Oregon’s health care system ranks 12th among states, according to a just-released report measuring access, outcomes and affordability produced by The Commonwealth Fund. But like sunshine in the rear-view mirror, the state’s relative success may soon be overtaken by federal changes that would jolt the nation’s health care landscape.
Commonwealth’s well-regarded Scorecard report is the product of intensive study and analysis of multiple sources of health data across a range of categories. It measures data ranging from what percentage of the population is uninsured, to preventable emergency room visits, to how many people die because of suicide. The 2025 version relies heavily on data from 2020 to 2023.
Oregon showed improvement in some areas, such as the percentage of children who received the full complement of recommended vaccines, but worsened in others, including its rate of drug- and alcohol-related deaths.
Many of the outcomes are affected by health coverage, and the report captures continuing improvement by Oregon and the nation’s, continuing improvement in insurance coverage rates since implementation of the Affordable Care Act.
But experts expect that trend start to reverse as a result of changes contemplated in the “Big Beautiful Bill” passed by the House and now under consideration in the U.S. Senate.
Since 2014, said David Radley, the author of the scorecard and director of data and analytics at the Oregon Health & Science University’s Center for Evidence-Based Policy, “we’ve seen more people gain coverage, therefore gain access to the health care system.”
But today, he said, “We’re facing a set of policies at the federal level that look to undermine all those gains,” citing expected cuts in Medicaid and the end of the subsidy for those who enroll in insurance plans through state marketplaces.
According to data collected in the 2025 scorecard, Oregon fared better than most states in terms of:
- Avoiding hospitalizations for people aged 18-64
- Medicare spending per beneficiary
- Employee total potential out-of-pocket medical costs as a share of state median income
It fared worse than most states in terms of:
- Children not receiving needed mental health care
- Primary care spending as a share of total health care spending for people 65 and older
- Use of Inappropriate lower back imaging for adults
The data on children’s needed mental health care treatment comes from surveys from federal agencies, Radley said. Spending on primary care is an important subset of health care spending efficiency because experts agree it is the most cost-effective way to produce healthier outcomes.
And Radley said he isn’t certain why Oregon rated so poorly — 48th in the nation — in inappropriate back imaging, but the ranking suggests that health care providers in Oregon are too quick to order expensive scans for patients with nebulous pain.
Radley said one of the casualties of the reorganization of the U.S. Department of Health and Human Services is the volume of publicly available data, some of which has already disappeared and some that may be reduced or eliminated. That means, for example, future scorecards will be less complete than the 2025 version.
“We’ve been living in an era of really wonderful data transparency,” Radley said. “I’m afraid we’re moving toward an era of data scarcity.”