US Healthcare Spending by State in 2026 – A State-by-State Breakdown of America’s Costliest System

That disparity is not new, but in 2026, it has never been more financially significant. The United States as a whole is spending at a scale that, even by its own historic standards, is staggering.

Healthcare spending in the US reached $5.3 trillion and increased 7.2 percent in 2024, coming in at $15,474 per person, according to Health Affairs.

For context, that’s more than the entire GDP of Germany. And while national numbers tend to flatten out the extremes, the state-level picture tells a far more granular, far more human story about how differently Americans experience, and pay for, that system.

The National Baseline

Before getting into the state-by-state breakdown, it’s worth grounding yourself in the national picture, because you can’t understand the outliers without knowing the average.

National health spending is expected to grow 5.4 percent in 2026, which is a slower rate than the 7.1 percent increase seen in 2025.

That deceleration sounds like good news, and to some extent it is. But slowdowns in healthcare spending growth don’t mean healthcare is getting cheaper. They just mean costs are rising slightly less fast than before. The trendline is still heading in one direction.

The 7.1 percent projected growth rate for 2025 demonstrates the sector’s resilience, while the $4.9 trillion total expenditure in 2023 establishes healthcare as a dominant economic force, as noted by The Global Statistics.

According to the CMS NHE Fact Sheet, the breakdown of where that national spending actually goes in 2024 is illuminating: Medicare spending grew 7.8% to $1,118.0 billion, or 21 percent of total NHE. Medicaid spending grew 6.6% to $931.7 billion, or 18 percent of total NHE.

Private health insurance spending grew 8.8% to $1,644.6 billion, or 31 percent of total NHE. Out-of-pocket spending grew 5.9% to $556.6 billion, or 11 percent of total NHE.

Hospital expenditures alone hit $1.63 trillion in 2024. That’s roughly what the US federal government spends on everything besides healthcare and defense, combined.

The federal government and households together bear the largest share of that burden. The largest shares of total health spending were sponsored by the federal government at 31 percent and by households at 28 percent.

Per Capita Spending by State: The Gap Is Larger Than You Think

Highest per-capita healthcare spending states (approximate): District of Columbia ($14,381), New York, Massachusetts, Alaska, Connecticut, New Jersey

Lowest per-capita healthcare spending states (approximate): Utah ($7,522), Idaho, Nevada, Georgia, Arizona, Texas

Here’s where it gets really interesting, and, for a lot of Americans, personally relevant.

Based on the most recent state-level data, Utah has the lowest healthcare spending per capita at approximately $7,522. Utah’s relatively young population and lower overall use of healthcare services help keep average costs down compared with most other states.

On the other end of the spectrum, the District of Columbia sits at the extreme high end. The District of Columbia has the highest per-capita health care spending, at about $14,381. Healthcare costs in D.C. are influenced by high service prices, a concentration of specialized providers, and a generally high cost of living.

To put that gap in human terms: a resident of the District of Columbia, on average, has nearly double the healthcare spending attributed to them compared to a resident of Utah. That’s not a rounding error.

That’s a $6,859 annual difference per person, and that’s before you factor in what individuals are actually paying out of pocket versus what’s being covered by employers, insurers, or public programs.

As noted by CMS’s own state-level data, the regional patterns are stark and durable: the New England and Mideast regions had the highest levels of total per capita personal health care spending at $12,728 and $12,577, respectively, or 25 and 23 percent higher than the national average.

In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal healthcare spending per capita at $8,497 and $8,587, respectively.

What drives these differences? It’s rarely one thing. Age of population, cost of living, prevalence of chronic disease, market consolidation among hospital systems, whether the state expanded Medicaid, and how many physicians are per capita, all of this feeds into the final number.

A state-by-state comparison using current data produces a general picture that looks something like this:

The states with the lowest per capita healthcare spending were Idaho with $6,028, Utah with $6,147, and New Mexico with $6,368. In contrast, the states with the highest expenses were Alaska with $9,282, New York with $9,115, and Massachusetts with $9,097, as noted by the Institute for Health Metrics and Evaluation (These figures reflect earlier county-level IHME research and will be proportionally higher in 2026, given subsequent growth.)

