HJNO Mar/Apr 2026

36 MAR / APR 2026 I  HEALTHCARE JOURNAL OF NEW ORLEANS MEDICAID COLUMN MEDICAID EVERY YEAR, when America’s Health Rankings publishes its national report, Louisiana finds itself near or at the bot- tom. And, every year, the reaction is the same: frustration, confusion, and a famil- iar refrain from both policymakers and the public: “We have invested so much in healthcare — why are health outcomes still so bad?” It’s a fair question. Louisiana has invest- ed in hospitals and healthcare providers, expanded Medicaid, and improved access to preventive screenings. Yet we continue to place 50th in this ranking. The apparent disconnect between effort and outcome can feel discouraging, but the explanation America’s Health Ranking ≠Healthcare SystemQuality Why Louisiana’s health ranking looks worse than its healthcare system is surprisingly straightforward: A state’s health ranking is determined primarily by factors outside the healthcare system. Health vs. Healthcare Health rankings are not healthcare rankings. “Health” and “healthcare” are not the same thing, however, they are too often used interchangeably. Health is your overall physical, mental, and social well-being. It’s an outcome, a result of how well your life supports your well-be- ing. Healthcare is the system designed to prevent, diagnose, and treat a condition or injury. Healthcare treats illness, while good health is created where people live, learn, work, and play. You can have excellent healthcare but have poor health if those broader condi- tions — the social drivers of health — are weak. Conversely, you could have good health with minimal healthcare if you have economic stability, access to nutri- tion, safe neighborhoods, and a strong social fabric. In other words, the health rankings are primarily “social well-be- ing” rankings. This distinction is important, as it shifts the conversation about health rankings from “What’s wrong with our healthcare system?” to “What’s causing poor health to begin with?”