The Commonwealth Fund has conducted their Scorecard on State Health System Performance for Low-Income Populations for 2013. This annual analysis helps identify opportunities for states to make improvements in their health systems for economically disadvantaged populations and provides the states with benchmarks for achievement.

The analysis includes 30 indicators of access, prevention and quality, potentially avoidable hospital use and health outcomes. It documents sharp disparities in the health care among the states as well. Between the states leading and lagging, up to a fourfold disparity in performance exists in a range of key health care indicators for low income groups. Wide differences also exist within individual state incomes.

If all states were able to reach the benchmarks set by leading states, it is estimated that around 86,000 fewer people would die prematurely, tens of millions more people would be able to receive timely preventative care and 750,000 fewer Medicare beneficiaries would be unnecessarily prescribed high risk medicines. Many of the benchmarks for low income groups in top states were better than average and better than those for higher income and well educated people in the states that are lagging.

A core goal of a high performance health system is to ensure that all people have equal access to high quality health care that can help them live healthy and productive lives. In the United States, however, if you are a low income individual it matters where you live. Many states have a wide gap in access to quality care between individuals with below average income and the rest of the population.

As of 2010 to 2011, 55 percent of the nations population under age 65 with income less than 200 percent of the federal poverty level were either uninsured or were spending a large portion of their income on medical care. The percentage of uninsured and underinsured people ranged from 36 percent in Massachusetts to over 60 percent in about 10 other states.

A look across all states reveals a lack of timely, affordable health care access, particularly primary care, that is undermining health outcomes and contributing to high medical costs.

Upper Midwest and Northeast states, as well as Hawaii, performed the best overall among low income population groups. Southern and Central states, however, often lagged other states in performance.

States falling at the bottom were found to have the highest rates of poverty, with almost half of their populations having a low income or no more than a high school education. For the states with such high rates of poverty, federal resources to expand coverage and invest in local health systems offers many new opportunities to improve their populations’ health and care experiences.

Every states needs improvement since none were in the top half of the range of states from all 30 indicators. Nine of the 10 topped ranked states had at least four indicators in the bottom half of state distribution.