These trends are clear: millions of Americans are facing growing challenges to their health and financial wellbeing. A first-of-its-kind study from the newly launched West Health-Gallup Center for Healthcare in America reveals that these struggles differ significantly depending on where people live and help explain why healthcare is so central to our politics and our everyday lives.
The new release, State of the States (SOS) Study: Insights on Healthcare in America, offers a comprehensive picture of healthcare across all 50 states and the District of Columbia, uncovering big differences in how Americans experience healthcare. Unlike many existing rankings that focus on system-level metrics or health outcomes, the West Health-Gallup rankings fill a critical gap by capturing how Americans perceive cost, quality and access in their daily lives.
Based on the responses of nearly 20,000 Americans conducted across all 50 states and the District of Columbia, the study looks at three core pillars: cost, quality and access, assessing each state and ranking them based on how people responded to 27 detailed questions about their personal healthcare experiences. Together, the results reveal a sobering portrait of healthcare in America -- while some states outperform the national average, no state earns top marks.
Healthcare Experiences Vary Sharply by State
The SOS Study finds that where Americans live has a significant impact on how they experience healthcare. Iowa, Massachusetts, the District of Columbia and Rhode Island rank highest in the nation for healthcare, with residents reporting better overall experiences, particularly in their ability to afford, access and receive quality care when and where they need it, according to the West Health-Gallup State of the States (SOS) 2025 Study, released today.
However, even in the top 10 states, sizable percentages of people are still struggling. In the top-ranked states, about 15% of residents say they’ve been unable to pay for prescriptions in the past three months, compared with 29% in the bottom 10 states. The share who skipped a recommended medical test or procedure in the past 12 months due to cost ranges from 18% in Massachusetts to 46% in Mississippi. The situation is also dire in states like Texas (43%), Montana (43%), and Alaska (41%), where considerably higher percentages of residents say they avoided medical care.
States at the bottom of the rankings such as Texas, New Mexico, Nevada and Alaska report widespread challenges. Adults in these states are significantly more likely to delay or forgo care because of affordability, report difficulty accessing services and express lower confidence in the quality of care available to them.
“While no state is without room for improvement, ZIP code should not determine whether you can afford to see a doctor or fill a prescription — but in America today, it often does,” said Shelley Lyford, CEO and Chair of the West Health Institute and the Gary and Mary West Foundation. “This research shows just how variable care can be between states and provides new insights into how policymakers can make care more consistent across borders.”
A National Wakeup Call
Healthcare costs remain the most pressing concern nationwide. Nearly one in three Americans say they’ve skipped a needed medical procedure or test in the past year because they couldn’t afford it, with rates climbing above 40% in states such as Texas and Montana and Mississippi, compared with fewer than 21% in Iowa and Massachusetts. Cost pressures persist: 11% of Colorado residents report being unable to pay for prescriptions, compared with 36% in Mississippi. Nearly half of adults nationally worry they won’t be able to afford needed healthcare services in the next year, underscoring the widespread impact of rising costs.
“Spiking insurance premiums, rising costs and issues with quality and access have dramatically increased the struggle millions face at the hands of a high-priced healthcare system,” said Tim Lash, President, West Health Policy Center. “This study captures this struggle directly from the mouths of residents in each state to help policymakers and other stakeholders develop more effective and targeted policies that improve outcomes, expand access, and lower costs. The stakes couldn’t be higher and the voices could not be louder.”
Access and Quality Show Uneven Patterns
Perceptions of care quality vary widely across the country. Across the nation, only 59% of adults believe their medical professionals understand their health needs, and younger adults, parents and LGBTQ+ Americans report lower satisfaction levels.
Nationally, 68% of Americans say their medical professionals provide high-quality care, ranging from 79% in Massachusetts to 56% in Texas. Residents in states ranked in the top 10 also report more proactive provider engagement: 76% say their clinicians discuss healthy lifestyle choices, and 69% say they are asked about mental health, both significantly higher than rates in bottom-ranked states. These patterns suggest that strong provider-patient relationships and preventive care help define quality in the best-performing states.
Access to care shows some of the starkest divides. While 66% of Nebraskans say it is easy to get needed healthcare, just 30% in New Mexico and 31% in Nevada agree. Barriers such as knowing how to find a provider or securing transportation continue to limit care for many Americans. Nationally, 25% say they did not know how to find a provider, and 15% cite transportation as a barrier. These access challenges reveal how geography and infrastructure continue to shape Americans’ healthcare opportunities.
“This research arrives at a moment of intense strain for the U.S. healthcare system. Hospitals and clinics continue to face workforce shortages, rising costs and mounting patient demand following years of pandemic disruption and demographic change,” said Joe Daly, Global Managing Partner at Gallup. “National policy debates remain deeply polarized, with growing uncertainty around issues like Medicaid expansion and prescription drug pricing. The State of the States 2025: Insights on Healthcare in America offers a timely, data-driven lens into how these pressures are being felt by people in every state. Not through performance metrics but through the direct experiences of patients.”
Future insights from the West Health-Gallup Center on Healthcare will continue to offer fresh insights about how Americans are navigating these issues, providing a roadmap for meaningful improvements nationwide.
Explore the Data
The full data from State of the States 2025: Insights on Healthcare in America is available at the newly launched West Health-Gallup Center on Healthcare in America website. The Center delivers trusted, data-driven insights to bring Americans’ voices to the forefront and drive meaningful conversations about the nation’s healthcare system.
Methodology
The West Health-Gallup State of the States 2025 study surveyed 19,535 U.S. adults (aged 18 and older) across all 50 states and D.C. via web from June 9 to July 25, using the Gallup Panel and address-based sampling. Surveys were conducted in English and those without internet access were excluded. Gallup weighted the combined samples to U.S. demographics (Current Population Survey). The design-effect-adjusted margin of error is ±1.3 percentage points nationally and ±5.4-8.0 points for states. State healthcare rankings reflect averages from self-reported experiences on cost, quality and access.
About the West Health-Gallup Center on Healthcare
The Center on Healthcare in America is a joint initiative from West Health and Gallup dedicated to elevating the voices and experiences of Americans within the healthcare system. Through rigorous research and human-centered storytelling, the Center aims to drive actionable insights and inform policy solutions nationwide. Visit westhealth.gallup.com
About West Health
Solely funded by philanthropists Gary and Mary West, West Health is a family of nonprofit and nonpartisan organizations that include the Gary and Mary West Foundation and Gary and Mary West Health Institute in San Diego and the Gary and Mary West Health Policy Center in Washington, D.C. West Health is dedicated to lowering healthcare costs to enable seniors to successfully age in place with access to high-quality and affordable health and support services that preserve and protect their dignity, quality of life and independence. Learn more at westhealth.org.
About Gallup
Gallup delivers analytics and advice to help leaders and organizations solve their most pressing problems. Combining more than 80 years of experience with its global reach, Gallup knows more about the attitudes and behaviors of employees, customers, students and citizens than any other organization in the world.
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