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State-by-state rankingKFF analysis of CDC 2025 BRFSS data
The Appointment That Never Happened
Healthcare is getting harder to afford, and the newest state data shows exactly where that pressure is turning into skipped care. Explore every state, see how yours compares, and use the questions at the end to test your own organization.
Share of adults who skipped a physician visit because of cost, 2025
Select any state to see its rank, its gap from the national rate, and its regional comparison.
Texas
About 1 in 6 adults needed a physician and could not go because of cost.
5.3 points above the national rate
How it compares
Regional averages are simple averages of the reporting states in each U.S. Census region, not population weighted.
By region
Simple average of reporting state rates in each U.S. Census region. Not population weighted.
What the map shows
- Six states reach 14% or higher, and all six are in the South: Texas, Georgia, Oklahoma, Arkansas, Alabama and Louisiana.
- Only 13 of 48 reporting states sit above the national rate, while 35 sit below it. A population-based national figure leans toward large, high-rate states such as Texas, Florida and Georgia.
- Chronic illness raises the risk. Adults with a chronic condition skipped care at 13.9%, compared with 10.8% for those without one: the patients who can least afford a gap in care are the most likely to have one.
Full ranking, highest to lowest
| Rank | State | Region | Share of adults | vs. national (pts) |
|---|---|---|---|---|
| 1 | Texas | South | 18.1% | +5.3 |
| 2 | Georgia | South | 16.0% | +3.2 |
| 3 | Oklahoma | South | 15.1% | +2.3 |
| 4 | Arkansas | South | 14.9% | +2.1 |
| 5 | Alabama | South | 14.6% | +1.8 |
| 5 | Louisiana | South | 14.6% | +1.8 |
| 7 | Colorado | West | 13.9% | +1.1 |
| 8 | Florida | South | 13.7% | +0.9 |
| 9 | Arizona | West | 13.6% | +0.8 |
| 10 | New Jersey | Northeast | 13.4% | +0.6 |
| 11 | Tennessee | South | 13.3% | +0.5 |
| 12 | Wyoming | West | 13.2% | +0.4 |
| 13 | Illinois | Midwest | 13.0% | +0.2 |
| 14 | Montana | West | 12.6% | −0.2 |
| 15 | Missouri | Midwest | 12.5% | −0.3 |
| 15 | New Mexico | West | 12.5% | −0.3 |
| 17 | Utah | West | 12.4% | −0.4 |
| 18 | Indiana | Midwest | 12.3% | −0.5 |
| 19 | Alaska | West | 12.2% | −0.6 |
| 20 | West Virginia | South | 12.1% | −0.7 |
| 21 | Kentucky | South | 12.0% | −0.8 |
| 22 | Idaho | West | 11.9% | −0.9 |
| 22 | Ohio | Midwest | 11.9% | −0.9 |
| 24 | Oregon | West | 11.8% | −1.0 |
| 25 | Connecticut | Northeast | 11.7% | −1.1 |
| 25 | Delaware | South | 11.7% | −1.1 |
| 25 | South Carolina | South | 11.7% | −1.1 |
| 25 | Washington | West | 11.7% | −1.1 |
| 29 | Kansas | Midwest | 11.5% | −1.3 |
| 30 | Pennsylvania | Northeast | 11.4% | −1.4 |
| 31 | Maryland | South | 11.2% | −1.6 |
| 31 | Nebraska | Midwest | 11.2% | −1.6 |
| 31 | New York | Northeast | 11.2% | −1.6 |
| 34 | Michigan | Midwest | 11.0% | −1.8 |
| 34 | North Carolina | South | 11.0% | −1.8 |
| 36 | Rhode Island | Northeast | 10.9% | −1.9 |
| 37 | Wisconsin | Midwest | 10.7% | −2.1 |
| 38 | Minnesota | Midwest | 10.4% | −2.4 |
| 39 | Virginia | South | 10.1% | −2.7 |
| 40 | Maine | Northeast | 9.9% | −2.9 |
| 41 | South Dakota | Midwest | 9.5% | −3.3 |
| 42 | New Hampshire | Northeast | 9.3% | −3.5 |
| 42 | North Dakota | Midwest | 9.3% | −3.5 |
| 44 | Massachusetts | Northeast | 8.9% | −3.9 |
| 45 | District of Columbia | South | 8.8% | −4.0 |
| 46 | Iowa | Midwest | 8.6% | −4.2 |
| 47 | Vermont | Northeast | 8.3% | −4.5 |
| 48 | Hawaii | West | 7.3% | −5.5 |
Tied states share a rank, as published. Not ranked for lack of reliable 2025 data: California, Mississippi, Nevada.
The affordability squeeze behind the map
of U.S. adults were cost secure in 2025, able to afford needed care. A five-year low, down from 61% in 2022.
adults made at least one financial trade-off to pay for care in the past year (survey of 19,535 adults).
borrowed money to pay for care, and another 15% delayed or stretched prescriptions: the two most common trade-offs.
of uninsured adults made such a trade-off. Enhanced ACA premium tax credits expired at the end of 2025.
“Delaying care or waiting until health problems are critical and require emergency care.”
Leadership signal
Deferred care does not disappear. It comes back later, sicker, and through the emergency department.
Questions for leadership teams
- Are cancellations and no-shows coded for cost, so finance and access teams can see how much missed volume is an affordability problem rather than a scheduling one?
- Do patients receive a price estimate and an offer of financial counseling before the appointment, not after the bill?
- Have charity care and presumptive eligibility screening been updated for patients who lost exchange coverage when enhanced tax credits expired?
- Is the emergency department tracking visits for conditions that began as deferred primary or specialty care?
- Where does your state sit on this map, and does your own service area look better or worse than the statewide figure?