A report released Wednesday highlights successes in reducing health disparities in U.S. states. Since the last iteration of the analysis by the Commonwealth Fund, two states expanded eligibility for Medicaid, many states extended postpartum coverage for mothers, and enrollment in Affordable Care Act marketplace plans increased at an unprecedented clip.
But given the report covered the years 2022 to 2024, many equity researchers fear the gains may be short-lived. Outside experts who reviewed the report predict that policies from the second Trump administration, including changes to insurance coverage and vaccine policies and cuts to programs promoting diversity, equity, and inclusion, will exacerbate inequities.
“I was certainly not surprised to see these persistent inequities along racial lines, but what I kept thinking as I was reading this Commonwealth report was, ‘Oh my gosh, it’s about to get so much worse,’” said Miranda Yaver, a political scientist at the University of Pittsburgh who just published a book on the ways insurance coverage drives inequities.
The Commonwealth report, which follows two similar studies released in 2021 and 2024, assessed health disparities among five racial and ethnic groups, analyzing rates of premature deaths from avoidable causes, health insurance coverage, and access to preventive care, among other measures. Despite the improvements in some measures, in every state where the authors were able to collect data, Black people were more likely to die early from avoidable causes than people from other racial groups.
That disparity may be the result of a lack of access to care. One case examined by the Commonwealth report was breast cancer screenings: Black women tended to get mammograms at high rates, but in 37 out of 40 states, they died at the highest rate from breast cancers. That gap may be because Black women tend to have breast cancer detected at later stages, and because screenings are covered by the Affordable Care Act while follow-up care often is not.
“We must be able to deliver on the promise of health, well-being and high quality care for everyone. This is what we commit to as health systems and as health care providers. The disparities we are bringing into the spotlight today are not inevitable, they are shaped by policy choices and health system decisions that can be changed,” said Joseph Betancourt, president of the Commonwealth Fund.
The report shows that gaps among racial groups in vaccination rates have narrowed, likely because of federal programs to ensure children have access to shots. But confusion over vaccine policy, amid Trump administration rhetoric questioning vaccine safety and its efforts to revise the childhood vaccine schedule, could walk back that progress, the report’s authors note.
The granular data on the way disparate health outcomes play out across states and races may help health disparities researchers discern which policies are successful and which are not, said Philip Alberti, an epidemiologist and the director of the AAMC Center for Health Justice. “Efforts underway to really get more granular data on ethnic groups and on racial groups will only help clarify some of these patterns even more and ensure that we can develop interventions that are smart, that are focused, and that are developed in partnership with communities,” he said.
The data breaking down the ways some states have had success in providing access to care could also provide local governments with ideas on how to make strides in a moment where health equity advocates are looking away from the federal government for assistance.
“My lodestar from all health equity work is community engagement, really understanding at the very local level the experiences, the desires, the assets and the needs of different communities. It is impossible to do that at the federal level,” Alberti said. “I think that ability to build policy that is more directly connected to the lived experience of communities is much easier to do at the local and state level.”
While the report is a welcome addition to the literature, it follows a large body of research that has documented such inequities, and has yet to move the needle, several experts said.
“This report continues to document the fact that health inequities exist, that we as a nation have made little progress closing those inequities that numerous research studies have helped us better understand” said Georges Benjamin, CEO of the American Public Health Association, who chaired a National Academies Committee on racial disparities.
STAT’s coverage of health inequities is supported by a grant from the Commonwealth Fund. Our financial supporters are not involved in any decisions about our journalism.