Even within states, the variation is extraordinary. Nassau County in New York City’s metropolitan area is spending $13,332 per capita, nearly four times some of the lowest figures in the country, like Clark County’s $3,410 in Idaho. That’s not a different country. That’s a five-hour drive.

The Medicaid Story: Spending Up, Enrollment Down

One of the most counterintuitive dynamics in 2026 is what’s happening with Medicaid, America’s public insurance program for low-income residents. You might expect that if fewer people are enrolled in a program, it would cost less. But Medicaid in 2025 and 2026 has been defying that logic in striking fashion.

According to KFF’s 25th annual Medicaid Budget Survey, total Medicaid spending growth was 8.6% in FY 2025 and is expected to slow slightly to 7.9% in FY 2026. State Medicaid spending growth was 12.2% in FY 2025 and is projected to slow to 8.5% in FY 2026.

Meanwhile, Medicaid enrollment fell 7.6% in FY 2025 and is expected to be largely flat in FY 2026. So enrollment went down by more than seven percent, but spending still went up by nearly nine percent. How?

The answer, as noted by Healthcare Dive, is that the people who stayed enrolled are sicker and more expensive to cover. Provider rate hikes and greater health needs among beneficiaries, alongside rising costs for long-term care, pharmacy benefits, and behavioral healthcare, are the biggest drivers of increased spending.

As per KFF’s analysis, the states themselves are very aware of this squeeze: nearly two-thirds of states say they face at least a “50-50” chance of a Medicaid budget shortfall in FY 2026 as they anticipate state Medicaid spending growth of 8.5% in FY 2026 and tight fiscal conditions.

That is a remarkable statistic, most states essentially flipping a coin on whether they’ll run out of Medicaid money before the fiscal year ends.

The pharmacy piece is worth examining on its own. Net spending on Medicaid prescription drugs is estimated to have grown substantially in recent years, increasing from $31 billion in FY 2019 to $46 billion in FY 2024, a 46% increase. That’s nearly a $15 billion increase in just five years, even as rebate programs provided some counterbalancing relief.

Medicaid Per-Enrollee Spending by State: A Window Into the Inequalities

One of the most telling metrics in the entire healthcare debate is what Medicaid actually spends per enrollee in each state, because that number reveals a lot about how generously (or poorly) a state has built out its public health infrastructure.

As noted by The Global Statistics, state-level variations in per-enrollee Medicaid spending, ranging from $4,754 in Georgia to $12,314 in North Dakota, highlight the complex interplay between state policies, regional healthcare costs, and population health needs.

That nearly three-to-one ratio between Georgia and North Dakota isn’t just a budgetary curiosity. It reflects the lived experience of Medicaid enrollees in those states, the services available to them, the providers willing to see them at Medicaid rates, and the ease or difficulty of accessing specialty care.

A Medicaid card in North Dakota gets you, in simple dollar terms, nearly three times more than the same card in Georgia. The legal entitlement may be federal; the practical reality is almost entirely local.

Medicare Spending by State: Why Florida Is an Outlier

Medicare, which covers Americans 65 and older, shows a similarly wide state-by-state spread, and it tells a distinct story about geography, physician behavior, and how healthcare markets evolve.

As per CMS data, Medicare expenditures per beneficiary were highest in Florida at $13,652 and lowest in Vermont at $8,726. Florida’s status as the top Medicare-spending state is not an accident of demographics alone, though its disproportionately large elderly population is part of it.

Florida has long been associated with high-intensity Medicare utilization, more specialist visits, more procedures, and more hospitalizations per enrollee than many comparable states.

The Institute for Health Metrics and Evaluation found that Florida’s Sumter County had the highest per capita total in the US for Medicare, at $18,284, three times higher than the lowest amounts in the country, which were in states such as Texas, Nebraska, and Vermont.

Private Insurance Costs: Where People Are Actually Feeling the Pinch

Medicare and Medicaid grab a lot of policy attention, but the majority of non-elderly Americans get their coverage through private insurance, and that’s where the consumer-side pain is most acute.

Private health insurance spending grew 11.5% to $1,464.6 billion in 2023, accounting for 30 percent of total NHE.

