We rank all 50 states on 17 different measures of how life actually goes for the people who live there. Not opinions. Not vibes. Hard numbers from the CDC, the USDA, America's Health Rankings, the Commonwealth Fund, and the Annie E. Casey Foundation — things like how long people live, how many babies die before their first birthday, how many families can't afford food, how many kids grow up poor, how many people are shot, and how good the schools are.
Then we add it all up. Here are the top four:
- Massachusetts
- New Hampshire
- Vermont
- Connecticut
Now here's the part worth sitting with.
Those four states send 25 people to Congress — 17 Representatives and 8 Senators. Not one of them is a Republican. Not one. Massachusetts has nine House members and two Senators, all Democrats. Connecticut hasn't sent a Republican to Congress since Chris Shays lost his seat in 2008. New Hampshire has two House Democrats and two Democratic Senators. Vermont has one Democratic Representative, one Democratic Senator, and Bernie Sanders.
Twenty-five seats. Zero Republicans.
Now look at the bottom
Flip the list over. The four worst states on our rankings:
- #50 Louisiana
- #49 Arkansas
- #48 Mississippi
- #47 Alabama
All four are Republican trifectas — the Republican Party controls the governor's office, the state senate, and the state house in every one of them, according to Ballotpedia. Louisiana, Arkansas, Mississippi, and Alabama send 24 Republicans to Congress between them, including the Speaker of the House.
So the four best states in America have zero Republicans in Washington. The four worst states have 24.
That's not a coincidence you can wave away. That's a pattern.
The gap isn't small
This isn't a photo finish. On measure after measure, the top four and the bottom four are living in different countries.
- Dying young. Massachusetts ranks #2 in the country for life expectancy and Connecticut #3. Mississippi is dead last, with Alabama #48 and Louisiana #47.
- Babies. New Hampshire has the lowest infant mortality rate in America. Vermont is #2, Massachusetts #3. Mississippi is #50, Arkansas #49, Alabama #48.
- Hunger. New Hampshire has the lowest food insecurity rate in the country. Arkansas has the highest — #50 of 50. In Arkansas, 1 in 4 kids faces hunger. Same in Louisiana, Mississippi, and Alabama.
- Poverty. New Hampshire has the lowest poverty rate in America, Vermont #3. Louisiana is #50 and Mississippi #49.
- Paychecks. Massachusetts has the highest median household income in the country. Mississippi has the lowest.
- Guns. Massachusetts has the second-lowest firearm death rate in America, Connecticut #6, New Hampshire #9. Mississippi is #50, Louisiana #49, Alabama #47.
- Women's health. Massachusetts ranks #1 in the nation, Vermont #2, Connecticut #4, New Hampshire #5. Mississippi is #50, Arkansas #46, Alabama #44.
- Kids. New Hampshire is #1 for child well-being, Massachusetts #2, Vermont #4. Mississippi is #50, Louisiana #48.
Same country. Same economy. Same federal government. Wildly different outcomes.
These are choices, and we can name them
Here's the cleanest example. The Affordable Care Act let every state expand Medicaid, with the federal government picking up almost the whole tab. Massachusetts, Vermont, and Connecticut all took the deal on January 1, 2014. New Hampshire followed that August.
Mississippi and Alabama — #48 and #47 — still haven't taken it, twelve years later. They are two of only ten holdout states in America. Mississippi has the worst life expectancy, the worst infant mortality, and the worst women's health ranking in the country, and its leaders have spent over a decade turning down federal money to fix it.
That's not bad luck. That's a decision somebody made, on purpose, more than once.
Then they voted to make it worse
On July 1, 2025, the Senate passed Trump's "One Big Beautiful Bill Act" 50–50, with Vice President Vance breaking the tie. Two days later the House sent it to Trump's desk.
Look at how the two groups of states voted.
Every single one of the 25 members of Congress from Massachusetts, New Hampshire, Vermont, and Connecticut voted no. All 17 House members. All 8 Senators. Unanimous.
Every single one of the 24 Republicans from Louisiana, Arkansas, Mississippi, and Alabama voted yes. All 16 House Republicans. All 8 Senators.
