More states improved than worsened over time on most measures examined in new health rankings out Wednesday — the first since the Affordable Care Act's coverage expansions took effect. The Commonwealth Fund Scorecard on State Health System Performance looks at access to medical care, prevention and treatment of disease, avoidable hospital use and cost, healthy lives and health equity. Some of the 42 indicators on the scorecard are numbers of insured adults, people 50 and older who got recommended screenings, adults who went without care because of cost, breast cancer deaths and infant mortality.