Over the past decade, states have made historic gains in health coverage and access, but that progress is at risk from proposed Medicaid and marketplace cuts and added red tape.

Historic Coverage Gains at Risk, New State Health Scorecard Shows

June 18, 2025

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Every state has reduced its uninsured rate over the past decade, and today there are fewer adults who are skipping needed care because of the cost. This progress is largely due to the Affordable Care Act’s Medicaid expansion, marketplace plan subsidies, and consumer protections.

That progress is now at risk. Proposed Medicaid funding cuts, work requirements, new requirements for enrolling in marketplace plans, and the expiration of enhanced ACA premium subsidies could together leave millions of Americans uninsured and drive up costs for many more.

The Commonwealth Fund’s new 2025 Scorecard on State Health System Performance offers a comprehensive look at how well health care systems are meeting people’s needs ([link removed] ) in all 50 states and the District of Columbia, based on the most recent data available. While coverage and access have improved, the report also identifies some troubling trends and persistent gaps:

- Early childhood vaccination rates have dropped in nearly every state.
- Infant mortality worsened, with wide disparities between states.
- Avoidable deaths remain high, with stark racial gaps.

Get the scorecard
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Affordable, quality health care. For everyone.

The Commonwealth Fund, 1 East 75th Street, New York, NY 10021

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