The state-level experience of private insurance costs varies enormously, and not always in the ways you’d expect. States with very high overall healthcare spending don’t always translate that into high private insurance premiums, and vice versa.

According to WalletHub’s 2025 healthcare study, New Hampshire residents had the lowest average monthly health insurance premium, at around $470.

LiveNOW from FOX notes that’s a significant data point because New Hampshire is consistently a high-performer on health system quality metrics, suggesting that lower cost and better quality aren’t always mutually exclusive.

On the costly end, West Virginia, Mississippi, and Alaska see some of the highest premiums and out-of-pocket burdens relative to income. Hospital spending in New York has been “rising twice as fast as wages” over the past decade, pushing premiums and out-of-pocket costs higher across the state, a dynamic that plays out, at various intensities, in other high-cost states too.

Geographic variations in Medicare spending reveal significant disparities across states, with per-beneficiary costs ranging from $8,726 in Vermont to $13,652 in Florida. These differences reflect varying costs of living, regional medical practices, population health characteristics, and healthcare infrastructure development.

One major inflection point coming in 2026 is the expiration of the Inflation Reduction Act’s enhanced Marketplace subsidies.

The expiration of the temporarily enhanced premium tax subsidies for Marketplace plans in 2026 is projected to reduce enrollment in direct-purchase insurance by 4.7 million enrollees, representing a 12.3 percent drop in direct-purchase insurance enrollment.

States with high Marketplace enrollment, like Florida, Texas, and California, are likely to see the sharpest fallout as millions of Americans suddenly face much higher unsubsidized premiums.

Healthcare Rankings by State: Who’s Actually Doing It Well?

Per capita spending is one measure. Health outcomes and system quality are another. And importantly, the two don’t always correlate.

As noted by the Commonwealth Fund’s 2025 Scorecard on State Health System Performance, leading the 2025 rankings are Massachusetts, Hawaii, New Hampshire, Rhode Island, and the District of Columbia. The lowest-ranked states overall were Mississippi, Texas, Oklahoma, Arkansas, and West Virginia.

The disconnect between spending and outcomes is particularly visible in states like Mississippi. Mississippi doesn’t spend little on healthcare; in some respects, its residents are deeply engaged with the healthcare system because they have high rates of chronic disease.

But Mississippi topped the list of states where residents spend the most on healthcare as a share of income, with residents spending 18.66% of their median household income on health care costs.

That’s the brutal arithmetic of being poor and sick in a state with limited infrastructure. You spend more of what you have, and you get less for it.

Hawaii, Massachusetts, and New Hampshire consistently rank as the top three states for healthcare in 2025, excelling in access to care, quality outcomes, and lower costs across multiple independent rankings.

Mississippi, West Virginia, and Oklahoma consistently rank as the worst states for healthcare, struggling with physician shortages, high uninsured rates, poor maternal and infant health outcomes, and chronic disease prevalence.

One structural factor that explains a lot of the gap: Medicaid expansion under the Affordable Care Act. As of 2025, ten states have not expanded Medicaid: Texas, Florida, Georgia, Tennessee, Mississippi, Alabama, South Carolina, Wyoming, Kansas, and Wisconsin (partial expansion).

These states have significant coverage gaps, leaving millions of low-income adults without affordable insurance options.

The effects of non-expansion ripple through everything: more uninsured residents, more uncompensated care costs absorbed by hospitals, higher uninsured rates, and worse preventive care utilization that leads to more expensive acute episodes down the line.

What’s Driving Up Costs in 2026, State by State

If you talk to healthcare economists, hospital administrators, and state budget directors across the country right now, a consistent set of culprits keeps emerging. They’re not equal in their impact across all states, but they’re present almost everywhere.

Hospital consolidation. When hospital systems merge or acquire physician practices, they gain pricing power that translates directly into higher rates for insurers, and ultimately higher premiums and out-of-pocket costs for patients.

States where consolidation has been most aggressive, including Pennsylvania, Ohio, and several New England states, tend to see above-average price inflation even controlling for other factors.

Specialty drug costs. This is the single fastest-moving cost driver in public programs right now. Net spending per prescription in Medicaid grew by 42% over the period from FY 2019 to FY 2024 (from $43 to $61), and net spending per enrollee grew by 25% (from $481 to $603).

