States are losing ground when it comes to preventing deaths from suicide, alcohol, and drugs, a report from the Commonwealth Fund finds. Based on an analysis of publicly available data across forty-seven healthcare indicators as well as income-based disparities within states, the report, 2019 Scorecard on State Health System Performance (65 pages, PDF), found that, in 2017, West Virginia had the highest rate of drug overdose deaths (57.8 deaths per 100,000 residents) — more than double the national average — followed by Ohio (46.3 deaths per 100,000). Since 2015, those two states have also experienced the fastest and third-fastest growth in their drug-related death rates. According to the report, the number of deaths nationally from drug overdose, alcohol, and suicide hit all-time highs in 2017, up 115 percent, 37 percent, and 28 percent, respectively, since 2005, while progress in expanding health insurance coverage since the Affordable Care Act was enacted has stalled and, in some states, been reversed, with sixteen states — including both those that did and didn't expand Medicaid eligibility — seeing upticks of a percentage point in their adult uninsured rates. The scorecard put Hawaii, Massachusetts, Minnesota, Washington, Connecticut, and Vermont at the top of its state rankings, and Arkansas, Nevada, Texas, Oklahoma, and Mississippi at the bottom, and found that only Delaware, Hawaii, New Mexico, and Wyoming had more indicators worsen than improve over the five-year period.