A study by the Commonwealth Fund ranked the 50 U.S. States as to the quality of their health care in 2009.
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Recently, U.S. States have signaled increasingly divergent approaches to health care, moving in opposite directions in the type and quality of health care systems they seek to make available to their citizens. This has renewed the question, which states and which health care systems provide the best health care? Which are ranked highest in quality?
Vermont Moves toward Single Payer System
Vermont, famously, just adopted legislation signed by the State’s Governor which aims to move the State in the direction of a Single Payer Health Care system. As reported by the New York Times, and Reuters, Vermont’s legislation adopts a state health benefits exchange, as mandated by the new federal Affordable Care Act.
The state exchange will offer coverage from private insurers, state-sponsored and multi-state plans, and will include tax credits to help make premiums affordable for uninsured residents of Vermont. Residents and small employers will be able to compare rates from the various plans and enroll for coverage of their choosing.
The exchange, called Green Mountain Care and managed by a five-member board, will also set reimbursement rates for health care providers and streamline administration into a single, unified system. The stated goal of the system is an eventual state-funded and operated single-payer system. In the long run, it aims to replace fee-for-service payment with a system that will pay health-care providers a specific amount of money to care for a specific population, providing incentives for preventive care.
Under the plan, the State will seek federal waivers that will allow it to reallocate some federal Medicaid funds, and will develop and adopt by 2014 a financing plan including other sources of funding aimed at ensuring that the new system costs less than the current fee-for-service one. Under the plan, these steps are expected to allow Vermont to proceed with the single-payer option by approximately 2017.
Vermont has already been recognized as leading the nation in the delivery of health care. The 2009 study by the Commonwealth Fund ranked Vermont # 1 – the Best State in the Nation – in terms of the quality of health care it provides to its residents.
Other States Move in Opposite Direction
On the opposite end of the spectrum, 26 states have joined in lawsuits seeking to overturn the new federal Affordable Care Act, which they dub “ObamaCare.” These states decry the individual insurance mandate which the Affordable Care Act couples with tax breaks, an expansion of Medicaid eligibility, subsidies, and insurance exchanges to help the approximately 55 million Americans currently without health insurance gain access to health care coverage.
Public officials in the 26 states opposing the Affordable Care Act have professed beliefs that health care should move further in the direction of a free market system than it already is. They argue against regulating insurance companies, and basically take an ideological approach that government should not be involved in health care. See. e.g. arguments by the South Carolina Policy Council for “Market-Based Alternatives to Federal Health Care Mandates.”
For a map showing the 26 states that have filed lawsuits seeking to overturn the Affordable Care Act, see States filing against Health Care Law, provided by MultiStateLawsuit.com, a website dedicated to promoting the litigation.
Which States Rank the Best in Health Care?
This apparent growing divergence among the States’ approaches to health care, leads one to question: which states currently are ranked best for health care? If obtaining good health care coverage is important to you, where would you choose to live?
As referenced, in 2009, the Commonwealth Fund sponsored a comprehensive study on the health care systems of all 50 U.S. States. The Commonwealth Fund is a private foundation founded in 1918 that funds independent research on health care issues and makes grants to improve health care practice and policy. The study report, Aiming Higher: Results from a State Scorecard on Health System Performance, 2009, is available on the website of the Commonwealth Foundation.
It features an interactive map of the 50 U.S. States, with clickable links on each state to detailed information on the state’s ranking and all data collected on the state’s health care system. Results are given for each of the multitude of indicators used to measure the quality of the states’ health care systems.
As reflected, Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire ranked 1 to 5 in 38 indicators of health care. At the bottom were Mississippi, along with Oklahoma, Louisiana, Arkansas, Nevada and Texas.
An image of the Commonwealth Fund map, showing the states’ rankings by quartile appears at the top of this article.
A quick comparison of the Commonwealth Foundation map ranking the current quality of health care in each of the 50 states, with the map of States filing against Health Care Law provided by MultiStateLawsuit.com, reveals that:
- Of the top 25 states in health care quality, 11 (44%) have joined the litigation to repeal the Affordable Care Act, whereas
- Of the bottom 25 states in health care quality, 15 (60%) have joined the litigation to repeal the Affordable Care Act.
Which Approach Will Provide the Best Health Care?
The future impact on health care quality of the divergent approaches being taken by the different U.S. states, of course, remains to be seen.
For health care quality alone, which state would you prefer to live in? Which approach do you believe will lead to the best health quality, most affordable, and most universally available health care — a system geared more toward unregulated free markets or one nearer to a single-payer government-run system?
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