2025 Commonwealth Fund Health Scorecard: What It Means for Nurses
- What the 2025 Scorecard Measures
- Best and Worst Performing States in 2025
- Gains in Insurance Coverage—but They May Be at Risk
- Worsening Trends in Maternal and Child Health
- Disparities in Health Equity Remain Widespread
- The Nursing Lens: Where the Profession Makes a Difference
- Policy Recommendations: What Nurses and Organizations Can Do
- Using the Scorecard as a Roadmap for Nursing Advocacy
- Latest Articles & Guides
Each year, the Commonwealth Fund releases a detailed Scorecard on State Health System Performance, evaluating how well U.S. states deliver high-quality, affordable, and equitable care. The 2025 edition sheds light on fragile healthcare improvements amid growing disparities – and highlights opportunities for transformation. For registered nurses across all practice areas, the data is more than just a report card. It's a roadmap pointing to areas where the nursing workforce can lead change, especially in preventive care, maternal health, and equitable care delivery.
Whether you’re a bedside RN, nurse educator, public health nurse, or aspiring nurse leader, understanding your state's healthcare performance can help you advocate for patients and the profession.
What the 2025 Scorecard Measures
The Commonwealth Fund ranked all 50 states and Washington, D.C., using 50 indicators across five major domains:
- Access & Affordability – insurance coverage, cost barriers to care
- Prevention & Treatment – vaccination rates, chronic and behavioral care
- Avoidable Hospital Use & Cost – ER visits, readmissions, post-acute transitions
- Healthy Lives – premature death, infant mortality, and preventable conditions
- Equity – disparities in care and outcomes by income and race/ethnicity
The data, based on performance in 2023, reflects the combined impact of COVID-19 recovery efforts, Medicaid policy changes, and long-standing structural inequities.
Best and Worst Performing States in 2025
According to the 2025 scorecard:
- Top performers: Massachusetts, Hawaii, New Hampshire, Rhode Island, and Washington D.C.
- Lowest-ranking states: Mississippi, Texas, Oklahoma, Arkansas, and West Virginia
These rankings consider both overall health outcomes and how equitably care is delivered. Even top-performing states had weaknesses; for instance, Massachusetts showed challenges in hospital readmission rates for older adults.
Browse nursing programs in your state.
Gains in Insurance Coverage—but They May Be at Risk
One of the report's bright spots is the continued decline in uninsured adults:
- The national uninsured rate among adults dropped to 11%, compared to over 20% in 2013.
- D.C. led the nation with just 3.4% uninsured, while Texas remained highest at 23%.
This progress is credited to the Affordable Care Act's Medicaid expansion and enhanced marketplace subsidies. However, these gains are fragile: with policy changes to reduce Medicaid access, millions could lose coverage, impacting patients and providers alike.
For nurses, expanded coverage means fewer patients delaying care, more consistent management of chronic illness, and less pressure on emergency departments.
Worsening Trends in Maternal and Child Health
Unfortunately, the Scorecard revealed alarming declines in child health indicators:
- Fewer than 75% of children in most states received all seven recommended early-childhood vaccinations.
- Infant mortality increased in 20 states between 2018 and 2022.
- Mississippi's infant mortality rate reached 9.1 per 1,000 births, compared to 3.3 in Massachusetts.
- Black infants faced mortality rates more than double those of white infants nationwide.
These outcomes are a call to action for maternal-child health nurses, pediatric nurses, and community-based RNs to support outreach, patient education, and culturally responsive care, especially in underserved communities.
Disparities in Health Equity Remain Widespread
One of the most sobering aspects of the 2025 Scorecard is the entrenched inequity:
- In 42 states and D.C., Black Americans experienced avoidable mortality rates twice as high as their lowest-risk peers.
- Similar disparities were found in care quality, preventable ED visits, and chronic disease outcomes.
These findings underscore the essential role of nurses in advancing health equity. By incorporating social determinants of health screening, coordinating culturally competent care, and participating in policy advocacy, nurses can directly address these inequities.
The Nursing Lens: Where the Profession Makes a Difference
1. Primary Care & Preventive Services
States with strong primary care infrastructure saw better overall scores. Nurse practitioners, especially in rural and underserved areas, are central to expanding access and reducing preventable illness.
2. Transition & Post-Acute Care
High-performing states had lower hospital readmission rates and better skilled nursing transitions—areas often led by RN care coordinators, case managers, and geriatric nurses.
3. Health Education & Vaccine Outreach
RNs are frontline educators. In states where vaccine rates declined, public health nurses and school nurses are key to reversing hesitancy and closing immunization gaps.
4. Maternal and Infant Support
The rising maternal mortality crisis in the U.S. is intertwined with poor birth outcomes. Labor and delivery nurses, NICU nurses, and OB nurse practitioners must be empowered and resourced to intervene early and advocate for systemic change.
5. Nurse Leadership & Policy Engagement
Nurses have a growing voice in policy development and health system redesign. The Scorecard’s findings present a chance for nursing professionals to lead improvements in care quality, access, and equity.
Policy Recommendations: What Nurses and Organizations Can Do
- Expand the NP workforce to increase primary care availability
- Integrate equity metrics into nursing performance and education
- Fund vaccine and maternal-child outreach programs led by RNs
- Advocate for payment models that reward value, not volume
Using the Scorecard as a Roadmap for Nursing Advocacy
The 2025 Commonwealth Fund Scorecard paints a mixed picture of American healthcare: improvements in coverage are offset by declines in child health and deep racial and geographic disparities. For nurses, this data is not just informative—it's actionable.
By understanding how their state performs and where gaps remain, nurses can champion reforms, shape public policy, and deliver the kind of high-quality, patient-centered care that turns metrics into meaningful outcomes.
No matter your role in nursing, your work matters – now more than ever.
For full scorecard data and state-by-state breakdowns, visit the Commonwealth Fund Scorecard website.
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