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Lack of Medicaid Expansion Hurts Florida in National Health Care Rankings

Thank God for Mississippi. And Oklahoma and Louisiana. Those are the only states that fared worse than Florida on a national health care survey released Thursday.

Florida ranked No. 48 overall among the 50 states and District of Columbia on The Commonwealth Fund’s 2018 Scorecard on State Health System Performance. Among categories, the state ranked No. 49 for access and affordability; prevention and treatment; avoidable hospital use and cost; and providing equal access to health care.

The state improved in more areas than not. The number of uninsured adults and children declined. Fewer adults went without care because of cost. More home health care patients were up and walking. More mentally ill adults found treatment. Fewer breast cancer patients died.

But many areas saw no improvement. Or are getting worse. For example, the hospital 30-day mortality rate. More adults smoked, were obese, lost six or more teeth or reported only fair or poor health. In other areas, the state held steady.

“Florida is one of the states that has not expanded Medicaid,” Sara Collins, vice president for health care coverage and access, said during a conference call. “States that expanded their Medicaid programs had much larger drops in their uninsured rates than states that didn’t. Florida is very much in that category.”

Fund President David Blumenthal outlined the national trends.

“While the 2018 State Scorecard provides some good news about the direction we’re heading, we do continue to see wide disparities between states. Also of concern are some areas where we see no progress or even reversal of positive trends,” he said.

Life expectancy has fallen, largely because of the opioid crisis, and premature deaths from preventable or treatable causes are increasing in many states. Obesity rates are on the rise, too, he said.

The Affordable Care Act is behind much of the improvement. “But these gains may be at risk,” Blumenthal said. Tracking data show an increase in the uninsured rate among working-age adults, from 12.7 percent in 2016 to 15.5 percent in 2018.

“Recent administration policies such as repeal of the individual mandate penalty and promotion of plans that do not comply with ACA rules could accelerate this trend,” Blumenthal said. These potential setbacks remind us that holding on to gains made, and addressing new problems that arise, will take concerted efforts on the part of federal, state, and local policymakers, the public, and private health care sectors.”

The organization is a private foundation dedicated to improving access, quality, and efficiency in the health care system. It has released its annual scorecards since 2006. The report compared 43 measures of performance for every state.

In addition to the findings on premature deaths and the ACA, researchers found that many states are not getting good value for their health care dollars, in the form of mental health care gaps and delivery of high-cost services that provide little benefit to patients.

Among other findings, the highest and lowest ranked states — Hawaii and Mississippi, respectively — stood out among even similarly ranked states. Oregon made the biggest jump in its ranking — 10 spots.

“It’s worth noting that eight of the 10 top-ranked states expanded their Medicaid programs under the Affordable Care Act, while seven of the 10 bottom-ranked states did not,” senior scientist David Radley said.

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