MIAMI — Florida, with high numbers of uninsured and the lofty cost of care, ranks among the worst states in the country for women’s health, according to a new national report.

The Commonwealth Fund, a health care research nonprofit, ranked Florida 39th overall for women’s health and reproductive care in its 2024 scorecard, making it one of the “bottom-performing states” in the country.

“Women’s health in the U.S. is in a fragile spot,” said David Radley, a senior scientist and public health expert at the Commonwealth Fund who helped write the report. “It’s true nationally and it’s true in Florida.”

The Commonwealth Fund used public data from 2021 and 2022 to compile the report, including government-surveys, vital statistics and mortality data.

Florida’s low rank was driven primarily by issues of health care cost and accessibility, according to the report.

“Women are not getting the health care that they need due to affordability issues, due to access issues, due to transportation issues,” said Viviana Alvarado Pacheco, senior research and policy manager at The Women’s Fund Miami-Dade, a nonprofit advocacy group. “Florida as a state has to really step up its game.”

The report noted Florida’s decision not to expand Medicaid, the state and federal health coverage program for people with low incomes, as a possible reason why the state is struggling with health care access and affordability issues for women. It also explicitly mentions the state’s six-week abortion ban as a possible constraint on women’s health care.

But there are some bright spots among Florida’s struggles, including the state’s work screening for HIV and certain cancers.

So what exactly is driving Florida’s low ranking? Here’s what the report tells us:

Why is Florida ranked so low for women’s health care?

The scorecard breaks women’s health care into three categories: health outcomes, coverage access and affordability, and health care quality. Florida’s health care system struggles across all of them.

The state ranked 25th in health care outcomes, such as breast and cervical cancer death rates, about the national average. But Florida ranked 37th in health care quality and 48th in access and affordability.

Several factors are bringing down Florida’s access and affordability ranking:

—14% of women 19 to 64 don’t have health insurance in Florida, compared to the national average of 10%. That puts Florida in the bottom five states.

—22% of women in Florida reported a time in the previous year that they needed to see a doctor but didn’t because it was too expensive. The national average is 17%.

—29% of women in the state said they did not have a person who they considered to be their personal healthcare provider, compared to the national average of 23%.

This means that women in Florida “don’t necessarily have a doctor that they can call when they get sick. That’s going to make it harder to access” health care when they need it, Radley said. “It’s a big problem.”

In addition, Florida ranked last in terms of early prenatal care for pregnant women, reporting the highest percentage in the country of women who received no prenatal care in the first three months of their pregnancy.

“Health care is not affordable in Miami-Dade,” said Alvarado Pacheco, “and it causes extreme harm to women.”

Any positives for women’s health care in Florida?

It’s not all bad news for women’s health care in the Sunshine State.

Only 19% of Florida women reported having more than 14 “poor mental health days” in the past month, compared to the national average of 21%.

Cancer screening was another bright spot, with 78% of women ages 50 to 74 reporting having had a mammogram in the last two years, and 83% of women 21 to 65 reporting having had a pap smear within the past three years. Both of these percentages were slightly higher than the national average.

In addition, Florida had one of the highest rates of HIV/AIDS testing in the country, with 54% of women saying they had been tested in their lifetime, compared to the national average of 44%.

These numbers “show that we are able to do well,” Alvarado Pacheco said.

“We are doing things right in some” areas, she said, “yet in others, we could do better.”

Who created this scorecard and how did they do it?

The Commonwealth Fund, founded in 1918, supports “independent research on health care issues” and gives “grants to improve health care practice and policy,” according to its website.

To create the scorecard, the Fund identified 32 separate indicators that “span health care system performance,” and evaluated each state according to these metrics.

These metrics included infant and maternal mortality, rates of insurance, and receipt of preventive care.

What does the report say about the rest of the country?

Massachusetts ranked No. 1 for women’s health care by the scorecard. Mississippi ranked last.

The report says that women’s health care is in a “perilous place” across the country, citing a nationwide rise in preventable deaths and large care inequities, especially for Black and Indigenous women.

These health care issues are partially the result of government policy, according to the report. The report mentions the decision, made by Florida and other states, not to expand Medicaid benefits as a policy that’s harming women’s access to health care.

Abortion restrictions, like the six-week ban in Florida, can also weaken women’s health care, according to David Radley, who co-wrote the report.

“One of the best ways to think about this is in terms of the potential impact on the health care workforce,” Radley said. “There was a big drop in 2023 and in 2024 in the share of medical students who were applying to residencies, specifically in states that banned abortion.”

Radley said if that trend continues, it could lead to a smaller maternal care workforce in states with abortion restrictions such as Florida. “That’s going to potentially be a problem,” he said.

Alvarado Pachecho says that she is already seeing harm from abortion restrictions play out in Florida.

“You’re seeing less OB-GYNs in the state,” she said. “You’re seeing more health care deserts, so women don’t even have places where they can go.”

For some female patients, an OB-GYN can be a portal to overall health care, identifying issues that need medical attention from other doctors.

Florida’s six-week abortion ban, signed into law by Gov. Ron DeSantis, went into effect in April. Florida voters will have a chance to keep it or scale back the ban by voting on a ballot initiative in November.

©2024 Miami Herald. Visit at miamiherald.com. Distributed by Tribune Content Agency, LLC.