The overall U.S. healthcare system received a “C” grade from a broad survey of U.S. adults, according to the West Health-Gallup Center for Healthcare in America, which released its inaugural report, “State of the States 2025: Insights on Healthcare in America.”
Nationwide, the healthcare system received a “D+” for cost, a “C+” for quality and a “C+” for access.
The rankings are based on an online survey of 19,535 U.S. adults conducted June 9 to Aug. 25 across all 50 states and the District of Columbia. Respondents graded the healthcare system in their state, with letter grades converted to a 4.0 GPA scale for analysis.
Across all states, 47% of survey respondents said they are concerned they will not be able to afford healthcare in the next year.
One in 5 Americans said they or someone in their household could not afford prescription medications in the past three months. That figure rose to 29% in the 10 lowest-ranked states and dropped to 15% in the 10 highest-ranked states.
Nationally, 30% said they skipped a recommended medical test or procedure in the past year due to cost. This percentage rose to 40% in the bottom 10 states and was 25% in the top 10 states.
Quality ratings also varied by state. While 71% of Americans said their provider ensures they receive all recommended screenings and evaluations, that number rose to 78% in Massachusetts and Rhode Island and dropped to 59% in Oregon and Wyoming.
Additionally, 25% of Americans said not knowing how to find a provider prevented them from receiving care. That percentage dropped to 14% in Iowa — the top-ranked state overall — and rose to 36% in New Mexico, which ranked 49th.
Access remains a top priority for hospital and health system leaders amid growing demand and capacity constraints. Many are expanding ambulatory networks and launching telehealth programs in response.
Here are the rankings of all 50 states and the district, by grade, in descending order:
1. Iowa — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
2. Massachusetts — Overall: C+ | Cost: D+ | Quality: B- | Access: C+
3. District of Columbia — Overall: C | Cost: D+ | Quality: C+ | Access: C
4. Rhode Island — Overall: C | Cost: D+ | Quality: C+ | Access: C
5. Virginia — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
6. Pennsylvania — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
7. North Carolina — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
8. North Dakota — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
9. Michigan — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
10. Nebraska — Overall: C+ | Cost: D | Quality: C+ | Access: C+
11. Ohio — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
12. Minnesota — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
13. Wisconsin — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
14. Maryland — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
15. New York — Overall: C | Cost: D+ | Quality: C | Access: C
16. New Jersey — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
17. Connecticut — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
18. Missouri — Overall: C | Cost: D+ | Quality: C+ | Access: C+
19. New Hampshire — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
20. South Carolina — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
21. South Dakota — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
22. California — Overall: C | Cost: D+ | Quality: C+ | Access: C
23. Georgia — Overall: C | Cost: D+ | Quality: C | Access: C
24. Hawaii — Overall: C+ | Cost: C- | Quality: C+ | Access: C
25. Tennessee — Overall: C | Cost: D | Quality: C | Access: C
26. Colorado — Overall: C | Cost: D | Quality: C+ | Access: C+
27. Illinois — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
28. Maine — Overall: C | Cost: D | Quality: C | Access: C
29. Utah — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
30. Indiana — Overall: C | Cost: D+ | Quality: C+ | Access: C+
31. Idaho — Overall: C | Cost: D | Quality: C+ | Access: C
32. Alabama — Overall: C+ | Cost: D+ | Quality: C+ | Access: C+
33. West Virginia — Overall: C | Cost: D | Quality: C | Access: C
34. Washington — Overall: C | Cost: D+ | Quality: C+ | Access: C
35. Kentucky — Overall: C | Cost: D+ | Quality: C | Access: C
36. Louisiana — Overall: C | Cost: D+ | Quality: C | Access: C+
37. Kansas — Overall: C | Cost: D+ | Quality: C+ | Access: C+
38. Florida — Overall: C | Cost: D+ | Quality: C+ | Access: C+
39. Wyoming — Overall: C | Cost: D+ | Quality: C | Access: C
40. Oklahoma — Overall: C- | Cost: D+ | Quality: C | Access: C
41. Oregon — Overall: C | Cost: D | Quality: C | Access: C-
42. Montana — Overall: C | Cost: D | Quality: C+ | Access: C
43. Arkansas — Overall: C | Cost: D+ | Quality: C | Access: C
44. Mississippi — Overall: C | Cost: D+ | Quality: C | Access: C+
45. Arizona — Overall: C | Cost: D+ | Quality: C | Access: C
46. Delaware — Overall: C | Cost: D+ | Quality: C | Access: C-
47. Vermont — Overall: C- | Cost: D | Quality: C | Access: C-
48. Texas — Overall: C | Cost: D+ | Quality: C+ | Access: C+
49. New Mexico — Overall: C- | Cost: D+ | Quality: C | Access: D+
50. Nevada — Overall: C- | Cost: D+ | Quality: C- | Access: C-
51. Alaska — Overall: C- | Cost: D | Quality: C | Access: C-
