Health Freedom Index: 2026 Edition
A 50-State Freedom Index of Health and Healthcare
Download the Full Report [PDF]
Download the Data [XLSX]
"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. Also shown are the rankings from the most recent predecessor index (the Healthcare Openness and Access Project from 2020), and the delta between the old and the new rankings.
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.
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.
