Wow, have you seen the report on the state of women’s health across the United States? It’s a real eye-opener, and frankly, it highlights some of the serious challenges we face, especially when it comes to reproductive health care. This new state-by-state scorecard, released by the Commonwealth Fund, reveals growing disparities and raises significant concerns about where we stand and the ripple effect of the major Supreme Court decision overturning Roe v. Wade in 2022.
This 2024 State-by-State Women’s Health and Reproductive Health Care Scorecard is actually The Commonwealth Fund’s first in-depth survey of women’s health care in the 50 states and the District of Columbia. Using the most recent data available, the findings are stark. We see significant disparities among states not only in reproductive health care, but also in women’s overall health, as well as troubling and deepening racial and ethnic disparities in health outcomes. There are stark inequities in avoidable deaths and access to essential services – and the report suggests that these disparities are likely to get even larger, especially for women of color and low-income women in states that have tightened reproductive health services.
Let’s dive into some of the scorecard’s highlights. In women’s health and reproductive health care, this year’s top-ranked states are Massachusetts, Vermont, and Rhode Island. These states did the best on 32 measures that cover health care access, quality, and health outcomes.
But at the other end of the spectrum, we see Mississippi, Texas, Nevada and Oklahoma performing the worst. This geographic disparity becomes even more pronounced when looking at specific health outcomes such as mortality rates.
The number of deaths from all causes among women of childbearing age (15-44 years) is highest in the southeastern states. These deaths are not only pregnancy-related, but also include other preventable causes such as substance use, COVID-19, and even treatable chronic diseases. This is a sobering picture.
When we look specifically at maternal mortality, Tennessee, Mississippi, and Louisiana have the highest rates. In contrast, Vermont, California and Connecticut have the lowest maternal mortality rates. Nationally, the disparities are heartbreakingly obvious, with the highest rates among black, American Indian and Alaska Native women. This crisis is particularly acute in the Mississippi Delta region, which includes Arkansas, Louisiana, Mississippi and Tennessee. Notably, a significant number of counties in these states do not even have a hospital or birthing center that provides obstetric care.
These states also tend to rank low in other factors contributing to maternal deaths. Low screening rates for postpartum depression, high rates of cesarean sections for low-risk births, and high rates of uninsurance even before pregnancy. It may not be a coincidence that all four states had abortion restrictions before the Dobbs decision and now have total bans on abortion.
Interestingly, the report emphasizes that mental health conditions are actually preventable. The most common causes of pregnancy-related deaths include suicide deaths and overdose deaths related to substance use disorders. The good news is that the states with the highest rates of postpartum depression screening also had the lowest rates of postpartum depression. This really highlights the power of preventive care and screening!
Insurance coverage is a key factor in making health care accessible and affordable, and we see even more disparities when it comes to insurance coverage. Among women ages 15-44, Texas, Georgia, and Oklahoma have the highest rates of uninsured women. Meanwhile, Massachusetts, the District of Columbia, and Vermont have the lowest uninsured rates.
Access to insurance is absolutely critical. Insured women are more likely to have access to needed preventive care, primary care, and specialty services, and they are also more likely to have access to the latest advances in women’s health. By 2023, one in ten women ages 19-64 will be uninsured, a sizable number considering that most women have some form of insurance.
Let’s talk about types of insurance. Employer-provided insurance is the most common, covering about 60 percent of women ages 19-64 in 2023. Women in households with full-time workers are more likely to have this type of work-based insurance. Of course, premiums can be high, averaging more than $8,400 per year for an individual and nearly $24,000 per year for a family in 2023, with workers paying a significant portion.
By 2023, the ACA provides premium tax credits for many individuals who purchase coverage through state marketplaces and ends practices such as gender rating and denial of coverage for pre-existing conditions such as pregnancy. In addition, insurance plans must now cover essential health benefits, including maternal and newborn care. While the temporary subsidies have increased enrollment, the possibility of their expiration at the end of 2025 is a looming concern that could significantly increase costs for enrollees.
Medicaid, a program for low-income people, will cover 19 percent of adult women ages 19 to 64 by 2023, a higher percentage than men.The ACA allows states to expand Medicaid to more low-income people, regardless of family or disability status, and 40 states and Washington, D.C., have already done so.
In addition to maternal health and insurance, the scorecard focuses on issues such as cancer mortality. Breast and cervical cancers are usually preventable and treatable through timely screening, but there are significant regional differences in mortality rates for these two cancers. Southeastern states tend to have higher mortality rates for these cancers and lower screening rates than Northeastern states, which typically have higher screening rates and lower mortality rates.
This isn’t just about statistics; these are real people facing real barriers. Consider this experience shared in the background material: An Oklahoma woman who got an abnormal mammogram result was told she would have to wait 54 days for a follow-up appointment with the necessary technology in Oklahoma City.54 days! Thinking it was a mistake, she called the clinic directly, only to have the scheduler be shocked that she got an appointment so quickly, saying it usually takes longer. Can you imagine the agony of waiting that long for a potential cancer diagnosis?
This first-hand story highlights the depressing reality behind the numbers, and makes something else extraordinarily unpleasant: Gov. Kevin Stitt’s recent decision to veto bipartisan legislation aimed at increasing access to diagnostic mammography testing. The bill would have required insurance companies to cover the cost without co-pays or deductibles. The bill overwhelmingly passed both houses of the legislature and appeared to be a no-brainer, especially in a state like Oklahoma where women die from breast cancer at a rate higher than the national average (22.4 per 100,000 women versus 19.3 nationally, and a staggering 36.4 in the rural area of McCurtain County).
The United States Preventive Services Task Force emphasized that early detection significantly improves breast cancer survival rates and that black women are 40 per cent more likely to die from breast cancer than white women. It also emphasized the importance of fair and appropriate follow-up treatment.
The disparities highlighted in the Commonwealth Fund Scorecard, as well as individual stories from states such as Oklahoma, paint a clear picture: women’s access to basic health care is not uniform across the United States.
Factors such as geography, race, income, insurance coverage, and state laws regulating reproductive health care have a profound impact on health outcomes. Addressing these disparities requires multifaceted measures to ensure that policies truly prioritize patient well-being and access to care over political ideology or economic interests.
We call for action to ensure that necessary screenings are not delayed for months at a time, that life-saving procedures are not complicated by confusing legislation, and that every woman around the world has the opportunity to access the care she needs, when she needs it, without unnecessary burden or fear. This scorecard is a powerful reminder of how much more we have to do to build a future where every woman’s health is truly valued and protected.
Related posts:
How Does Your State Rank on Women’s Health and Reproductive Care?
Oklahoma women die of breast cancer at high rates, yet Gov. Kevin Stitt rebuffed access to screening
Anti-abortion bill passes out of Oklahoma House Public Health Committee
