The states at the bottom of WalletHub’s 2026 healthcare ranking share a consistent profile: access gaps, high chronic disease burdens and outcomes failures that persist even when costs are relatively affordable. Eight of the bottom 10 are in the South.
WalletHub compared all 50 states and the District of Columbia across 44 metrics in three categories: cost, access and outcomes. Each metric was graded on a 100-point scale, with 100 representing the best care at the most reasonable cost, and states were ranked by weighted average score.
51. Alaska
Alaska ranks last overall, placing 51st in cost and 41st in outcomes. It has the highest average monthly insurance premium in the country and among the lowest physician density relative to population. Geographic isolation compounds every access metric.
50. Mississippi
Mississippi ranks last in health outcomes of any state, with the highest infant and maternal mortality rates, the lowest life expectancy and among the highest rates of type-2 diabetes and heart disease nationally. It ranks 32nd in cost.
49. Georgia
Georgia ranks 49th in access and 43rd in outcomes, with low physician density, limited Medicaid coverage and high uninsured rates. High rates of chronic disease and below-average life expectancy compound the access failures.
48. Texas
Texas ranks 50th in access, the second-worst in the country, with the highest uninsured rate of any state, among the lowest Medicaid acceptance rates and well-below-average hospital bed counts per capita. It also ranks 46th in cost.
47. West Virginia
West Virginia ranks 47th in outcomes, with the second-highest prevalence of type-2 diabetes, elevated rates of heart disease and stroke, and among the worst maternal mortality rates nationally. Insurance coverage rates are relatively high, but coverage has not offset the state’s heavy chronic disease burden.
46. Alabama
Alabama ranks 14th in cost, but 48th in access and 45th in outcomes. Low insurance premiums are offset by low physician density, limited urgent care infrastructure and among the lowest Medicaid acceptance rates nationally.
45. Louisiana
Louisiana’s access rank of 13th is surprisingly strong, with solid hospital bed counts and reasonable physician density. What it cannot overcome is a 48th-place outcomes ranking driven by among the highest maternal and infant mortality rates and chronic disease prevalence in the country.
44. New Mexico
New Mexico ranks 44th in access and 40th in outcomes. The state has significant rural access challenges, low physician density outside its largest cities, and elevated rates of chronic disease compounded by high poverty rates.
43. Arkansas
Arkansas ranks 15th in cost but 49th in outcomes. High rates of infant and maternal mortality, the second-lowest life expectancy nationally and limited Medicaid expansion have produced outcomes failures that low costs alone cannot address.
42. Tennessee
Tennessee ranks 46th in outcomes, with high rates of cardiovascular disease, elevated maternal mortality and below-average life expectancy. Significant rural access gaps outside its major metro areas and a narrower Medicaid program than comparable states contribute to outcomes that rank near the bottom nationally.
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