Commonwealth Fund 2020 health care rankings

The Commonwealth Fund released its 2020 Scorecard on State Health System Performance Sept. 11, offering a state-by-state comparison on a broad range of health indicators prior to the COVID-19 pandemic.


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The new scorecard includes a total of 49 measurements, such as “Access and Affordability” which looks at rates of insurance coverage and cost barriers, “Prevention and Treatment” which measures preventive care and quality of care in hospital, ambulatory, and long-term care settings, and “Healthy Lives” which measures premature death, health risk behaviors, and state public health funding. 

From a national perspective, this year’s report indicates several concerning trends:

    • “Insurance coverage gains associated with the Affordable Care Act (ACA) have stalled, and affordability and out-of-pocket costs are worsening.
    •  Increased prices for health care services are a major driver of overall spending growth, and this has led to higher costs for consumers in commercial plans.
    • Premature deaths from treatable conditions and deaths from suicide, alcohol, and drug overdose continue to impact life expectancy.” 

Broken down by individual states including the District of Columbia, the data reflects a wide variation in health indicator rankings across the country, particularly in the Southwest region.  


Texas’s health care scorecard hasn’t changed much according to The Commonwealth Fund, with the state’s overall ranking is 42 out of 51, up 6 spots from their baseline score but still indicating many areas in need of improvement. 

Texas is one of the bottom states in improvement according to Commonwealth Fund, having only shown improvement on 9 indicators.

The most improved indicators for Texas include nursing home residents with fewer antipsychotic medication, home health patients with increased mobility, and more children receiving mental health care. 

The indicators that worsened the most were preventable hospitalizations in the 18-64 age range, the 30-day mortality rate in hospitals, and adults without all recommended vaccines. 

Compared to the U.S. average, Texas is above average in prevention and treatment of illnesses and overall healthy lives of residents, but falls below average on access and affordability to health care, hospital use and cost, and health care disparity. 


Colorado, on the other hand, is ranked 6th in the country, with the latest data showing a decrease in obese adults, high patient satisfaction ratings for hospital service, and a decrease in preventable hospitalizations among patients aged 18-64. 

The state also ranks above the U.S. average in access and affordability to health care services, prevention and treatment of illnesses, avoidable hospital use and cost, healthy lives, and disparity. 

Colorado has also expanded Medicaid and offers reinsurance programs for residents who may have lost their coverage. 

Like Texas, Colorado does not require employment for residents to receive Medicaid benefits. 


Utah follows closely behind Colorado with an overall rank of 9 out of 51, but the state’s score decreased by 3 positions with an increase in preventable hospitalizations and an increase in hospital readmission rates. 

Compared to the U.S. average, however, Utah is above average on all factors but one. 

The state is above average when it comes to access and affordability of health care, avoidable hospital use and cost, healthy lives and disparity, and below average on illness prevention and treatment. 

Unlike Texas and Colorado, however, not only has Utah expanded Medicaid, but the state also requires eligible Medicaid recipients to be employed. 

Like Texas, they do not operate a reinsurance program. 


Nine spots above Texas, Arizona has an overall rank of 33, up three spots from the previous ranking. 

Arizona’s most improved indicators are an increase of home health patients with mobility, nursing home residents without antipsychotic medication prescriptions, and diabetic adults receiving their annual hemoglobin A1c tests. 

Like Colorado, Arizona ranks above the U.S. average for affordability and access to health care, illness prevention and treatment, avoidable hospital use and cost, healthy lives, and disparity. 

Also similar to Colorado, Arizona has expanded Medicaid and will also required Medicaid enrollees to have employment to receive benefits in the future.