The 2014 National Health Systems Scorecard was released this week. The Commonwealth Fund assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007-2012 period, which includes the recession, but does not include the affordable care act. Idaho's overall ranking was in the bottom quarter of the country, ranking at number 31. Several factors make up that ranking. One of the key categories is Access to Health Care. Idaho ranks number 42 in that category. Blue Cross of Idaho said that ranking is accurate because of how rural Idaho is as a state.