A report released Wednesday highlights the success of reducing health disparities in U.S. states. Since the last analysis by the Commonwealth Fund, two states have expanded Medicaid eligibility, many states have expanded postpartum coverage for mothers, and enrollment in Affordable Care Act marketplace plans has increased at an unprecedented rate.
However, given that the report covers the period from 2022 to 2024, many equity researchers are concerned that this rally will be short-lived. Outside experts who reviewed the report predict that the policies of the second Trump administration will worsen inequities, including changes to insurance coverage and vaccine policy and cuts to programs that promote diversity, equity and inclusion.
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“I certainly wasn’t surprised to see persistent inequalities along racial lines, but what I kept thinking as I read this federal report was, ‘Oh my God, things are about to get even worse,'” said Miranda Yarber, a political scientist at the University of Pittsburgh who just published a book about how insurance coverage causes inequality.
The federal report follows two similar studies published in 2021 and 2024 that assessed health disparities among five racial and ethnic groups by analyzing rates of premature death from avoidable causes, health insurance coverage, and access to preventive care. Despite improvements in some measures, black people were more likely to die prematurely from avoidable causes than people from other racial groups in every state where the authors were able to collect data.
This disparity may be a result of lack of access to care. One of the cases investigated in the Commonwealth report was breast cancer screening. Black women tend to have higher rates of mammography, but they also have the highest breast cancer death rates in 37 of 40 states. This gap may be because black women are more likely to have breast cancer detected at a later stage, and because while screening is covered by the Affordable Care Act, follow-up care is often not.
Commonwealth Fund President Joseph Betancourt said: “We must be able to provide health, well-being and quality care for all. This is what we are doing as a health system and as health care providers. The disparities we are highlighting today are not inevitable, they are shaped by policy choices and health system decisions and can be changed.”
The report shows that disparities in vaccination rates among racial groups are narrowing, likely due to federal programs that make it easier for children to get immunized. But that progress could be reversed by confusion over vaccine policy amid the Trump administration’s rhetoric questioning vaccine safety and efforts to overhaul the childhood vaccination schedule, the report’s authors said.
Philippe Alberti, an epidemiologist and director of the AAMC Center for Health Justice, said detailed data on how different health outcomes play out across states and races could help health disparities researchers identify which policies are successful and which are unsuccessful. “The efforts that are underway to actually get more detailed data on ethnic and racial groups will only help us clarify some of these patterns even further and ensure that we can develop smart, focused interventions that are developed in partnership with local communities,” he said.
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The data, which analyzes how some states have succeeded in providing access to care, could also give local governments ideas on how to move forward at a time when health equity advocates are turning a blind eye to federal aid.
“My mainstay in any health equity work is community engagement and really understanding the experiences, aspirations, assets, and needs of different communities at a very local level. It’s impossible to do that at the federal level,” Alberti said. “I think the ability to build policies that are more directly connected to the lived experiences of local communities is much easier to do at the local or state level.”
While the report is a welcome addition to the literature, it builds on a large body of research documenting such inequalities and does not yet change course, experts said.
“This report continues to document the fact that health disparities exist and that we as a nation have made little progress in closing them, and many research studies are helping to improve our understanding,” said Georges Benjamin, CEO of the American Public Health Association, who chairs the National Academies Committee on Racial Disparities.
STAT’s health inequalities coverage is supported by a grant from the Commonwealth Fund. Our financial supporters have no input into any decisions about our journalism.
