North Dakota Highlights

13 North Dakota's 2020 Rank
To learn more about state rank, visit our 2020 Scorecard on State Health System Performance.
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Source: Commonwealth Fund 2020

Key Demographics

North Dakota US Average
Total Population 743,288 322,324,172
Median Household Income $68,080 $67,877
Below 200% of Federal Poverty Level (FPL) 25% 30%
% White Race, Non-Hispanic 84% 60%
% Black Race, Non-Hispanic 3% 12%
% Other Race, Non-Hispanic 10% 9%
% Hispanic Ethnicity 3% 18%

Key Health Policies in North dakota

North dakota has put no rules in place to promote ACA marketplace competition.
North dakota has stricter short-term coverage regulations than the federal government: short-term coverage is allowed, but contract duration and the length of time a consumer can be enrolled is limited. 
North dakota expanded Medicaid.

North Dakota Performance Data

CSV
Indicator Source 2016 2017 2018 2019
Uninsured adults ages 19–64 American Community Survey, Public Use Microdata Sample (ACS PUMS) 9% 9.4% 9.9% 8.6%
Uninsured children ages 0–18 American Community Survey, Public Use Microdata Sample (ACS PUMS) 10.1% 7% 6.5% 8.3%
Hospital admissions for pediatric asthma, per 100,000 children ages 2-17 Healthcare Cost and Utilization Project (HCUP), via AHRQ National Healthcare Quality Report - - - -
Adults age 18 and older who went without care because of cost in past year Behavioral Risk Factor Surveillance System (BRFSS) 8% 8% 9% 9%
Adults age 18 and older with a usual source of care Behavioral Risk Factor Surveillance System (BRFSS) 74% 71% 73% 69%
Adults age 18 and older without a dental visit in past year Behavioral Risk Factor Surveillance System (BRFSS) 34% - 32% -
Adults with age- and gender-appropriate cancer screenings Behavioral Risk Factor Surveillance System (BRFSS) 64% - 65% -
Adults with age-appropriate vaccines Behavioral Risk Factor Surveillance System (BRFSS) 41% 40% 38% 45%
Adults ages 18–64 who report fair or poor health Behavioral Risk Factor Surveillance System (BRFSS) 13% 13% 11% 12%
Adults ages 18 and older who smoke Behavioral Risk Factor Surveillance System (BRFSS) 20% 18% 19% 17%
Adults ages 18–64 who are obese (BMI >= 30) Behavioral Risk Factor Surveillance System (BRFSS) 32% 33% 35% 35%
Mortality amenable to health care, deaths per 100,000 population CDC National Vital Statistics System (NVSS): Restricted Use Mortality Microdata 73.1 71.6 - -
Central line-associated bloodstream infections (CLABSI), Standardized Infection Ratio CDC Healthcare-Associated Infections (HAI) Progress Report 0.844 0.811 0.65 -
Breast cancer deaths per 100,000 female population CDC National Vital Statistics System (NVSS): WONDER 17.9 19.6 16.9 -
Colorectal cancer deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 12.8 10.2 12.5 -
Suicide deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 19 20.1 19.2 -
Alcohol-related deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 14.9 14 17.2 -
Drug poisoning deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 10.6 9.2 10.2 -
Infant mortality, deaths per 1,000 live births CDC National Vital Statistics System (NVSS): WONDER 6.4 4.4 - -
Hospital admissions among adults ages 18–64 with employer-sponsored insurance for ambulatory care–sensitive conditions, per 1,000 enrollees Truven MarketScan 6.5 6.6 - -
Hospital admissions among Medicare beneficiaries age 65 and older for ambulatory care–sensitive conditions, per 1,000 beneficiaries Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File 39.8 40.7 35.9 -
Potentially avoidable emergency department visits among adults ages 18–64 with employer-sponsored insurance per 1,000 enrollees Truven MarketScan 133.1 158.1 - -
Potentially avoidable emergency department visits among Medicare beneficiaries age 65 and older per 1,000 beneficiaries Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File 166.6 - - -
30-day hospital readmissions among adults ages 18–64 with employer-sponsored insurance, per 1,000 enrollees Truven MarketScan 3 3.1 - -
30-day hospital readmissions among Medicare beneficiaries age 65 and older per 1,000 beneficiaries Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File 32.8 34.3 32.5 -
Individuals under age 65 with high out-of-pocket medical costs relative to their annual household income Current Population Survey Annual Social and Economic Supplement (CPS ASEC) 10% 9.5% 8.7% -
Total Medicare (Parts A & B) reimbursements per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $8,192 $8,490 $8,684 -
Total Medicare reimbursements for inpatient hospital services per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $2,314 $2,386 $2,297 -
Total Medicare reimbursements for ambulatory Evaluation and Management services per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $569 $578 $580 -
Total Medicare reimbursements for inpatient skilled nursing care per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $955 $959 $950 -
Total Medicare reimbursements for home health care services per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $132 $134 $126 -
Home health patients who got better at walking or moving around Outcome and Assessment Information Set (OASIS), via CMS home Health Compare 72% 76% 79% -
Home health patients whose wounds improved or healed after an operation Outcome and Assessment Information Set (OASIS), via CMS home Health Compare 90% 92% 88% -
Home health patients also enrolled in Medicare with a hospital admission Medicare Claims, via CMS Home Health Compare 17% 15% 15% -
Risk-adjusted 30-day mortality among Medicare beneficiaries hospitalized for heart attack, heart failure, pneumonia, or stroke CMS Hospital Compare 14.6% 14.2% 14.2% -
Hospitalized patients given information about what to do during their recovery at home Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 85% 86% 84% -
Overall patient hospital experience rating (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 67 66 - -
