Nearly half of South Dakotans worry they cannot afford necessary healthcare in the coming year, according to a comprehensive new national survey that highlights persistent problems with medical costs and access across the state.
Middling Grades Across the Board
South Dakota ranked 21st out of 51 jurisdictions in the West Health-Gallup “State of the States 2025” study, which surveyed nearly 20,000 Americans about their real-world healthcare experiences based on residents’ self-reported experiences with cost, quality, and access. The state earned middling grades: C+ overall, D+ for cost, C+ for quality, and C+ for access.
The findings mirror national trends showing Americans grappling with healthcare affordability regardless of where they live. One in five Americans reported they or a household member could not pay for prescription medications in the past three months in this survey series.
How the Survey Works
The survey asked 27 detailed questions about residents’ actual experiences navigating the healthcare system, from whether they skipped recommended care due to cost to how long they waited for appointments. Researchers focused on patient experiences rather than traditional metrics like hospital capacity or mortality rates.
The Northern Plains Picture
South Dakota’s middle-of-the-pack ranking puts it behind several Northern Plains neighbors, based on residents’ experiences with cost, quality and access. Iowa tied with Massachusetts for first place nationally. North Dakota ranked eighth, Nebraska placed 10th and Minnesota came in 12th.
No State Gets an ‘A’
No state earned an A grade in any category, revealing widespread problems with healthcare affordability and access across America. Even in top-performing states, 15 percent of residents reported they could not afford prescriptions in the past three months.
Cost Burden Falls Hardest on Lower-Ranked States
The cost burden hits hardest in lower-ranked states. The share of residents who skipped recommended medical tests or procedures due to cost ranged from 18 percent in Massachusetts to 46 percent in Mississippi. Nationally, 30 percent avoided doctor-recommended procedures in the past year because they could not afford them.
Distance and Wait Times Create Additional Barriers
Access barriers extend beyond cost. Twenty-six percent of Americans reported that distance to medical professionals prevented or delayed healthcare access. Forty-four percent experienced delays due to long appointment wait times.
Worst and Best Performers
Alaska, Arkansas and Texas showed the poorest performance across all measured areas. Iowa and Massachusetts topped rankings by excelling in cost, quality and access.
About the Study
The West Health-Gallup Center for Healthcare in America conducted the research between June and August 2025, surveying adults aged 18 and older in all 50 states and the District of Columbia. Researchers weighted responses to match national demographics.
The study’s release comes as healthcare costs continue rising and workforce shortages persist following pandemic disruptions. National policy debates remain polarized over issues like Medicaid expansion and prescription drug pricing.
Full data and individual state scorecards are available at westhealth.gallup.com. The margin of error is plus or minus 1.3 percentage points nationally and plus or minus 5.4 to 8.0 percentage points for states.
