The 10 states with the best health care, according to patients, Medical Economics, November 18, 2025, by Austin Littrell
A West Health-Gallup survey of nearly 20,000 U.S. adults finds large differences in health care affordability, access and quality across the country.
#1. Iowa
Iowa ranks first in the nation for overall health care experience, earning an overall grade of C+, with D+ for cost and C+ for both quality and access.
Iowa is among the states where fewer than 21% of residents say they skipped a recommended medical test or procedure in the past 12 months because of cost, compared to rates above 40% in several bottom-ranked states. In addition, 12% of Iowans report that someone in their household could not afford prescription medications in the past three months, one of the lowest rates highlighted in the analysis and well below the national figure of 20%.
#51. Alaska
Alaska sits last in the national rankings at 51st, with an overall grade of C-, and receives a D for cost. C for quality and C- for access.
Alaska is grouped with other bottom-ranked states like Texas, New Mexico and Nevada that report “widespread challenges,” including higher rates of delayed or foregone care, more difficulty accessing services and lower confidence in available care.
Although national-level figures show affordability pressures rising everywhere, Alaska’s combination of weak cost and access grades within the Scorecard helps explain why it trails the rest of the country on overall health care experience.
Comment:
By Don McCanne, M.D.
West Health and Gallup have a reputation for developing reliable surveys in health care. This one, which ranks the health care systems of the fifty states and D.C., is remarkable because the first ranking state and the last one are strikingly similar in their performance grades: Cs & Ds.
It is not that the lowest ranking state ranked nearly as high as the highest one, instead the highest one ranked nearly as low as the lowest. It’s stunning. All states are bunched together with very high costs and extremely poor performance.
Many advocate for enacting health system reform state by state, just as Canada did by starting in one province (Saskatchewan). The fact is, we need comprehensive reform in all states, and prior experience demonstrated that many state governments will be unresponsive to the needs of citizenry (none will be, according to this survey).
Thus reform should be universal, including all residents in the nation, regardless of state of residence. A well-designed single payer program does precisely that. It would be simple, generous, equitable, efficient, and health enhancing – for everyone. As this West Health-Gallup survey indicates, no state should be left out. And we need to do it now.
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