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Florida ranks among the worst states for health care, ranking 50th for percent of adults with health insurance, 47th for percent of children insured, and 38th for adults who have not visited a dentist during the past year.

An analysis sponsored by WalletHub, a personal finance website, reviewed 40 health care and financial metrics and scored Florida 42nd among its 2018’s Best & Worst States for Health Care. The study compared all 50 states and the District of Columbia.

The study revealed that only 53 percent of Floridians between ages 18 and 64 have medical insurance, contributing to its poor showing.

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The 2018 ranking was a slight improvement over WalletHub’s 2017 ranking, when Florida finished 43rd.

The latest study and ranking is also consistent with Citrus County’s health ranking as one of Florida’s sickest counties.

In a 2018 nationwide and statewide county health ranking — measuring indicators including teen births, childhood poverty, physical inactivity, and premature deaths — Citrus County ranked 54th out of 67 Florida counties. The county ranked 61st for length of life and 40th in other heath-related factors.

Florida Rep. Ralph Massullo, R-Lecanto, said he was not surprised by the findings.

Although Florida is an international tourist destination, the state is still primarily a service-sector state with relatively little industry attracting better paying jobs, he said.       

The solution for Florida will have to be multipronged, Massullo told the Chronicle.

The state’s workers have to be better equipped for industrial and manufacturing jobs and Florida’s educational system needs to offer more technical training opportunities for its high school and post high school students, he said.

In the meantime, Massullo said, the Legislature is trying to make health care more accessible.

He said the solution to driving down health insurance prices is for the federal government to allow health insurance companies to compete across state lines.

He opposes expanding Medicaid to more people, saying it discourages people not working from finding employment. 

It’s also important for Floridians to live healthier, Massullo said, so there’s less need for medical care. Massullo has proposed bills to stop allowing the recipients of the  Supplemental Nutrition Assistance Program (or SNAP, and also known as food stamps) to use the benefits to buy sugary soft drinks. His efforts failed.

“We’re in a system that continues to worsen,” Massullo said.

Florida rejected the federal government’s offer to expand Medicaid. Massullo also rejected the notion.

WalletHub analyst Jill Gonzalez said there is a correlation between states that ranked low with those that chose not to expand Medicaid to include a larger segment of poor patients under the Affordable Care Act.

“States that did not expand Medicaid tend to have higher uninsured rates,” she said.

Nearly 12 percent of Florida adults who were at risk for a medical problems and lacked access to health care reported that they had not had a routine doctor’s examination in the last two years.

Gonzales said that much of Florida’s bad health outcomes is due to so many adults and children not having health insurance and the ripple effect that it causes.

Because Florida has the second-lowest adult insured rate in the country and child insured rates is the fourth-lowest, “unfortunately, many of the health outcomes are worse because of that,” she said.

The WalletHub ranking took data from a variety of sources, including the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Association of American Medical Colleges.

To determine Florida’s ranking, WalletHub compared all 50 states and the District of Columbia based on cost of health care, accessibility, and treatment outcome.

Cost was then broken down the costs of medical visits, dental visits, average costs of monthly insurance premiums, and the patient’s share of out-of-pocket medical spending compared to their income, and the number of adults who do not go to the doctor because they can’t afford it.

Health care accessibility was measured by such things as the quality of state hospitals, the number of doctors and nurses per capita, number of urgent care centers per capita and the percent of residents having health insurance.

Medical outcomes were based on such issues as infant mortality rates, number of patients readmitted to the hospital, share of at-risk adults who haven’t seen their doctor, life expectancy, and share of patients who were released from the hospital without home recovery instructions.  

According to the WalletHub study, Florida ranked 27th for both doctors and dentists per capita, and 47th for insured children.   

The WalletHub study noted that the Centers for Medicare and Medicaid Services estimates that the average American spends more than $10,000 annually on health care, nearly 18 percent of the nation’s gross national product, but that health care outcomes vary from state to state.

Contact Chronicle reporter Fred Hiers at fred.hiers@chronicleonline.com and 352-397-5914.