A new Commonwealth Fund report finds that racial and ethnic health disparities exist in every state — and warns that recent federal policy changes are likely to deepen them. On April 28, the Commonwealth Fund held a media briefing to discuss the report, “The Commonwealth Fund 2026 State Health Disparities Report.”

“The data in this report reflect the most recently available information on how the health system was performing through 2024, before the expiration of enhanced marketplace tax credits for the Affordable Care Act (ACA), Medicaid funding cuts, tighter eligibility rules, and restrictions on coverage for legal immigrants all took effect,” Joseph Betancourt, M.D., president of the Commonwealth Fund, shared.

Jess Maksut, Ph.D., director of Health Equity Research at the Commonwealth Fund, explained the report's data. The focus was on three core areas of health system performance: access to care, the quality of health services, and people's health outcomes.

The four key takeaways, she said, are as follows:

• Disparities persist everywhere. No state has eliminated racial and ethnic gaps in healthcare access, quality, and health outcomes. The size of racial and ethnic gaps varies widely, both between and across states.
• Coverage and affordability remain central. The years 2022 to 2024 saw real gains. Medicaid unwinding marketplace changes and new restrictions affecting immigrants and asylees are now eroding access with disproportionate impacts to American Indian, Alaska Native, Black, and Hispanic communities.
• Opportunities remain to improve the quality of routine care. For example, in most states, all but eight states, Black and Hispanic children were less likely than white children to receive age-recommended preventive medical and dental visits.
• Disparities measurement is at risk due to declining federal support for race and ethnicity data collection and reporting, which could weaken accountability for eliminating disparities.

Kristen Kolb, M.P.H., R.N., research associate with the Commonwealth Fund, explained the performance scores in more detail. “Notably,” she remarked, “the performance score for Black residents of most states fell below the median across all groups. Exceptions to this included Maryland, Rhode Island, New York, Massachusetts, and a few other states.”

Also of note, the Hispanic population had some of the lowest scores in the report, particularly in a handful of southern and southeastern states, including Arkansas, Georgia, Oklahoma, and Texas.

“The lowest rate of uninsurance among adults we observed was among white residents in DC at around just 2 percent,” Kolb said. “In contrast, around 40 percent of residents in Tennessee were uninsured.” Hispanic, American Indian, and Alaska Native adults are also the most likely to lack health insurance.

Furthermore, Kolb pointed out, “in all but eight states, Black and Hispanic children and adolescents are less likely to get recommended medical and dental preventive care than white children, defined as having at least one age-appropriate medical and dental visit in the past year.”

Laurie Zephyrin, M.D., SVP of Achieving Equitable Outcomes at the Commonwealth Fund, noted that disparities are persistent and widespread. They appear in every state across all three domains: access, quality, and outcomes. In most states, American Indian and Alaska Native people and Black and Hispanic people continue to bear the highest burden and face the worst access and affordability in healthcare. “Additionally, when we look at premature and avoidable deaths, they're the highest for people in these communities in every state with available data,” Zephyrin said.

“In the majority of states, we see that Hispanic adults reported the highest rate of going without needed care because of costs,” Zephyrin added. “Studies have shown that the social drivers of health account for as much as 80 percent of health outcomes. Therefore, to fully address disparities, we must ensure strong, and economic social supports are available.”

Disparities are pervasive, and state policy matters, Zephyrin underscored. Priorities include extending ACA tax credits, simplifying Medicaid and marketplace enrollment and renewal, and expanding Medicaid or closing the coverage gap. Additionally, Zephyrin suggested, it’s important to have incentives for care in underserved communities. It's important to expand the ability of community health workers, strengthen the diverse workforce pipelines, and modernize cross-state licensing. Protecting access to preventive services is critically important. Also, Zephyrin remarked, digital health and AI are an opportunity to advance equity.