‘Health Freedom Index’ ranks states by free-market measures not directly related to costs or outcomes. Here are the 20 ‘most free’

August 28, 2026 - 15:29

A new report aiming to measure healthcare freedom through a free-market lens places Arizona at the top of the list, while New Jersey lands at the bottom. The index, which evaluates states based on policy choices rather than health outcomes or spending, seeks to highlight where individuals have the most leeway in making their own medical decisions.

The ranking focuses on regulatory and legal structures that either expand or restrict patient choice. Factors include the scope of practice for nurse practitioners and midwives, certificate-of-need laws that limit new medical facilities, and the ability to purchase health insurance across state lines. The index also weighs the presence of direct primary care agreements and the legal climate for alternative treatments.

Notably, the index does not factor in the cost of premiums, life expectancy, or disease rates. Instead, it is designed to show which states allow market forces to operate with fewer government constraints. Supporters of the approach argue that reducing red tape lowers prices and spurs innovation. Critics, however, say the measures ignore real-world access issues and often benefit healthier, wealthier populations.

Following Arizona in the top five are Iowa, Oklahoma, Wisconsin, and Kansas. These states generally have fewer restrictions on who can provide care and how facilities are built. At the other end of the spectrum, New Jersey is joined by New York, Rhode Island, Delaware, and Massachusetts as the least free. Those states tend to have more stringent licensing requirements and broader regulatory oversight.

The authors of the report suggest that states looking to improve their ranking should review occupational licensing mandates and allow more flexibility in telehealth across state borders. They also point to tort reform as a key factor, as states with caps on malpractice damages score higher. The full list of 50 states is available, with the report noting that regional patterns are clear, but individual state choices matter more than geography.