The report examines health insurance coverage trends across states since the beginning of the decade and finds a decline in health insurance coverage for adults-in 1999-2000 there were only two states with 23 percent or more of adults uninsured, by 2007-2008 there were nine. In 1999-2000, 22 states had less than 14 percent of adults uninsured; by 2007-2008 the number dropped to only 11 states. Children fared much better-due in large part to the CHIP program. The number of states with 16 percent or more of children uninsured dropped from nine to three between 1999-2000 and 2007-2008.

Gaps in coverage between states were particularly stark, with 32 percent of working-age adults uninsured in Texas compared to only 7 percent in Massachusetts as of 2007-2008. Several states stood out in terms of health insurance coverage expansions, as part of comprehensive reforms. Massachusetts, which had only begun to implement its universal health insurance program during the period covered by the State Scorecard, had the greatest increase in coverage for adults and gains in coverage for children. The reforms passed by Vermont in 2006 to cover the uninsured and establish a "blueprint for health" focused on preventing and controlling chronic disease are providing a new model for other states. And, Minnesota has achieved high rates of adult coverage and better preventive care through public-private collaboration.Additional Opportunities to Improve

Poorly coordinated care and inefficient use of resources continue to undermine care and drive up costs in many state health care systems, according to the report. States with higher medical costs tend to have higher rates of readmissions to the hospital and potentially preventable hospital admissions for chronic conditions like asthma and diabetes.

The report finds that several states in the Upper Midwest-Iowa, Minnesota, Nebraska, North Dakota, and South Dakota-were all providing high quality care at lower cost. Their examples suggest that better coordinated care and more efficient use of resources could improve the quality of care people receive while keeping cost in check.Moving Forward

The State Scorecard's overall findings of eroding coverage and rising costs, and concerns about poorly coordinated care, underscore the need for comprehensive national reforms that can expand health insurance coverage, improve quality, and control costs. The report points to the uneven performance or failure to improve on many scorecard indicators as further evidence of the pressing need for coordinated national action. The authors conclude that federal action is needed to raise the floor on performance levels across all states and create a supportive climate for state innovation. If the health care system continues on its current course of rising costs and declining health insurance coverage, states will have an increasingly difficult time going it alone on providing access to affordable, quality health care.

Source: Commonwealth Fund