Connecticut ranks 11th in U.S. healthcare, but disparities remain wide, new report finds

CT Insider – Wednesday, June 18, 2025
By Cris Villalonga-Vivoni

People in all 50 states, in addition to Washington, D.C., have had more access to health coverage and care than ever before over the last decade, according to the latest report from the national nonprofit and health care think tank, the Commonwealth Fund.

The number of people living without health insurance or skipping care due to cost is at an all-time low, thanks to federal and state efforts to increase access to Medicaid, like the Affordable Care Act’s coverage expansion and the creation of financial aid programs through the state’s insurance marketplace.

“These gains are remarkable. They are also fragile,” said Dr. Joseph Betancourt, president of the fund. “Proposed federal policy changes, like cuts to Medicaid funding, work requirements, making marketplace coverage harder to afford, threaten to reverse the significant progress that has been made.”

Since 2006, the Commonwealth Fund’s annual health system report has compared the effectiveness of a state’s health care system based on 50 measures assessing access, affordability, quality of care, and resulting health outcomes and equity. It relies on the most recently available public data through the federal agencies, which, for the newest report, is as of 2023.

Massachusetts, Hawaii, New Hampshire, Rhode Island and the District of Columbia ranked in the top five states with the best health system performance, said David Radley, senior scientist for health system tracking at Commonwealth Fund and one of the authors of the study.

Speaking at a press conference, Radley said the top five rankings reflect the states where residents generally have better access to high-quality care, better health outcomes, and experience lower rates of racial and economic disparities.

Several factors cause variations between health systems, but state policy choices ultimately influence these, the report found. For example, several states that didn’t expand Medicaid with the passage of the Affordable Care Act reported worse health outcomes than the states that did.

“When it comes to having affordable health coverage, good-quality care, and the opportunity to live a healthy life, where you live matters in the U.S.,” the report concludes. “Targeted, coordinated federal and state policies are needed to raise health system performance across the nation.”

The growing access to health coverage and care, however, has not helped address some of the ongoing and widening racial and economic disparities between communities and states.

Premature deaths from avoidable causes, like treatable chronic conditions, are more common in the U.S. and are rising faster than in other high-income countries. Death rates vary significantly between states, yet Black Americans had premature death rates that were often two to three times higher than the lowest rate in their home state, reflecting a history of racial and discriminatory policies, health-related social challenges and lower rates of insurance coverage.

Infant mortality rates also worsened in 20 states between 2018 and 2022 despite nationwide efforts to improve maternal care access. More than double the number of children born to Black women die within a year of life compared to babies born to white women.

“Some recently released provisional data for 2024 shows some improvement in the infant mortality rate at the national level, but decreasing access to women’s health and reproductive care services raises concern about the potential for disparities between states to worsen further,” said Kristen Kolb, Commonwealth Fund research associate and one of the study’s authors.

Nearly every state also saw a decline in the number of children receiving all seven of the recommended early childhood vaccines, like measles and polio, said Kolb. She said fewer than 75% of young children nationwide received all doses in 2023, with the northeast reporting some of the highest vaccination rates.

There are several reasons children may start the vaccine series but not receive all of the recommended doses. Uninsured children living in poverty or rural areas are less likely to complete the vaccine series, Kolb said. The nation’s long history of vaccine hesitancy, which was worsened by the COVID-19 pandemic, is also driving the decline in childhood vaccines.

Kolb added that recent actions by the federal government may also further erode the public’s confidence in vaccines, including the abrupt changes to the CDC’s Advisory Committee on Immunization Practices, which puts out the vaccine and immunization recommendations.

“We need clear messages from local, state and federal health officials regarding the importance of vaccination and strategies for clinicians to engage with families regarding their concerns,” Kolb said.

How does Connecticut compare?

Connecticut’s health system ranked 11th overall on the fund’s scorecard; however, the Nutmeg State has some significant disparities between its communities. Despite ranking in the top 10 for its access and prevention efforts, Connecticut is ranked 48th in avoidable hospital costs and 37th in income disparities.

Then, when compared more regionally, Connecticut ranks the lowest among its New England neighbors —Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.

Disparities in access to care and affordability are helping drive the gaps in health outcomes. For example, Hispanic adults over 18 are three times more likely to go without a usual source of care than white residents from 2021-2022. In addition, the premature death rate caused by treatable health issues for Black residents is more than double that of white people.

The report highlighted ways Connecticut has improved over the years, such as having fewer people with medical debt in collections and lowering the number of children going without medical and dental preventive care.

Future of care

Recent proposed changes on the federal level could ripple out in various ways, as the report and its authors caution, potentially impacting all the gains made over the last decade.

The Congressional Budget Office projects that Medicaid and the ACA marketplace provisions in the reconciliation bill going through Congress, combined with the expiration of extra premium tax credits for marketplace plans, will increase the number of uninsured by 16 million by 2034, said Sara Collins, vice president for health care coverage, access and tracking health system performance at The Commonwealth Fund.

For example, one of the proposed changes to the Medicaid program would be the introduction of nationwide work requirements and more frequent eligibility checks. The report estimates that nearly 8.8 million nationwide may become uninsured as a result.

Implementing work requirements would also come at “an enormous federal and state expense that far outweighed what it would have cost just to do a normal Medicaid expansion,” said Collins.

“The irony of these changes is that most people that will be impacted are already working. They have jobs,” she said. “The reporting requirements will be the thing that really does lead to people just not enrolling and becoming uninsured. People really have no other options.”

The drastic funding cuts to federal agencies also have a trickle-down effect on local and state efforts to address public health issues. For example, although the report found that the number of overdose deaths has fallen in recent years, there may be a rise in the number of people who can’t access treatment with the recent elimination of the federal Substance Abuse and Mental Health Services Administration.

“States have shown they can make lasting gains in the health of their residents, but they can’t go it alone,” Collins said. “Improvement requires from the federal government leadership, commitment to science and stable financial support.”

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