This story was reprinted by Stateline, an initiative of The Pew Charitable Trusts.
Healthcare systems in Hawaii and Maine performed best of all states during the COVID-19 pandemic, according to new rankings that assessed factors such as vaccination rates, capacity in hospitals and intensive care units, and mortality rates.
Alabama finished last in the rankings, followed by Oklahoma, Kentucky, Mississippi and Georgia.
Maryland has come in at number 6.
The rankings, released last week, were compiled by the Commonwealth Fund, a private foundation that promotes health equity and greater quality, efficiency and access to health care. Each year, the Commonwealth uses dozens of measures to produce a ranking of state health systems. This year, it added specific categories on the performance of state health systems during COVID-19 from February 2020 to late March 2022. Vermont, Washington, and Oregon completed the top five.
In general, states believed to have overall stronger health systems also ranked well in their COVID-19 performance. The reverse was true for those who scored poorly on the overall health care ranking.
The rapidity with which states were shot in arms after vaccines first became available in late 2020 was one of the measures used by the Commonwealth to assess the state’s response to COVID-19.
Vermont was the fastest, followed by Massachusetts, Connecticut and Maine. They were able to fully vaccinate (i.e., typically, two doses) 70% of the population 12 years of age and older within 200 days of the vaccines becoming available.
In contrast, 21 states had not yet reached 70% by the end of March 2022. Alabama, Mississippi and Wyoming had not even managed to reach 60%.
Although the U.S. Centers for Disease Control and Prevention recommended the boosters, fewer than 40 percent of adults in the United States had received one by the end of March, with rates varying considerably across states.
More than half of adults have received boosters in Maine, Rhode Island, and Vermont. In contrast, not even a quarter of adults in Alabama, Mississippi and North Carolina had received a booster injection.
Another measure examined by Commonwealth analysts was the stress of hospital systems during the pandemic. The report found that between August 2020 and March 2022, the nation suffered 4.6 million COVID-19-related hospitalizations. To determine how pressured health systems were, analysts measured the number of days during that time when at least 80 percent of ICU beds in each state were occupied.
They found that 16 states and the District of Columbia operated in ICU with a capacity of 80 percent or greater for at least 150 days. Texas and Alabama were at or above this rate for 566 and 517 days, respectively. Georgia, Mississippi, New Mexico, Oklahoma, and Rhode Island each exceeded 300 days of 80% or more.
Another measure used by the Commonwealth in its rankings was the number of “excess” deaths that each state suffered during the pandemic. The excess deaths, the analysis explains, mean deaths above the norm, some due to COVID-19, but others the consequence of interruptions in access to health care caused by the pandemic.
In general, states with stronger overall health systems had fewer excess deaths than states with weaker systems.
The excess death toll ranged from a low of 110 per 100,000 people in Hawaii to a high of 596 per 100,000 in Mississippi.
Nationally, the analysis found that premature deaths from treatable diseases such as heart disease and diabetes increased between 2019 and 2020 from 83.8 to 89.8 deaths per 100,000 residents. The most pronounced increases were in the Midwest and the South.
The good news in the report is that the rate of people with health insurance remained fairly stable across states during the pandemic, even though it dropped slightly in 2021.
The reasons: Fewer people than expected have lost their employer-sponsored health insurance, the Affordable Care Act’s safety net provisions helped those who lost their insurance, Congressional action at the start of the pandemic it kept people enrolled in Medicaid, and during the pandemic, more subsidies became available to help people pay for private health insurance plans.
Some of these provisions will expire when the national public health emergency is lifted, which could cause a sharp drop in the number of people with health insurance.
State Health System Performance on COVID-19
|1. Hawaii||26. Ohio|
|2. Maine||27. Kansas|
|3. Vermont||28. Michigan|
|4. Washington||29. Rhode Island|
|5. Oregon||30. South Dakota|
|6. Maryland||31. Tennessee|
|7. Utah||32. North Carolina|
|8. Massachusetts||33. Indian|
|9. Minnesota||34. Montana|
|10. Connecticut||35. Nevada|
|11. Virginia||36. Wyoming|
|12. Illinois||37. New Mexico|
|13. New Hampshire||38. Arizona|
|14. Alaska||39. Missouri|
|15. Nebraska||40. Louisiana|
|16. New York||41. North Dakota|
|17. Colorado||42. Arkansas|
|18. New Jersey||43. Texas|
|19. California||44. West Virginia|
|20. Wisconsin||45. South Carolina|
|21. Iowa||46. Georgia|
|22. Idaho||47. Mississippi|
|23. Delaware||48. Kentucky|
|24. Florida||49. Oklahoma|
|25. Pennsylvania||50. Alabama|
Source: The Commonwealth Fund