The 2014 Women’s Health Report Card underscores that states have a long way to go to ensure that all women, regardless of where they are born or live, their racial/ethnic backgrounds, and their income levels, have access to the health care they need to lead healthy and prosperous lives. The report card finds wide variations across states in the areas of health coverage for women, women’s access to health care, and women’s health outcomes. It also finds serious racial disparities in women’s health within states.
Best and Worst Overall Rankings
The states with the best overall rankings are Massachusetts (#1), Connecticut (#2), Hawaii (tied for #3), Vermont (tied for #3), and Minnesota (#5). The states with the worst overall rankings are Mississippi (#50), Oklahoma (#49), Texas (#48), Nevada (#47), and Arkansas (#46).
Consistently Poor Performers
Some states performed consistently poorly across all three subject areas. Twelve states received grades of D or F (meaning they ranked in the bottom 20) in all three subject areas, including Arkansas, Georgia, Idaho, Indiana, Louisiana, Mississippi, Missouri, Oklahoma, South Carolina, Texas, West Virginia, and Wyoming. Seven more states received grades of D or F (ranking in the bottom 20) in two of the three categories, including Alaska, Arizona, Florida, Montana, Nevada, New Mexico, and Utah. In these states, many women lack health coverage, lack access to routine and preventive health care, and have correspondingly worse health outcomes.
Widespread Room for Improvement
Even among states that tended to perform better, there is still significant room for improvement in specific areas. For example: Delaware and Maryland received A-level grades on health coverage and access to care, but C-level grades on health outcomes; Maine received an A-level grade on access and a B-level grade on coverage, but a D-level grade on outcomes; Ohio and Pennsylvania received B-level grades on coverage and access, but D-level grades on outcomes; and Michigan received B-level grades on coverage and access, but an F-level grade on outcomes. Only two states — Massachusetts and Connecticut — received A-level grades in all three subject areas.
Persistent Racial Disparities
Examining states’ performance for different racial groups underscores that there is much work to do to eliminate racial disparities in women’s health. Across the country, major race-based disparities persist across a wide range of women’s health measures.
These disparities are evident in the data on health coverage for women of color. In 28 states, the uninsured rate for black women was at least 10 percent higher than for women overall; in 17 states, it was at least 20 percent higher. The disparities were even wider for Latina women: in 49 states, the uninsured rate for Latina women was at least 20 percent higher than for women overall; in 44 states, it was at least 50 percent higher; and in 18 states, it was at least twice as high.
Racial disparities are also evident in the data on health outcomes for women across communities. For example:
- Hypertension rates among black women: In all 38 states with reported data for black women, the hypertension rate for black women was at least 20 percent higher than for women overall; in 13 states, it was at least 50 percent higher.
- Infant mortality rates among black women: In all 38 states with reported data for black women, the infant mortality rate for black women was at least 20 percent higher than for women overall; in 33 states, it was at least 50 percent higher; and in seven states, it was at least twice as high.
- Diabetes rates among Latina women: Diabetes rates for Latina women: in 28 states, the diabetes rate for Latina women was at least 20 percent higher than for women overall; in 19 states, it was at least 50 percent higher; and in three states, it was at least twice as high.
- Asthma rates among Native American women: In 13 of the 22 states with reported data for Native women, the asthma rate for Native women was at least 20 percent higher than for women overall; in 10 states, the asthma rate for Native women was at least 50 percent higher; and in seven states, it was at least twice as high.
- Infant mortality rates among NativeAmerican women: In 14 of the 15 states with reported data for Native women, the infant mortality rate for Native women was at least 20 percent higher than for women overall; in eight states, it was at least 50 percent higher.
While all states should seek to improve their records on women’s health overall and work to reduce racial disparities, the results of the 2014 Women’s Health Report Card should be of particular concern to policymakers in states that received grades of C, D or F. These states have a middling, poor, or failing record when it comes to meeting women’s health needs. They have, to date, failed to give their women residents fair opportunities to lead healthy, prosperous, and productive lives. This harms not only women but also their families, their communities, and their states.
Many of the 21 states that have, as of September 2014, rejected federal funding to expand health coverage to low-income state residents through Medicaid received poor overall grades in this report card. In fact, seven of the states that have rejected Medicaid expansion received an F grade, six more received a D, and four more received a C. All told, 17 of the 21 states rejecting Medicaid expansion as of September 2014 received a grade of C or worse.2
Expanding health coverage through Medicaid presents an opportunity for states to improve their overall performance on women’s health, gain ground in relation to higher-performing states, and reduce racial disparities within their states. On that last point, there is a strong racial equity case for states that have so far rejected Medicaid expansion to change course, particularly considering demographic shifts that mean communities of color are making up an increasing share of the population in many of these states. But, as long as these states continue to refuse this opportunity, they will risk falling even further behind other states that have moved forward with expanded coverage.
The results of the 2014 Women’s Health Report Card should serve as a call to action for state policymakers to commit attention and resources to advancing an agenda that improves women’s health and promotes racial equity. The report card concludes with a set of recommendations to support these goals, summarized here:
Health Coverage for Women
- Implement Medicaid expansion in all states that have not yet done so.
- Invest in community-based outreach and enrollment strategies targeted toward low-income women and communities of color.
- Ensure robust competition in state insurance marketplaces and strengthen oversight to ensure that all plans cover required essential health benefits important to women.
Women’s Access to Health Care
- Establish and enforce strong network adequacy standards in state insurance marketplaces to ensure that services will be accessible without unreasonable delay.
- Ensure that all women, regardless of income, have access to the reproductive and family planning services they need to be healthy.
- Invest in workforce development strategies that increase health workforce diversity.
- Strengthen cultural competency in states’ health workforces.
- Ease provider shortages by investing in community health clinics, updating scope of practice rules, and creating incentives for providers to locate in underserved areas.
Women’s Health Outcomes
- Invest in preventive care for women.
- Improve chronic disease management for women.
- Improve health data collection focusing on women, with a particular focus on low-income women and women of color.
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