WASHINGTON — High-income people who live in states that generally do poorly in health care are worse off than low-income people in states with high health care scores, according to a Commonwealth Fund study released today.

"In the United States, income is not a guarantee of good healthcare or good health," said David Blumenthal, president of The Commonwealth Fund, a private foundation that works to increase access to health care. "Where you live plays a very big part in your experience.

As an example, Blumenthal said low-income seniors who live in Connecticut and Wisconsin are less likely to receive medications considered high-risk than are high-income seniors in Mississippi, Louisiana and Alabama.

To compile health scores, investigators looked at everything from how many people in a state had health insurance versus those who had none or did not have enough coverage. They also considered how many people used the emergency room for care rather than a doctor's office or how well a state's health care system protected its citizens from dangerous medications.

While the northern and western states generally did well in the report, the South, Southeast and Southwest "performed badly," Blumenthal said. He compared access to health care in those areas as similar to developing countries in Southeast Asia.

The organization compared states based on access and affordability, prevention and treatment, avoidable hospital use and healthy lives. They found that:

• In Massachusetts, which has had a requirement for people to buy insurance comparable to the Affordable Care Act since 2006, about 12% of people are uninsured, while in Texas, 55% of people have no insurance.

• In some states, 32% of low-income adults older than 50 received preventive care, such as cancer screenings and vaccines. In Idaho, Oklahoma and California only 26% received such care. In Massachusetts, 42% did.

• In eight states, at least 40% of Medicare beneficiaries were prescribed medications considered dangerous for seniors. That was more than double the rate than for states with higher marks.

• In New York, low-income children with asthma were hospitalized eight times more often than low-income kids in Oregon.

But states that performed well in some areas didn't do as well in others. For example, Colorado performed in the top quartile for avoiding the hospital and healthy lives, but in the lowest 25% for access and affordability.

"We see potential for real gains if we aim high," said Cathy Schoen, senior vice president of The Commonwealth Fund. "This is putting everyone at risk, not just the low-income population."

Alabama, Mississippi, Oklahoma and Louisiana, none of which opted for a state-based exchange or expanded Medicaid under the Affordable Care Act, all performed in the bottom quarter in all areas of the health scorecard.

"The lack of Medicaid will only exacerbate the disparities our scorecard highlights," Blumenthal said.

Nearly 40% of the U.S. population falls below 200% of the poverty level, and in some states, including Arkansas, Louisiana, Mississippi and New Mexico, half the population falls below that level. For a family of four, that's $47,100 a year. For the report, those who made more than 400% of the poverty level, or $94,200 for a family of four, were considered well off.

REPORT: State health study

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