CHARLESTON – West Virginia was in the bottom five of all 50 states and Washington, D.C., for health system performance according to a new report, with the state’s performance set to get worse if changes are not made to a megabill under consideration by Congress.

The Commonwealth Fund, a non-profit that studies health care issues, issued its annual 2025 Scorecard on State Health System Performance Wednesday morning. The report comes as the U.S. Senate continues work on the One Big Beautiful Bill Act that proposes changes to Medicaid.

“This report shows how much progress states have made expanding health coverage for millions through Medicaid expansion and subsidized marketplace coverage. But these gains are fragile,” said Sara R. Collins, one of the study’s authors and senior scholar and vice president for Health Care Coverage and Access for the Commonwealth Fund.

According to the report, West Virginia was ranked 47th for overall health system performance. Only Arkansas, Oklahoma, Texas, and Mississippi were ranked worse. Massachusetts, Hawaii, New Hampshire, Rhode Island, and Washington, D.C., were ranked in the top five respectively.

The report reviewed several other factors related to health care. According to the report, the number of adults between the ages of 19 and 64 without health insurance dropped in West Virginia from 20.3% in 2013 to 9.1% in 2023 thanks to the passage of the Affordable Care Act (ACA) by Congress in 2010. West Virginia ranked 27th in the category.

“In 2024, 44 million Americans were enrolled in the ACA’s health insurance coverage expansions: 21.4 million had coverage through a marketplace plan, 21.3 million were enrolled in Medicaid through the eligibility expansion, and 1.3 million were covered through the Basic Health Program that some states opted to provide,” the report stated. “These expansions have led to historic declines in the uninsured rate across the country. The Medicaid expansion alone has saved an estimated 27,000 lives.”

Former governor Earl Ray Tomblin announced in 2013 that West Virginia would participate in the Medicaid expansion program made possible through the, which went into effect in 2014. According to DoHS, there were 503,637 people enrolled in Medicaid in West Virginia as of January, or 29% of the state’s population – one in every four adults. According to the report, West Virginia ranked 34th for healthcare access and affordability.

West Virginia ranked 39th for the percentage of adults age 18 and older who reported a time in the 12-month period when they needed to see a doctor but couldn’t due to cost. But that percentage has dropped, from 18.4% in 2013 to 12.4% in 2023.

“In 2023, 11.7% of U.S. adults did not get care because of cost, down from 15.9% in 2013,” according to the report. “Improvement in this measure in nearly every state coincides with major drops in the uninsured rate. That’s because health insurance facilitates access to care and limits what people have to spend out of pocket on their care.”

West Virginia ranked dead last – 51st – for health outcomes and healthy behaviors. West Virginia was one of 16 states and D.C. that reported more than 300 avoidable deaths per 100,000 people.

“In 2023, there were 278 premature avoidable deaths for every 100,000 people under age 75. Rates were highly variable across states, ranging from 201 per 100,000 in Massachusetts to 445 per 100,000 in West Virginia — a more than twofold difference.”

There are concerns by several groups, including the Commonwealth Fund, that changes being considered by federal lawmakers to Medicaid and the ACA could either keep West Virginia in the bottom of healthcare rankings or make matters worse.

“This scorecard makes one thing very clear: where you live continues to define your health and your ability to get and afford the health care you need,” said Dr. Joseph R. Betancourt, president of the Commonwealth Fund. “While some states have taken bold steps to improve coverage and invest in primary care and public health, others are falling behind.”

The Senate Finance Committee released the text of the budget reconciliation package Monday – the One Big Beautiful Bill Act – that will be considered by the U.S. Senate as soon as next week. The bill passed the U.S. House of Representatives at the end of May.

The One Big Beautiful Bill Act, getting its name from Trump, is a budget and spending reconciliation package which continues the 2017 tax cuts that went into effect during Trump’s first term and were set to expire at the end of 2025. It also includes a hodgepodge of Republican congressional priorities.

Among other things, the Senate Finance Committee version of the One Big Beautiful Bill Act would help pay for the extension of the Trump tax cuts by making cuts to Medicaid, which provided health care coverage for low-income individuals and their families and managed jointly by the federal government and the states.

Some of the things in the updated bill include requiring states to implement a work requirement for individuals between the ages of 19 and 64 seeking Medicaid unless they have children under the age of 14; requiring states to conduct eligibility determinations for Medicaid recipients every six months; and prohibiting the implementation of two rules issued by the Centers for Medicaid and Medicare Services that would ease barriers to Medicaid enrollment.

A previous review of the House version of the One Big Beautiful Bill Act by the Congressional Budget Office found that proposed Medicaid changes would reduce spending by more than $793 billion over a 10-year period and result in more than 10 million fewer people enrolled in Medicaid by 2034.

“If Congress allows the extra premium subsidies passed during the pandemic to expire and makes it harder to get and keep Medicaid and marketplace coverage, the number of uninsured will climb toward pre-ACA levels, when 49 million people lacked health insurance,” Collins said. “States already facing the biggest challenges will fall even further behind.”

“We need commonsense, people-centered federal and state policies so all Americans, no matter who they are, where they live, or how much money they make, can live a healthy life,” Betancourt said.