Florida has dropped to the 31st position among states in national health rankings. It's a decline from last year's 27th spot.

Local public health experts say more resources could help them address some of the gaps.

The rankings are from an annual United Health Foundation report, which indicates strengths for Florida's low prevalence of cigarette smoking and drinking.

But the Sunshine State ranks 44th in the nation for public health funding and 43rd in people avoiding medical care due to cost. Dr. Frederick Anderson is a family physician in Miami.

"Being sick or not well is very expensive - especially if you're low-income and uninsured, you can imagine having to go to an emergency room for care," said Anderson. "There's a reason why people are smart and they try to avoid going to the emergency room if they are sick, because they can get hit with thousands of dollars of medical bills."

According to the report, about 13% of Floridians avoid medical care because of the expense, exceeding the national rate of 10%.

Gov. Ron DeSantis' health budget proposal, revealed earlier this month, includes an increase in funding for children's health care - but no overall Medicaid expansion for lower-income residents.

And avoiding needed medical care comes at a risk.

On a national scale, UnitedHealthcare Employer and Individual's Chief Medical Officer Rhonda Randall said they're seeing concerning trends for chronic health conditions, such as diabetes and heart disease.

"This is something that we have been concerned about for quite some time," said Randall. "And when we looked at the data in this year's report, it's really unfortunate to see that the number of adults living with chronic conditions in the United States is the highest we've seen it."

Florida ranks 26th in the nation for the percentage of adults with multiple chronic conditions. Randall noted that this trend comes amid a decline in licensed primary caregivers nationwide.

Florida's uninsured rate is high, at 11% - compared to the national average of 8% - contributing to its 46th place ranking in this category.

Alison Yager, executive director of the Florida Health Justice Project, said she believes that's because Florida is one of the ten states that has opted out of expanding Medicaid.

"By continuing to play politics with the Medicaid program," said Yager, "our state politicians have really done a disservice to our residents by closing off access to coverage for far too many Floridians."

With the exception of expanding Medicaid, DeSantis highlighted more than $46 billion in healthcare funding in next year's budget - including money for cancer research, Alzheimer's programs, child welfare, waivers for Floridians with disabilities and initiatives for the elderly.

However, the report shows mental healthcare access remains a challenge, with the state ranking 43rd.

A coalition of Montana groups will rally at the Capitol Wednesday to advocate for the protection of Medicaid expansion, which legislators will debate this session before the program's scheduled expiration in June.

The state's 10-year-old Medicaid expansion program covers 75,000 low-income Montanans at an annual cost of about $1 billion, according to KFF Health News. The state picks up about 10% of the tab.

Kristen Stewart of Billings is a caregiver for her 90-year-old grandmother, and enrolled in Medicaid herself. As an organizer with the advocacy group Big Sky 55+, she noted many Medicaid enrollees work but the work is often undervalued.

"Medicaid supports a lot of people who are doing unpaid work," Stewart pointed out. "Things that were we to monetize, you would see an economic boost from their production level, often more than the cost of their care."

The Gianforte administration already tightened eligibility for the program, cutting the number of enrollees by nearly 40% between May 2023 and October 2024. The program currently covers nondisabled adults ages 19 to 64 who make less than $21,000 a year.

Jeannie Brown, a bus driver for the Belgrade Public School District and a full-time caregiver and legal guardian for her teenage granddaughter, said if Medicaid expansion does not get reauthorized, she will be on a "slippery slope."

"Because I'm 60 years old and I'm having my own health issues after being a caregiver, it's hard work and it takes a toll on you physically, financially and emotionally," Brown explained. "I'm hoping these legislators really take all of these things into consideration and reauthorize it."

Any laws passed on the issue could also affect the state's behavioral health services, which Gov. Greg Gianforte has made a priority.

Obtaining medical records can be a costly endeavor but there is hope Washington state lawmakers could find a fix this session.

Medical providers look for compensation when producing medical records because of the work involved in the process.

Holly Brauchli, an attorney at Seattle Injury Law, said an outdated process is used to determine the cost. Federal law requires all records to be digitized and Brauchli pointed out providers charge per page as if the records were on paper.

"We download it and we get a bill for thousands of dollars and the justification of that bill is that there's a per page charge," Brauchli explained. "I get these invoices that say copying charge per page. There are no copies."

Brauchli noted there are a variety of reasons why someone would want to obtain their medical records. For instance, the records could be important to an injury lawsuit or someone might want to check if their health insurance was billing them correctly.

Brauchli argued records should no longer be charged as if they are on paper.

"This seems like a really easy fix and certainly one that would help Washington citizens," Brauchli contended. "People have a right to know what's in their medical record and they have a right to be able to see it. So, to me, it's a really simple and elegant fix."

A bill has not been filed yet but is expected from Sen. Tina Orwall, D-Des Moines, soon. The 2025 legislative session starts today.

This Wednesday is the deadline to enroll in Affordable Care Act marketplace health coverage.

Advocates say this year is even more critical for those seeking a plan, because the expanded tax credits that allowed many Kentuckians to enroll in health coverage - at little or no monthly cost - are set to expire at the end of this year.

After Jan. 15, folks will have to qualify for a special enrollment period to take advantage of Advanced Premium Tax Credits while they still exist.

Priscilla Easterling, director of outreach and enrollment with Kentucky Voices for Health, said the state's uninsured rate could potentially increase if families can't afford coverage without the credits.

"I think we should all be very concerned," said Easterling. "Without these enhanced premium tax credits being extended, we're going to see enrollment drop off, because families will no longer be able to afford that monthly premium."

According to research from the Robert Wood Johnson Foundation, the elimination of expanded tax credits would especially impact older adults - who tend to have higher health coverage costs.

In 2024, people over age 50 made up more than one-third of total ACA enrollment.

Easterling said in many cases, for low-income individuals making around $22,000 per year, the credits covered the full cost of their plan, and have saved Kentuckians thousands of dollars a year.

"They have been around for the duration of the ACA," said Easterling, "but the enhanced part that was first expanded in 2021. They have, on average, saved most households over $500 per month."

Easterling said residents can find local experts at kynect.gov to help them take advantage of tax credits and find the best plan for them.

"There are 'kynectors' available in all 120 counties," said Easterling, "who can help and provide free assistance for anyone who needs help navigating Kynect.gov or trying to get enrolled in coverage."

During 2024, more than 71,000 Kentucky residents enrolled in a plan through the marketplace, according to the health advocacy group KFF.

Nationwide, a record 24 million people have signed up for insurance coverage through the Affordable Care Act, according to federal data.