State-by-state disparities in outcomes

Overall, health system performance scores still vary by race, with nearly every state showing higher scores for White and Asian American/Native Hawaiian/Pacific Islander (AANHPI) people. Health system performance scores were typically lower for Black, Hispanic and American Indian/Alaska Native (AIAN) patients.

Although nearly every state had racial inequities in health system performance, Connecticut, Maryland, Massachusetts, New York and Rhode Island performed somewhat better across all racial and ethnic groups. Conversely, health systems in Arkansas, Mississippi, Oklahoma and West Virginia had the steepest racial health disparities.

The report also examined outcome measures such as premature death, defined as deaths before age 75 from either preventable causes or treatable conditions.

Overall, Black people were the most likely to die a premature death compared to other racial and ethnic groups, while AANHPI people had the lowest rate of premature death.

Interestingly, Hispanic people had lower premature death rates than Black or White people, despite having the highest uninsured rates. This paradoxical trend could be attributed to several factors, including the diversity of the U.S. Hispanic population, which skews much younger than others and displays lower rates of risky behaviors, such as smoking.

The report also made a call-out for breast cancer mortality, which the authors said is highly treatable when detected early.

AI/AN, AANHPI and Hispanic women face lower rates of breast cancer screenings than other racial/ethnic groups.

Still, their breast cancer mortality rates are lower than those of their White and especially Black peers. In fact, Black women in the U.S. are among the most likely to get their mammograms and yet, they are the most likely to die from breast cancer.

According to the researchers, this problem is multifaceted. Black women are more likely to face delays in follow-up testing for abnormal mammograms and are more likely to have breast cancer detected at a later, more difficult-to-treat stage.

Many of these barriers stem from cost. Despite full coverage for initial breast cancer screening, there has historically been no guarantee that follow-up testing will be free. This might add a financial barrier to getting an early breast cancer diagnosis.

Disparities in insurance coverage, healthcare access

Perhaps the biggest driver of clinical outcomes disparities, the researchers also detected inequities in insurance coverage. Notably, Hispanic people have the highest uninsured rates, while White people have the lowest uninsured rate.

This translates almost directly to cost-related care access barriers, the report went on.

For example, about a fifth of Hispanic adults said they couldn't access care because of cost in 2024, compared to 8.9% of White people and 8.3% of AANHPI people. AI/AN and Black people were also more likely to face cost-related care access barriers compared to White and AANHPI people.

This was true in 43 of the 50 analyzed states, the Commonwealth Fund said.

Health disparities impacting kids, too

This report also assessed racial health disparities emerging in pediatrics, focusing on preventive care and receipt of the seven standard pediatric vaccines, such as those for measles, polio and tetanus.

White children in most states were the most likely to receive preventive and dental care. Even in the top-performing states, racial health disparities were steep.

For example, although Massachusetts is an exemplar in connecting White and Hispanic kids to preventive and dental care, Black kids lag significantly behind. Indeed, Black children in Massachusetts are less likely to receive preventive and dental care than Black children in Mississippi, the worst-performing state overall for pediatric preventive and dental care.

At the same time, uptake of the standard childhood vaccine schedule has increased, with The Commonwealth Fund noting that federal programs like the Vaccines for Children program have helped reduce disparities.

Currently, Black or Hispanic kids have the highest vaccination rate in 21 states. The Vaccines for Children program, which offers no-cost vaccinations to kids in Medicaid or who are uninsured/underinsured, increased the number of AI/AN kids getting recommended childhood vaccines.

Assessing policy implications

These findings do not exist on their own, the Commonwealth Fund reporters said. Rather, they exist in a complex health policy landscape poised to restrict, not expand, healthcare access for marginalized populations.

"Though not reflected in this report's findings (owing to a lack of more current data), pronounced shifts in the national policy environment in 2025 and 2026 have likely worsened -- and are on track to further exacerbate -- existing racial and ethnic disparities in access, affordability, and outcomes," the report authors wrote.

Such policy changes include changes to Medicaid and the ACA exchanges, bans on eligibility for most legal immigrants and asylees, regulations that potentially reduce marketplace plan enrollment by increasing patients' out-of-pocket costs and the expiration of enhanced premium tax credits.

State-wide policies ultimately shape these racial health disparities. Decisions around Medicaid eligibility, protecting against medical debt and supporting families and caregivers can all impact health outcomes, the report authors contended.

Policies that expand access to health insurance, strengthen primary care, improve access to preventive care, address social determinants of health and ensure equitable rollout of digital innovations -- such as AI -- will also be critical for industry experts keen on closing racial health disparities.

"The truth is, when health systems look at where they're falling short for their patients and make closing those gaps a real priority, they deliver better care for everyone," Joseph R. Betancourt, M.D., Commonwealth Fund president, said in the press release. "At the end of the day, this is exactly what we want -- high-quality care for all. We must remember this core principle, and it is clear more needs to be done in policy and practice to make this a reality."

Sara Heath has reported news related to patient engagement and health equity since 2015.