Georgia’s ranking on a health system score card has slipped to 46th in the nation.

The Commonwealth Fund’s 2015 scorecard, which ranked the 50 states plus the District of Columbia based on health issues, was released Dec. 9. It noted that Georgia had improved on 11 measures, including having more children and adults with insurance, and more children up to date on vaccines. Still, the state slipped from its ranking of 45th in 2014.

Nationally, the uninsured rate for working-age adults declined in nearly every state between 2013 and 2014, the first year of full implementation of the Affordable Care Act, the report said.

“These are the most substantial and widespread state improvements in access to care we’ve seen since we created the state scorecard series in 2007,” said Dr. David Blumenthal, the Commonwealth Fund’s president.

Georgia joined most Southern states in the bottom quartile of the rankings. Only three states in the region rated higher: Virginia, North Carolina and Florida.

Minnesota, Vermont, Hawaii and Massachusetts again ranked at the top nationally. The four lowest-ranking states were Louisiana, Arkansas, Oklahoma and Mississippi.

The scorecard is based on 42 indicators over five general areas: access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives and equity. Georgia scored in the bottom quartile in four of the areas, with the only exception being avoidable hospital use and cost.

Overall, states’ health-care systems improved more than they declined since they were measured in the 2014 scorecard, the Commonwealth Fund said.

Georgia was among 39 states whose uninsured rate dropped by more than 3 percentage points after the insurance exchanges debuted in 2014. But the state’s percentage of people without coverage is still among the highest in the nation.

“This report presents some very troubling data for the health of Georgians,’’ said Marsha Davis, an associate dean at the University of Georgia’s College of Public Health. “We rank at or near the bottom of states for adults being uninsured, adults without health care because of cost, and children without a medical home.”

A medical home is care-delivery model where treatment is coordinated through a primary-care physician to ensure the patient receives the necessary care.

She noted that Georgia ranked 50th in adults who went without care because of costs.

“If Georgians were insured at the rate of the nation’s leading state, over 1 million more adults in Georgia would have health-care coverage,’’ Davis said. “Improvements on numerous health-care indicators would no doubt follow.”

Davis called on state policymakers to examine the report as they consider the possibility of Medicaid expansion, which would extend coverage under the program to more low-income people.

The state’s political leadership has so far rejected Medicaid expansion, citing the costs involved.

Dr. Richard Rothenberg, a professor of epidemiology and biostatistics at the Georgia State University School of Public Health, said the state’s rankings reflect a large number of citizens who don’t have insurance coverage and access to care.

People without insurance often use a hospital emergency room for care, Rothenberg said, adding that the emergency-room cost is passed along by hospitals to insurers.

“It affects all of us, increasing the price of health care for everyone,” he said.

Rothenberg noted that Southern states largely have held back from expanding their Medicaid programs, though more than half the states overall have implemented it over the past three years. He said expansion would result in economic growth as well as health gains.

“The benefits to citizens and the economy are substantial,” he said.

The Georgia gains on the scorecard include better medication management for Medicare patients and on avoidable use of hospital ERs for seniors. The state, though, ranked 44th on breast-cancer deaths and 45th on children with emotional, behavioral or developmental problems who received the necessary mental-health care.

Nancy Nydam, a spokeswoman for the state Department of Public Health, said the rankings “serve as an important tool to raise awareness about the health of our state.”

“That said, the rankings are just one tool we use to identify areas in need of improvement,’’ Nydam added.

She said public-health officials also examine and evaluate numerous other sources of epidemiological data.

Nydam noted that Georgia has made significant progress in reducing the number of adult smokers.

“We know that programs like our Tobacco Free Schools and Smoke Free Campuses and Universities are having an impact,” she said.

She also cited improvements in child vaccinations, as well as agency programs to lower obesity rates in children and to reduce infant mortality.

“We know that there will always be challenges and additional work to do to improve the health of our state,’’ Nydam said. “DPH is committed to its mission to promote the health and well-being of all Georgians.”