The quality, access and equity of healthcare for children varies widely from state to state, and the differences have consequences for the potential of many kids to lead long healthy, productive lives, according to a new report. The report from The Commonwealth Fund, a foundation focused on research and advocacy of healthcare quality and access, is the first to assess how the health system is performing for children across these five dimensions on a state-by-state basis. Commonwealth researchers ranked states on 13 indicators for children and grouped them in categories that included access, quality, costs, equity, and healthy outcomes. Iowa topped the list overall while Oklahoma ranked last. No state can boast top scores in all categories, but states in the Northeast and Upper Midwest tended to rank high in multiple areas. States with the lowest scores tended to be in the South and Southwest. States that ranked lowest overall tended to lag well behind their peers on the access to care measure and struggled with other measures. In the overall ranking, Arizona, Florida, Louisiana, Mississippi, New Jersey, Nevada, and Texas all scored in the bottom ten states overall and also were at the bottom on the access measure. Five of the lowest ranked states for access to care (Arizona, Louisiana, Mississippi, New Mexico, Nevada, and Texas) also ranked at the bottom on the quality measures. The report, U.S. Variations in Child Health System Performance: A State Scorecard, can be viewed on The Commonwealth Fund’s website. Below is the overall scorecard of the state-by-state rankings.