Patients' experience communicating with nursing staff (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 76 75 - -
Patients' experience communicating with doctors (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 79 78 - -
Responsiveness of hospital staff when called by patients (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 62 62 - -
Patients' experience communicating with hospital staff about medicines they received (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 60 61 - -
Patients felt prepared to manage their care after a hospital stay (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 50 49 - -
Patients discussed discharge plans with hospital staff and received written instructions (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 88 87 - -
Hospitals with overall patient experience ratings higher than the national average Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 50% 17% - -
Adult diabetic patients ages 18–64 with employer-sponsored insurance with at least one hemoglobin A1c test during the year Truven MarketScan 90.8% 89.3% - -
Adult diabetic patients ages 18–64 with employer-sponsored insurance with at least one LDL-C test during the year Truven MarketScan 82.6% 76.6% - -
Adult patients ages 18–64 with employer-sponsored insurance and a diagnosis of bacterial pneumonia who received an appropriate empiric antibiotic Truven MarketScan 80.5% 78.9% - -
Adult patients ages 18–64 with employer-sponsored insurance and a diagnosis of major depression who were prescribed an antidepressant medication, and who had pharmacy claims of at least 5 months’ worth of the medication Truven MarketScan 61% 61.2% - -
Adult patients ages 18–50 with employer-sponsored insurance who had a new primary diagnosis of low back pain with an Imaging study (plain X-ray, MRI, or CT scan) within 28 days of the diagnosis Truven MarketScan 71.6% 68.1% - -
Total employer-sponsored insurance reimbursements per enrollee, ages 18–64 Truven MarketScan $4,786 $4,888 - -
Total employer-sponsored insurance reimbursements for inpatient hospital services per enrollee, ages 18–64 Truven MarketScan $1,279 $1,314 - -
Total employer-sponsored insurance reimbursements for physician office services per enrollee, ages 18–64 Truven MarketScan $547 $568 - -
Short-stay nursing home residents with a 30-day readmission to the hospital Residential History File 15% - - -
Long-stay nursing home residents with a hospital admission Residential History File 14% - - -
Medicare beneficiaries who received at least one drug that should be avoided in the elderly Medicare Part D Claims 7.3% - - -
Total premium cost for employer-sponsored health insurance plans Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $14,080 $15,093 $14,724 $15,234
Total premium cost for employer-sponsored health insurance plans as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 21.5% 21.9% 20.4% 20.1%
Employee contribution to total premium cost for employer-sponsored health insurance plans Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $3,671 $3,837 $4,069 $4,305
Employee contribution to total premium cost for employer-sponsored health insurance plans as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 5.6% 5.6% 5.6% 5.7%
Employee deductible for employer-sponsored health insurance plans Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $2,575 $2,675 $3,126 $3,432
Employee deductible for employer-sponsored health insurance plans as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 3.9% 3.9% 4.3% 4.5%
Employee total potential out-of-pocket medical costs (premium contribution + deductible) Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $6,246 $6,511 $7,196 $7,737
Employee total potential out-of-pocket medical costs (premium contribution + deductible) as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 9.5% 9.4% 10% 10.2%
Children ages 19–35 months who received all recommended doses of seven key vaccines National Immunization Survey (NIS) 68% 79% 82% -
Children ages 10–17 who are overweight or obese (BMI >= 85th percentile) National Survey of Children’s Health (NSCH) 37% 22% 32% -
Children ages 0–17 with all components of a medical home National Survey of Children’s Health (NSCH) 51% 55% 52% -
Children with age-appropriate medical and dental preventive care visits in the past year National Survey of Children’s Health (NSCH) - - 57% -
Children ages 3–17 who received treatment or counseling from a mental health professional when needed during the past 12 months National Survey of Children’s Health (NSCH) 90% 93% 95% -
Adults age 18 and older with any mental illness reporting unmet need National Survey on Drug Use and Health (NSDUH), via State of Mental Health in America 19% 21% - -
Adults age and older with any mental illness who did not receive treatment National Survey on Drug Use and Health (NSDUH), via State of Mental Health in America 58% 56% - -
Long-stay nursing home residents with an antipsychotic medication Minimum Dataset (MDS), via CMS Nursing Home Compare 17% 17% - -
High-risk nursing home residents with pressure sores Minimum Dataset (MDS), via CMS Nursing Home Compare 4% 3.9% - -
Deaths from suicide, alcohol, and drug use per 100,000 population CDC National Vital Statistics System (NVSS): WONDER - - - -
State-based public health spending per resident Trust for America’s Health (TFAH) $49 $55 - -
Primary care spending as share of total health care spending among adults ages 18–64 with employer-sponsored insurance Truven MarketScan 7.96% - - -
Primary care spending per enroleee among adults ages 18–64 with employer-sponsored insurance Truven MarketScan $541 - - -
Primary care spending as share of total health care spending among Medicare beneficiaries age 65 and older CMS Limited Data Set (LDS) 5.59% - - -
Primary care spending per Medicare beneficiary, age 65 and older CMS Limited Data Set (LDS) $638 - - -

