On Wednesday, June 18, the Commonwealth Fund released its 2025 Scorecard on State Health System performance, part of the Commonwealth Fund’s ongoing series of reports tracking how each state’s health system is working. While states have made historic progress in expanding health coverage and improving access to care over the past decade, several proposed federal policy changes may reverse those gains, according to a news release by the foundation.

Uninsured rates have fallen in every state since 2013, according to the press release. “Fewer adults skip needed care because of the cost, a reflection of the Affordable Care Act’s (ACA) Medicaid expansion, subsidized marketplace coverage, and various consumer protections.”

The states with high uninsured rates generally haven’t expanded Medicaid. Additionally, millions of uninsured people are eligible for Medicaid, subsidies for marketplace plans, or employer health benefits, but are not enrolled, according to the report.

According to the report, wide racial disparities in premature deaths are still the norm in most states. “The mortality rate for babies born to black women nationally was more than double the rate for babies born to white women,” David C. Radley, Ph.D., noted during a press briefing on June `7. “We also found that the number of preventable deaths remained elevated in 2023 well above pre-pandemic levels in almost all states.”

Meanwhile, the number of children receiving all doses of the seven recommended early childhood vaccines fell in most states between 2019 and 2023, the report found. In five states, including Nebraska and Minnesota, the decline exceeded 10 percent. “We need clear messages from local, state, and federal health officials regarding the importance of vaccination and strategies for clinicians to engage with families regarding their concerns,” Kristen Kolb, research associate, said regarding a drop in vaccinations. “Recent actions taken by the federal government could further erode the public's confidence in vaccines.”

“Another key area of improvement, a majority of states achieved declines in drug overdose mortality between 2022 and 2023,” Sara R. Collins, Ph.D., added. However, she cautioned, “There are considerable concerns for states in the report, including declines in early childhood vaccination in 36 states and increases in infant mortality in 20 states.”

“The 2025 scorecard tells the story of incredible progress,” Joseph R. Betancourt, M.D., president of the Commonwealth Fund, remarked. However, he added, “It also underscores the peril that lies ahead….Proposed federal policy changes, between cuts to Medicaid funding, having work requirements, and making Marketplace coverage harder to afford, threaten to reverse the significant progress that has been made.”

The Commonwealth Fund is a private American foundation dedicated to promoting a high-performing healthcare system.