Dive Brief:
- Racial and ethnic health disparities persist in all 50 U.S. states, even after some gains in coverage and affordability coming out of the coronavirus pandemic, according to a new report from the Commonwealth Fund.
- Native, Hispanic and Black communities experienced generally worse care access and affordability than white communities in most states, according to the research foundation’s report, which analyzed national health data primarily from 2023 to 2024.
- However, the analysis doesn’t include population data after the Trump administration’s sweeping cuts to health programs like the safety-net insurance program Medicaid and the expiration of more generous subsidies in Affordable Care Act plans. “These recent changes are likely to make it even harder for people to afford and access care and risk widening the very disparities this report documents,” Dr. Joseph Betancourt, president of the Commonwealth Fund, said at a Tuesday press briefing.
Dive Insight:
The Commonwealth Fund analyzed health disparities, care access and coverage details in the most recent years of publicly available data, as part of an annual report on state health outcomes.
Although some states delivered better care than others across racial and ethic groups — including Connecticut, Maryland, New York, Massachusetts and Rhode Island — none had eliminated disparities despite national progress that was made on some health measures during the study period, the report found.
For example, alhough U.S. life expectancy hit a record high in 2024, Black and American Indian and Alaska Native, or AIAN, people had higher mortality rates than other groups in every state.
Hispanic and AIAN adults were also more likely than other groups to lack health insurance despite the number of uninsured Americans falling to a record low of 7.7% in early 2023, according to the Commonwealth Fund.
Some health outcomes among certain racial groups persisted even when preventive care was sought out.
Black women, for instance, died from breast cancer at the highest rate of any group in almost every state, despite getting preventive mammograms. This may be due to delays in follow-up care and a lack of affordable coverage for imaging or biopsies after abnormal mammogram results, the foundation said.
Children were also impacted by the health disparities. In all but eight states, Black and Hispanic children were less likely to have age-appropriate preventive dental visits and other care compared to white children.
Care gaps were likely made worse after states began rechecking Medicaid eligibility in 2023 after a nationwide pause during the COVID-19 pandemic. The process, called redeterminations, started eroding some coverage gains, according to the Commonwealth Fund.
More Hispanic, AIAN and Black adults reported forgoing care due to cost after 2023.
Health outcomes, access and other metrics were likely made worse last year due to cuts to federal healthcare programs propelled by the Trump administration, but that data was outside the parameters of the Commonwealth Fund’s report.
Medicaid cuts and the loss of ACA subsidies will likely raise the amount of uninsured Americans. Nearly 11 million more people could lose insurance by 2034, according to federal estimates.
The expiration of more generous subsidies for ACA plans could also raise the uninsured rate, as patients drop coverage due to skyrocketing premiums. Large health systems have said they’ve seen increasing amounts of uninsured patients in first-quarter earnings calls this year.
In addition, future analysis of health equity metrics could be tricky after the Trump administration cut wide swaths of grants dedicated to collecting data on health disparities, according to Betancourt.
“In the face of significant and persistent disparities, we know you cannot fix what you cannot measure, and without this data, we lose our ability to identify who is being left behind and then be able to direct resources where they will have the greatest impact to eliminate gaps,” the Commonwealth Fund president said.
