A report unveiled on Wednesday details significant progress in addressing health disparities across U.S. states. Since the previous assessment by the Commonwealth Fund, two states have widened Medicaid eligibility, several states have extended postpartum coverage for mothers, and enrollment in Affordable Care Act marketplace plans has surged dramatically.
However, since the report spans the years 2022 to 2024, many researchers in equity are concerned that these improvements might not last. Experts who have evaluated the report suggest that policies implemented during the second Trump administration, which include modifications to insurance coverage, vaccine policies, and reductions in diversity, equity, and inclusion programs, could worsen inequities.
“While reading this Commonwealth report, I wasn’t shocked by the ongoing racial inequities,” said Miranda Yaver, a political scientist from the University of Pittsburgh who recently released a book on how insurance coverage impacts inequities. “But my reaction was, ‘Oh my gosh, it’s about to get so much worse.’”
The Commonwealth report, which follows similar studies from 2021 and 2024, evaluates health disparities among five racial and ethnic groups. It examines premature death rates from preventable causes, health insurance coverage, and access to preventive care. Despite some improvements, Black people in every state with available data were more likely to die early from preventable causes compared to other racial groups.
This disparity might stem from limited access to care. The report highlights breast cancer screenings, noting that while Black women receive mammograms at high rates, in 37 out of 40 states, they have the highest mortality rate from breast cancer. This gap may be due to later-stage detection in Black women and the Affordable Care Act covering screenings but not follow-up care.
“Our commitment as health systems and providers is to deliver health, well-being, and high-quality care for everyone. The disparities highlighted today are not unavoidable; they result from policy decisions and health system choices that can be altered,” stated Joseph Betancourt, president of the Commonwealth Fund.
The report indicates that racial gaps in vaccination rates have decreased, likely due to federal programs ensuring children have access to vaccines. However, confusion over vaccine policy, coupled with Trump administration rhetoric casting doubt on vaccine safety and attempts to revise the childhood vaccine schedule, threatens to reverse this progress, the authors caution.
Detailed data illustrating how disparate health outcomes manifest across states and races may assist researchers in identifying effective policies, according to Philip Alberti, an epidemiologist and director of the AAMC Center for Health Justice. “Efforts to gather more specific data on ethnic and racial groups will help clarify patterns further, enabling the development of smart, focused interventions in collaboration with communities,” he remarked.
Breaking down how some states have successfully provided access to care could offer local governments strategies to advance during a time when health equity advocates are turning away from federal assistance.
“Community engagement is key to all health equity work, understanding local experiences, desires, assets, and needs. This is difficult to achieve at the federal level,” Alberti said. “Crafting policies that connect directly to the lived experiences of communities is more feasible at the local and state level.”
Although the report contributes to existing literature, it follows extensive research documenting these inequities, and progress has been limited, several experts noted.
“The report continues to highlight existing health inequities and shows that as a nation, we’ve made minimal progress in addressing these inequities, which have been better understood through numerous research studies,” said Georges Benjamin, CEO of the American Public Health Association, who led a National Academies Committee on racial disparities.
STAT’s coverage of health inequities is funded by a grant from the Commonwealth Fund. Our financial supporters are not involved in any decisions regarding our journalism.
