2020 Scorecard on State Health System Performance

The Commonwealth Fund – Sept. 2020

by  David C. Radley Senior Scientist, Sara R. Collins Vice President & Jesse C. Baumgartner Research Associate

The 2020 Scorecard offers the latest available federal data on the state of the U.S. health system before it headed into the most severe public health crisis and economic collapse in modern times. It also highlights health system weaknesses that have left the U.S. far less prepared than other high-income countries to cope with public health threats like COVID-19. These weaknesses include:

• a health care delivery system that is highly unequal in its care of people of color and those with low and moderate incomes.
• an insurance system that still leaves millions without coverage.
• exorbitant commercial insurance prices that fuel growth in health spending and expose people to high premiums and deductibles.
• an inadequate primary care system.
• declining life expectancy.

Some regions lag even further.

The Scorecard also highlights the fact that the U.S. health system is characterized by considerable geographic variation in each of these areas. Some regions of the U.S. not only lag other regions on health performance indicators, but they also lag other economically advanced countries even further than national averages suggest.  For example, uninsured rates ranged from 4 percent of the adult population in the District of Columbia and Massachusetts to a high of 24 percent in Texas. These differences reflect demographic differences and U.S. immigration policy, but also political choices in the implementation of federal law. If states continue to be left to address the coronavirus pandemic with little federal leadership, performance gaps will only widen as the health and economic crises persist.

National gains if all states achieved top rates* of performance:

• 18 million more adults and children insured, beyond those who already gained coverage through the ACA
• 14 million fewer adults skipping care because of its cost
• 24 million more adults with a usual source of care
• 11 million more adults receiving recommended cancer screenings
• 632,000 more young children receiving all recommended vaccines *
• 9 million more children would receive recommended annual medical and dental visits
• 1 million** fewer hospital readmissions
• 10 million** fewer emergency department visits for nonemergency care or conditions treatable with primary care
• 91,000 fewer deaths before age 75 from treatable diseases

* Performance benchmarks set at the level achieved by the top performing state with available data for this indicator.

** Estimate based on working-age population, ages 18–64, with employer-sponsored insurance, and Medicare beneficiaries age 65 and older.