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Top 5 States with the Highest Levels of Healthcare Spending

Healthcare spending was highest in South Dakota, Louisiana, West Virginia, Florida, and Wyoming.

Kelsey Waddill
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Published: 17 Nov 2022

In the top five states with the highest healthcare costs, residents may struggle to cover children’s medical bills, face burdensome premiums, or forego care due to high out-of-pocket healthcare spending, according to a list compiled by Forbes Advisor experts.

The researchers examined consumer feedback through an online survey of 2,000 Americans conducted from October 28, 2022 to November 1, 2022. They compared these results to eleven metrics that represented data from as early as 2016 to 2021.

Metrics included healthcare spending per capita (which made up 20 percent of the state score), the percent of residents who avoided care due to cost in the past year (15 percent of the state score), the average silver tier health plan premium (10 percent of the state score), the average annual deductible per enrolled employee for single and for family coverage, and other factors.

Based on these factors, Forbes researchers identified five states that had the highest healthcare spending in the US.

South Dakota

South Dakota had the highest healthcare spending out of all 50 states plus the District of Columbia with a score of 100 out of 100 points. Twelve percent of children in the state had families who were struggling to cover their medical bills between 2019 and 2020. Additionally, the state had the ninth highest healthcare spending per person at $11,736 per capita for services.

Not only was the annual, per capita spending high, but this metric was climbing at a faster rate than most other states. South Dakota ranked third in healthcare spending growth over a five-year span.

Separate research showed that South Dakota saw a decrease in this share of employees, compared to 2020. The same work indicated that, in 2021, Wyoming--the state with the fifth-highest level of healthcare spending--had the lowest share of employees whose employers offered health insurance coverage in the US.

Louisiana

Louisiana had the second highest healthcare spending rate, scoring an 86.69 out of 100.

This state has some of the highest premiums nationwide, with single employees spending on average $1,740 per year, employees with an additional person on the plan paying $4,685 on average per year, and families paying an average of $6,999.67 annually. In the four years from 2016 to 2020, healthcare spending grew 23.10 percent.

Louisiana and West Virginia were among four states that saw the highest share of the average pay check go toward health insurance, separate studies have indicated.

West Virginia

West Virginia ranked third with a score of 82.31 out of 100 for healthcare spending.

West Virginians face high insurance premiums on the Affordable Care Act marketplace, high healthcare spending per person, and they have the eighth highest healthcare spending increase per person between 2016 and 2020. In that five-year period, healthcare spending grew 21.75 percent.

Residents of this state also face higher rates of having multiple chronic conditions compared to almost every other state, separate research indicated. In 2021, West Virginians were 2.9 times more likely to have multiple chronic conditions than residents of Hawaii, for example.

Florida

Florida ranked fourth on the list of highest healthcare spending, scoring 79.51 out of 100 points.

In the Sunshine State, 14 percent of children had families who struggled to meet their medical bills between 2019 and 2020. Only Wyoming surpasses Florida in this measurement. Floridians paid on average $7,079.33 for family coverage through employer-sponsored health plans. Individuals with one other person on the plan paid the second highest annual premium nationwide ($4,684.67).

Also, 14.87 percent of Florida adults skipped their doctor visits in the past year and over half of Floridian adults did not receive mental healthcare due to cost (51.9 percent).

Wyoming

Wyoming had the fifth-highest healthcare spending in the US. The state scored 78.63 out of 100 for its spending.

This state had the highest rate of children whose families struggled to cover their medical bills in the US, with 16 percent of children’s families facing this reality between 2019 and 2020. Wyomingites also paid the highest Affordable Care Act marketplace annual premium nationally—$1,400 higher than the nearest contender. The annual premium in Wyoming was $9,620. Additionally, 64.7 percent of Wyomingites did not receive mental healthcare treatment, avoiding care due to the cost.

Other studies have found important disparities in children’s health insurance coverage. In West Virginia, for example, the child uninsurance rate was 2.5 percent, which is 1.2 percentage points above the lowest rate. But in Wyoming, which has not yet expanded its Medicaid program, children’s uninsurance was 9.3 percent, trailing only behind Texas where the rate was 10.6 percent.

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