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Are You Better Off Based on Where You Live?


America’s fifty states are noted for their diverse array of identities, but they aren’t just different in cultural aspects. Influenced heavily by a combination of policy choices made by legislators, states also differ from each other in more tangible ways that affect their citizens’ quality of life, including healthcare, wealth, and education.

How do states compare to each other on some of the essential elements influencing quality of life?

Let’s begin with healthcare. A 2023 ranking in Forbes assigned states a rank on healthcare based on four metrics: access to healthcare, cost of healthcare, quality of hospital services, and healthcare outcomes. Based on aggregate scores, the top ten states were Pennsylvania, Maine, Oregon, Michigan, New Hampshire, Vermont, Connecticut, Rhode Island, Massachusetts, and Minnesota. The bottom ten included Indiana, Nevada, Texas, New Mexico, Arkansas, South Carolina, Mississippi, North Carolina, Alabama, and Georgia.

In the Forbes ranking, states at the top often ranked highly for the number of physicians practicing in these locations and for healthcare outcomes. Perhaps policies supporting a robust medical profession have a knock-on effect to better access and less expensive healthcare, which creates better health outcomes.

Similarly, another ranking by the Commonwealth Fund determined a top five ranking of Massachusetts, Hawaii, New Hampshire, Rhode Island, and Vermont. The lowest five were Arkansas, Texas, Oklahoma, West Virginia, and Mississippi. The report found a link between people having insurance and health outcomes and access: “The findings point to improving access to care and health insurance coverage as important first steps toward ensuring that all patients get recommended care that is patient-centered, well-coordinated, and efficient. In states with low rates of uninsured, adults and children are more likely to receive essential preventive and chronic care and to have an ongoing connection to care.”

The report estimates that if all states could do as well as the top states, 90,000 lives could be saved each year, 22 million additional adults and children would have health insurance, and millions of older adults, diabetics, and young children would receive essential preventive care. The unwillingness of states in the South to expand Medicaid coverage, a policy issue, impacts accessibility to insurance that would pay for these treatments.

The Forbes results identified a notable regional divide in quality for health based on these measures. Among the top ten ranking states, seven of them were located in the Northeast region, while seven of the ten bottom-ranked states were located in the South. Fortune Magazine reported on research in 2020 that indicated Americans in blue states tend to live longer than people in red states, primarily because of state policies on everything from seat belt to abortion laws. That research also identified health policies as a major factor. Research by the Kaiser Family Foundation also found that people in blue states tend to have higher rates of health insurance than people in red states. Moreover, when looking at the rates of people who are diagnosed with cancer in each state, it is clear that people in red states are generally less healthy than people in blue ones. Red-state residents are also more likely to die from heart disease than people in blue states.

People in different states also vary widely in average income. According to the World Population Review, in 2024 the states with the top ten average median incomes are Colorado, Connecticut, Washington, Hawaii, California, New Hampshire, New Jersey, Massachusetts, Washington DC, and Maryland. The lowest ten averages are in Tennessee, South Carolina, Oklahoma, Kentucky, New Mexico, Alabama, Arkansas, Louisiana, West Virginia, and Mississippi. These differences are not minor, either: the difference between the highest in the bottom ten and lowest in the top ten was nearly $24,000 (Tennessee, $59,695 vs. Colorado, $82,254). Similarly to healthcare, the majority of states ranking in the bottom ten are located in the South.

How does policy impact income levels? Five Southern states – Mississippi, Louisiana, Alabama, Tennessee, and South Carolina – have no state minimum wage. Poverty is more likely to occur in rural areas, and the rural South is poor. Also, politics in red states often oppose social programs and aid to those living in poverty that might help them improve their situation.

Level of educational achievement is another metric that is linked with better standards of living, but which varies widely between states. People with higher educational attainment are strongly correlated with higher incomes. Data from the World Population Review shows that the top ten states for residents who hold college degrees in 2024 are Massachusetts, Colorado, Maryland, New Jersey, Connecticut, Vermont, Virginia, New Hampshire, New York, and Minnesota. The bottom ten ranked include New Mexico, Indiana, Alabama, Oklahoma, Nevada, Kentucky, Louisiana, Arkansas, Mississippi, and West Virginia.

Once again, it is notable that a majority of the bottom ten are located in the same region. It’s also worth noting that both brackets for all three of these metrics feature some repeat names, pointing to the connections between them and their importance. State and local governments control the state’s educational system. This suggests that there are factors at the policy level that are impacting educational achievements in different geographies.

The reality is that some Americans enjoy better health, prosperity, and educational success than others based on the state they live in. And while many factors certainly influence these kinds of outcomes, it is interesting to note the common thread of lower performers appearing in one region. States that tend to elect blue representatives tend to have overall better health systems and outcomes, along with higher educational attainment and higher incomes. Those that have typically leaned red have the opposite. This suggests that if states have real interest in improving the lives of their citizens, it may be worth their while to look to other states with better performances to potentially glean lessons from their examples and to the policies that have helped them attain these ranking.

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