When it comes to an overall view of health care in the U.S., a recent study by Forbes Advisor has ranked Georgia and Alabama as the worst states in the nation for health care.

Including Georgia and Alabama at the top of the list, seven of the top 10 states are in the South (North Carolina, Mississippi, South Carolina, Arkansas and Texas are the others).

The ranking compared all 50 states across 24 metrics in four key categories: healthcare access, healthcare outcomes, healthcare cost and quality of hospital care.

States were scored from zero to 100, with 100 representing the worst performance.

According to the assessment, Georgia’s overall score was 100 out of 100, receiving high scoring in the “health care cost” category.

The category is 15 percent of the total 100-point scoring system and assesses the average annual premium paid by employees with single coverage through employer-provided health insurance, percentage of annual health insurance premium covered by employers, average annual deductible for employees and percentage of state residents who chose not to see a doctor at some point in the past 12 months due to cost.

Forbes used data from the Kaiser Family Foundation.

“The Peach State ranked third worst in healthcare cost due, in part, to the state having the second highest percentage of residents who chose not to see a doctor at some point in the past 12 months due to cost (15.50 percent),” the report states. “Georgia is also the third highest percentage of residents who lack health insurance coverage (12.63 percent).”

Health care access accounted for nearly half of the weight (46 percent) in the scoring system.

The metrics in that category assessed — in relation to the number residents and using data from the Kaiser Family Foundation — the number of hospital beds, the number of various physician types, nurses, community health centers, and primary care shortage areas.

Georgia and Alabama received scores of 80.87 and 65.88, respectively, in that category.

Overall, Alabama’s 87.03 out of 100 score landed the state in the number two position for worst health care.

Its highest number of points were in the “health care outcomes” category. The category is based on six metrics such as diabetes and kidney disease mortality rates per 100,000 state residents.

“Alabama has the second highest rate of both stroke deaths (53.63 per 100,000 state residents) and influenza and pneumonia deaths (17.03 per 100,000 state residents), and has the fourth highest infant mortality rate (7.42 deaths per 1,000 live births),” the Forbes assessment states.

The Forbes reports shows that Alabama employers cover the lowest percentage of employees’ annual health insurance premiums on average (73.42 percent for employees with single coverage) and Alabama ranked fourth worst in overall health care outcomes. Forbes used Centers for Disease Control and Prevention data to assess health care outcomes.

Earlier this year, Alabama Department of Public Health announced the launch of the Alabama Health Dashboard in an effort to provide Alabamians with up-to-date information about their health outcomes.

“By having data readily available, we can better communicate Alabama’s health status with partners while planning health outcome improvements,” State Health Officer Dr. Scott Harris said.

While Minnesota ranked the best for overall health care, seven of the Top 10 best states for health care are in the northeast, including Massachusetts, Rhode Island, Connecticut, Vermont, New Hampshire, Maine and Pennsylvania.

This year, in an effort to reform health care in the state, Georgia lawmakers commissioned a committee to study certificate of need laws for health care to determine ways to have better health outcomes at lower costs and to determine policies for financially struggling rural hospitals to survive and grow.

CON requirements were signed into federal law in the mid-1970s as a way to assess the availability and duplication of health care services within a certain radius; however Congress repealed it nearly a decade later leaving it to states to decide.

Opponents of CON say the restriction has contributed to the rising cost of health care, while proponents of CON said it helps provide balance and a repeal could negatively affect rural hospitals which would have to compete with newer hospitals.

Ana Adams of the Georgia Hospital Association, representing more than 140 hospitals across Georgia, told the study committee members to avoid a complete CON repeal. Keeping some restrictions, she said, could protect quality and prevent proliferation of one service.

“We have issues across the state with access to trauma care. We have issues with maternal mortality. Each of those things is a really large substantial issue that I think all of you want to address and have been trying to address and they’re not necessarily linked to certificate of need,” Hill said. “So what we would ask is that you sort of take a holistic approach to looking at health care, trying to figure out where we can make some changes that will be helpful for hospitals, physician practices, nurses, etc.”

Georgia and Alabama are among 10 states that have not expanded Medicaid to provide health insurance to more lower income residents. Federal incentives would cover 90 percent of those costs.

Advocates for expansion argue that Medicaid expansion can lead to better health care access and outcomes. Medicaid expansion could provide coverage to 300,000 more Alabamians who earn too much to qualify for the state’s Medicaid program, but too little to afford private plans.

“Medicaid expansion also would bolster health care access for Alabamians before, during and after pregnancies. This would be a critical life-saving move in Alabama, which has the nation’s worst maternal mortality rate,” according to public policy advocacy group Alabama Arise. “Those rates are even higher for Black women, who are twice as likely to die during birth as white women. Adding to the problem, more than two-thirds of Alabama counties offer little or no maternity care or obstetrical services.”

The Alabama Hospital Association noted that Alabama has among the most restrictive Medicaid eligibilities in the country, and without the economic benefits of Medicaid, hospitals, nursing homes and pharmacies would close, and less physicians accessible to Alabamians.