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"Health Freedom Index: 2026 Edition" Center for Modern Health & Knee Regulatory Research Center. August 2026.

The Health Freedom Index is a comparative assessment of the legal, regulatory, and policy environments governing healthcare across the United States. The index compiles state-level data on the degree of choice and freedom available to patients, healthcare professionals, insurers, and entrepreneurs. Individual measures are used to produce scores for each state, as well as an overall ranking. In addition to providing state rankings, the project aims to promote transparency and informed discussion about the role of freedom, voluntary exchange, and institutional design in American healthcare. It does not measure health or health outcomes.

ABOUT THE 2026 INDEX

This report expands the scope of analysis to 54 policy variables across five broad domains: 1) Professional Freedom, 2) Institutional Freedom, 3) Patient Freedom, 4) Payment Freedom, and 5) Delivery Freedom. Together, these categories provide a comparative picture of how much freedom patients, healthcare professionals, insurers, entrepreneurs, and institutions have to make voluntary healthcare decisions within each state.

Each variable in the index is scored on a freedom-oriented scale from 1 to 5, with higher scores indicating greater freedom (i.e., a less restrictive policy environment). The variables are then grouped into five category scores and combined into an overall Health Freedom score for each state and the District of Columbia. The index is unweighted, meaning each variable receives equal treatment. This choice avoids imposing assumptions about which policies matter most and allows readers to use the underlying data to conduct their own analyses with their own weighting choices.

THE STATE RANKINGS

Below are the 2026 Health Freedom Index state rankings, along with the actual scores for each state in each category, and each state's overal point total. A perfect score in each category would be a 5.0 points. A perfect score for the entire index (i.e., sum of all five categories) would be 25 points.

THE OVERALL MAP

The map below provides a visual snapshot of health freedom across the 50 states. Lighter shades indicate states with greater freedom, while darker shades indicate more restrictive policies. Together, the rankings and map show where states are removing barriers to competition, innovation, and patient choice. It also shows where researchers, advocates, and policymakers could improve health freedom.

This report is designed to be a useful resource and a conversation starter for those seeking to expand choice, competition, innovation, and voluntary exchange in American healthcare. By making state policy environments more transparent and comparable, we aim to support a more informed discussion about how policymakers can improve health freedom in their states.

FULL LIST OF VARIABLES

The 54 variables scored in this index are:

1. State allows medical license portability
2. State requires less postgraduate training for U.S. medical graduates
3. State has fewer continuing medical education requirements
4. State grants nurse practitioners broad scope of practice
5. State has fewer optician licensing requirements
6. State grants psychologists prescriptive authority
7. State allows midwives broad scope of practice
8. State grants pharmacists broad scope of practice
9. State grants dental hygienists broad scope of practice
10. State has less restrictive prescriptive authority for certified registered nurse anesthetists
11. State limits liability for charity caregivers
12. State recognizes off-label free speech in medicine
13. State allows foreign-trained physicians to apply for license without repeating residency training
14. State has fewer certificate-of-need restrictions
15. State allows freestanding birth centers
16. State allows freestanding emergency departments
17. State puts fewer restrictions on compounding pharmacies
18. State has fewer provider taxes
19. State doesn't restrict pharmaceutical company access to physicians
20. State allows ownership freedom for medical practices
21. State does not require advance notice for private equity activity
22. State does not impose rate-setting or price controls on hospitals
23. State allows mutual aid socieites to operate freely
24. State allows pharmacists to dispense hormonal birth control without physician prescription
25. State has lower excise taxes on e-cigarettes
26. State allows lay distribution of naloxone
27. State allows patients to use psychedelic substances for medical use
28. State allows patients to seek medical aid in dying
29. State allows minors to obtain/consent to contraception
30. State allows abortion
31. State does not interfere with reproductive technology
32. State allows patients Right-to-Try investigational treatments
33. State allows possession of drug checking equipment
34. State mandates fewer health insurance benefits
35. State does not constrict age rating further than federal law
36. State has fewer health savings account (HSA) taxes
37. State does not mandate that individuals buy health insurance
38. State does not restrict short-term renewable health plans
39. State does not mandate insurers have a Gold Card program
40. State allows out-of-state insurers to issue health insurance in the state
41. State allows underwriting (vs. guaranteed issue) starting at a lower employee threshold
42. State does not regulate Pharmacy Benefit Managers (PBMs)
43. State allows health savings-like accounts within Medicaid
44. State allows Medicaid patients to engage in direct pay for covered services
45. State allows broad Medicaid reimbursement by provider type
46. State has less restrictive telepresenter requirements
47. State has less restrictive telepharmacy location laws
48. State has more flexible opioid prescription rules
49. State allows online prescribing
50. State allows online eye exams
51. State offers protection for Good Samaritans
52. State does not treat concierge medicine / DPC practices as insurance
53. State allows drug dispensing by concierge medicine / DPC practices
54. State allows wholesale lab pricing by concierge medicine / DPC practices

Download the Full Report...

The 2026 Health Freedom Index is a joint research effort between the Center for Modern Health and the Knee Regulatory Research Center of West Virginia University.

The identical report and data can be downloaded from the Knee Regulatory Research Center's website. Both institutions plan to publish additional articles and analyses using the data from the Health Freedom Index, so stay tuned for more.