GLP-1 weight-loss medications like Ozempic and Wegovy are the newest entrants into this problem; they’re extraordinarily effective and extraordinarily expensive.

Several states have already responded: California, New Hampshire, Pennsylvania, and South Carolina all eliminated coverage of GLP-1s for obesity treatment in January 2026, likely reflecting recent state budget challenges and fiscal uncertainty.

Behavioral Health Demand

About a quarter of states reported increasing behavioral health costs, including growing use of intensive or specialty behavioral health services or certified community behavioral health clinic expansions, as a factor contributing to increases in spending.

The mental health and substance use disorder treatment pipeline has expanded significantly since COVID, and the costs are real.

Long-term Care And Aging Populations

More Americans are aging into care-intensive years, and the long-term care infrastructure in most states was already strained before the demographic wave arrived in earnest. States like Florida, Arizona, and the Carolinas, major retirement destinations, are feeling this particularly acutely.

Workforce Costs

Nurse and physician shortages have pushed wages up across the country. Contract nurse staffing, which became an expensive necessity during COVID, has partially normalized but still costs significantly more than pre-pandemic equivalents. These labor costs flow directly into provider rates, which flow into Medicaid and insurance spending.

Primary Care Investment: The States Getting Ahead of the Problem

Not everything in this picture is grim. There’s a growing body of evidence, being acted upon by an increasing number of states, that investing more in primary care is one of the most effective ways to bend the cost curve, because preventing hospitalizations is dramatically cheaper than treating them.

As noted by the Commonwealth Fund, Oregon found that a one-dollar increase in primary care spending was associated with $13 in savings for other health services, including emergency department use.

That’s a 13-to-1 return. And yet most states still allocate only a fraction of their Medicaid budgets to primary care.

Some are changing that. Oklahoma enacted legislation requiring Medicaid managed care programs to report how much they spend on primary care and to raise the share of total spending devoted to primary care from 5 percent to a targeted 11 percent over four years.

In Virginia, a state task force successfully advocated for $151 million in increased primary care spending within the state’s Medicaid program.

The Federal Wild Card: What $911 Billion in Cuts Means for States

No 2026 analysis of state healthcare spending is complete without reckoning with the political backdrop, because federal policy is about to fundamentally change the fiscal math for state Medicaid programs in ways that haven’t fully played out yet.

As per KFF’s reporting, states are preparing for $911 billion in federal Medicaid spending cuts enacted in the budget reconciliation law earlier this year, including new financing restrictions and work requirements, which will exacerbate existing budget challenges.

The full impact of those cuts won’t land in 2026; many provisions don’t take effect until FY 2027 or later. But states are already repositioning. Colorado has proposed capping dental benefits. Rhode Island is considering ending GLP-1 coverage.

Idaho’s governor has proposed cuts to dental, pharmacy, and various medical services. Medicaid issues are also likely to intersect with broader health care coverage and affordability debates leading up to the mid-term elections in November 2026.

For states that depend heavily on federal matching funds to sustain their Medicaid programs, and that’s almost all of them, a $911 billion reduction is not an abstraction. It’s a forced choice between cutting services, raising state taxes, finding alternative funding mechanisms, or some combination of all three.

The Bottom Line

The US healthcare spending story in 2026 is ultimately about a system that remains deeply, structurally unequal in its distribution of both costs and quality. When it comes to having affordable health coverage, access to good-quality care, and the ability to lead a healthy life, where you live matters.

Healthcare service prices have generally risen faster than the cost of most other goods and services in the US, often outpacing overall inflation. In many areas, hospital systems and specialist services face limited competition, which can drive up the price of common procedures and visits.

The numbers don’t lie. Whether it’s Utah at $7,522 per capita or the District of Columbia at $14,381, whether it’s New Hampshire’s affordable premiums or Mississippi’s crushing healthcare-to-income burden, whether it’s the 46 percent growth in Medicaid drug spending or the projected $911 billion federal cut, all of it points to a system that is consuming more of America’s resources every year while still leaving millions of its residents without adequate, affordable care.