With a rate of uninsured children that’s double the national average, Wyoming was ranked second to last in the United States for children’s health in a national study for the second consecutive year.

Overall, the Equality State ranked 21st for children’s well-being on the Kids Count report, which is released in June by the Annie E. Casey Foundation and assesses each state based on multiple children-related categories. Wyoming’s 2019 ranking is a slight drop from last year’s ranking of 18, itself an improvement from 2017’s 27th place finish.