Medicare and Medicaid spending on community health care services, and Kaiser State Health Facts data on the state’s prevalence of nurse practitioners and the state percentage of privately-insured individuals.     

If you have questions about this column or wish to receive an email notifying you when new Our Health Policy Matters columns are published, email gionfriddopaul@gmail.com.