Kentucky ranked one of worst states in COVID-19 performance, new nationwide study reports

In a new nationwide health system report, Kentucky ranked 49 out of 51 for its performance during COVID-19 — worse than the national average.

The annual Scorecard on State Health System Performance report is produced by research foundation The Commonwealth Fund. Using data from the Center for Medicare and Medicaid Services, the Scorecard ranks all 50 states and the District of Columbia on their health care systems.

Each report generates 49 indicators for how states rank in terms of access, quality, service use, cost of care and health outcomes. These are based on questions including:

• Do Americans have good access to health care?
• Are Americans getting the right health care, at the right time, and in the right setting?
• How healthy is America?

Released on June 16, the 2022 Scorecard included seven additional indicators related to COVID-19, based on the question: How well has each state responded to and managed the COVID-19 pandemic?

Using these indicators, the Scorecard sought to compare states’ response to and results of the coronavirus, such as vaccination rate and death toll, from the beginning of the pandemic to March 2022.

“As we have watched states take vastly different approaches to handling COVID, the very direct impact of different policy choices on people’s health and well-being has been made crystal clear,” Dr. David Blumenthal, Fund president, said.

Kentucky ranked 41 out of 51 overall, based on its performance in all indicators, placing it below average on the Scorecard. It ranked 6 out of 12 overall among Southeastern states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia).

Overall trends and findings

According to senior scientist and Scorecard author Dr. David Radley, the results found that states with historically strong health care systems performed higher in the COVID-specific criteria than states with historically weaker systems.

“By that we mean states with historically lower uninsured rates, high marks for care quality and better than average health outcomes,” he said.

For example, the study found that 21 states had not achieved 70% vaccination by March 31, 2022, while other states reached the target within 200 days of the CDC’s vaccination release.

Radley also said the pandemic impacted states in other ways, like excess death rates from preventable and treatable causes other than COVID-19 and insurance coverage statistics.

The U.S. saw a stark increase in drug overdose and alcohol-related deaths beginning in 2019, according to Jesse Baumgartner, an author and research associate on the 2022 Scorecard.

“Drug overdoses were responsible for more than 90,000 deaths, 20,000 more than the prior year, while alcohol-related deaths rose by 10,000,” he said.

Baumgartner also said death rates from treatable conditions like heart disease and diabetes rose in states across the U.S., particularly in the Southern and Midwestern regions, and especially among Black, indigenous and Latinx populations.

Additionally, while the national uninsured rate remained steady at around 12%, due to federal relief bills during the pandemic, several states still reported high uninsured rates. Baumgartner said these high rates mainly came from states without expanded Medicaid eligibility.

Kentucky’s results

For the COVID-19 indicators, Kentucky ranked 49 out of 51 nationally and 10 out of 12 regionally.

The commonwealth was one of the states that did not hit 70% vaccinated by March 31, 2022, and it has reported more overall deaths since February 2020 than the national average.

Kentucky reported 80% or above ICU capacity for 150-566 days between August 1, 2020, and March 31, 2022, putting the commonwealth among the states with high capacity for the longest amount of time.

Kentucky’s other rankings included:

• Access & Affordability: 32 nationally, 2 regionally
• Prevention & Treatment: 22 nationally, 4 regionally
• Avoidable Hospital Use & Cost: 49 nationally, 11 regionally
• Healthy Lives: 49 nationally, 10 regionally
• Income Disparity: 43 nationally, 7 regionally
• Racial & Ethnic Equity: 21 nationally, 2 regionally

According to the Scorecard, Kentucky’s top-ranked indicators included infant mortality, home health patients with improved mobility and uninsured adults. Its lowest-ranked indicators included preventable hospitalizations age 65 and older, adults who report fair or poor health and COVID-19 hospital admissions per 100,000 people.

Kentucky had one of the highest percentage increases in overdose death rates between 2019 and 2020 at over 51%, and it reported a higher than average death rate from treatable conditions.

Finally, 7.8% of Kentucky’s population was reportedly uninsured, one of the few criteria where the commonwealth fell below the national average of 12%.

Dr. Sarah Collins, the Fund’s vice president of coverage and access, said Kentucky’s results were “striking.”

“Kentucky is (a Medicaid) expansion state, and when you look at where it ranked, particularly in COVID, it is striking,” she said. “It just goes to show you that coverage is ... a necessary condition, but it is not a sufficient condition.”

Blumenthal added that while Kentucky’s insurance rates are high, its overall COVID score was brought down by other contributing factors like vaccination percentages and hospitalization numbers.

“The way to think about it is that it’s not one thing or the other. All of these things are sort of playing off each other,” he said.