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

For certain aspects of healthcare, Arizona is the freest state in the nation. The least free? New Jersey.

The findings have nothing to do with no-cost services and everything to do with the legal, regulatory and policy environments governing healthcare across the United States. 

They’re from the Center for Modern Health, a libertarian think tank focused on advancing free-market ideas in health policy.

In the Center’s own words, the 2026 Health Freedom Index reflects state-level data on the degree of choice and freedom available to patients, healthcare professionals, insurers and entrepreneurs. 

For each state, the project’s researchers measured performance across 54 variables and five kinds of “freedom”—professional, institutional, patient, payment and delivery—and used the sums to index the states from best to worst. 

In addition, the project “aims to promote transparency and informed discussion about the role of freedom, voluntary exchange and institutional design in American healthcare.”

Here are the top 20.

1. Arizona
2. Colorado
3. Idaho
4. North Dakota
5. Utah
6. New Hampshire
7. Montana
8. Maine
9. Oklahoma
10. Oregon
     
11. Iowa
12. South Dakota
13. Alaska
14. Nevada
15. Virginia
16. Texas
17. Wisconsin
18. Wyoming
19. New Mexico
20. Indiana

“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,” the researchers write. “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.”

Get the rest.