North Dakota Policy Data

CSV
Policy Source Action Taken Notes Info
Medicaid expansion status The Commonwealth Fund 1 Traditionally expanded Medicaid -
Medicaid work requirement status The Commonwealth Fund 0 No work requirement status -
Affordable Care Act health insurance marketplace type Center on Health Insurance Reforms, Georgetown University Health Policy Institute 1 Federally facilitated marketplace (17 states) The federal government (HHS) is legally responsible for all marketplace functions. Individuals must use HealthCare.gov to enroll in coverage.
State requirements for individuals to maintain adequate health coverage (individual mandates) J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 Does not require individuals to maintain adequate health coverage -
State subsidies for individual market coverage J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States."The Commonwealth Fund 0 Provides no premium or cost-sharing subsidies -
State regulation of short-term limited duration coverage J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 1 Sets stricter limits on the sale of short-term coverage than the federal government Does not prohibit underwritten short-term coverage; Limits the initial contract duration of underwritten short-term coverage to 6 months; Does not limit the total length of time a consumer may be enrolled in underwritten short-term coverage to less than 364 days
State decisions to extend the annual open enrollment period for ACA marketplace coverage J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 Did not extend 2018–2021 open enrollment Did not extend the open enrollment period for 2018, 2019, or 2020 coverage; Did not extend the open enrollment period for 2021, but in response to the COVID-19 pandemic, the federal government reopened HealthCare.gov for 2021 coverage from Feb. 15, 2021 through Aug. 15, 2021.
Rules to a promote competitive marketplace J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 No rules to promote marketplace competition Has not established a rule to promote a competitive ACA marketplace.
State decisions regarding whether to allow non-compliant transitional policies in the individual market J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 1 Permits non-compliant transitional policies Permits insurers to sell non-compliant transitional policies in the individual market
State decisions to exempt other coverage products from federal and state consumer protections J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 Does not exempt other coverage from insurance rules Does not exempt other coverage products from federal and state rules for individual market insurance
Status of state Affordable Care Act (1332) innovation waivers J. Giovannelli and K. Lucia, "States See Opportunities for Flexibility in the ACA’s Innovation Waiver Program." The Commonwealth Fund 3 Waiver approved by federal government (16 states) Waiver application approved by the federal government on July 31, 2019. Waiver secures federal funding to support a state-based reinsurance program.
State-operated individual market reinsurance programs supported by federal funding from an ACA innovation waiver J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 1 Operates a waiver-funded reinsurance program Operates an individual market reinsurance program supported by an ACA innovation waiver (since 2020); $47 million in program funding (2020); 55% state share of funding (2020); 45% federal share of funding via waiver (2020); 20% average projected reduction in individual market premiums due to program in first year of waiver (2020); Attachment point program design