The bill cut roughly $1 trillion from Medicaid to help pay for tax cuts weighted toward the richest 1 percent. Here's what that means in the states that voted for it:
- Louisiana loses an estimated $21.9 billion in federal Medicaid dollars over the next decade — 16% of what the state was set to get, one of the steepest percentage cuts of any state. Somewhere between 200,000 and 300,000 Louisianians are expected to lose coverage. That's the state already ranked #50.
- Arkansas loses about $8.9 billion, and rural hospitals there are expected to close.
- Mississippi — the state that never expanded Medicaid in the first place — loses about $3 billion, and 115,000 residents are projected to lose coverage in a state where 24% of everyone is on Medicaid.
- Alabama loses about $3.5 billion, and 53,000 more Alabamians lose coverage — rising to 170,000 if the enhanced ACA tax credits expire too.
The states with the least cushion took the hardest swing. Their own representatives swung it.
Here is every single one of them
No hiding in a party total. Here are the names, state by state. Every member of Congress listed below is a recorded yes on the House or Senate roll call.
Louisiana — ranked #50. Steve Scalise (LA-01), the House Majority Leader who runs the floor. Clay Higgins (LA-03). Mike Johnson (LA-04), the Speaker of the House, who decides what comes up for a vote at all. Julia Letlow (LA-05), who is now running for the Senate on this record. Senators Bill Cassidy and John Kennedy both voted yes too.
Arkansas — ranked #49 overall, and dead last in the country for hunger. Rick Crawford (AR-01), French Hill (AR-02), Steve Womack (AR-03), and Bruce Westerman (AR-04) — the entire House delegation. Senators Tom Cotton and John Boozman. Governor Sarah Sanders cast no vote — she doesn't get one — but she runs the state, and it has the highest food insecurity rate in the country, where 1 in 4 kids faces hunger.
Mississippi — ranked #48. Trent Kelly (MS-01), Michael Guest (MS-03), and Mike Ezell (MS-04). Senators Cindy Hyde-Smith and Roger Wicker. The only member of Mississippi's delegation who voted no was Democrat Bennie Thompson.
Alabama — ranked #47. Mike Rogers (AL-03), Robert Aderholt (AL-04), Dale Strong (AL-05), and Gary Palmer (AL-06), along with Barry Moore (AL-01). Senators Tommy Tuberville — now running for Governor on this record — and Katie Britt. Alabama's two Democrats, Shomari Figures and Terri Sewell, voted no.
Four states at the very bottom of the country. Twenty-four Republicans. Not one defection.
"But two of those states have Republican governors"
They do, and it's worth being straight about it.
Vermont's governor is Phil Scott, a Republican. He has also never voted for Donald Trump — he wrote in a former Vermont governor in 2016, voted for Joe Biden in 2020, and voted for Kamala Harris in 2024. He said he "had to put country over party." Whatever Phil Scott is, MAGA isn't it.
New Hampshire's governor is Kelly Ayotte, a Republican who took office in January 2025 — long after the numbers that put New Hampshire at #2 were built. New Hampshire is #2 because of what was built there over decades. Watch what happens to that number now.
The bottom line
A state's ranking is the sum of a thousand decisions: whether to take the Medicaid money, whether to fund the schools, whether to feed the kids, whether to make it easy or hard to get a gun, whether to expand coverage or hand the savings to the top 1 percent.
The four states that made those calls best send nobody to Washington to undo them. The four states that made them worst send 24 people to Washington who voted in 2025 to make them worse.
If the MAGA agenda worked, Louisiana and Mississippi would be at the top of this list. They've had total control for years. Instead they're #50 and #48, and their own Senators voted to cut the health care their constituents can least afford to lose.
We deserve better.
Sources
Rankings are our own composite of 17 state datasets — see the full comparison tool for every measure and its source. Vote records: U.S. Senate Roll Call Vote 372 (July 1, 2025) and House Roll Call 190 (July 3, 2025). Party control: Ballotpedia. Medicaid expansion status: KFF, May 2026.
