Though Hispanic people have high rates of uninsurance, they also have fewer risk factors such as smoking, which may help explain lower rates of premature death, a report says.
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The share of Americans with health insurance has soared over the past decade, thanks to the Affordable Care Act. But progress has been uneven, with persistent gaps in coverage, quality, access to care and health outcomes, particularly for people of color.
A new Commonwealth Fund report examined healthcare data from 2022-2024 across U.S. racial and ethnic groups, finding no state has eliminated disparities — though some are performing better than others.
The April “State Health Disparities Report” finds health systems perform strongest overall in Connecticut, Maryland, Massachusetts, New York and Rhode Island, while Arkansas, Mississippi, Oklahoma and West Virginia lag across multiple measures.
Despite record-high life expectancy nationwide, Black Americans are more likely to die early from preventable causes — including those that could be addressed through behavior changes, public health interventions or timely medical care — than Asian American, Native Hawaiian and Pacific Islander, Hispanic and white people.
Meanwhile, American Indian and Alaska Native residents in Alaska, Arizona, Minnesota, Montana, New Mexico, North Dakota and South Dakota experienced the highest rates of premature death before age 75 of any group in any state.
Across racial and ethnic groups, Hispanic people generally had lower rates of avoidable premature mortality. However, they also faced higher rates of uninsurance and cost-related barriers to care. Hispanic people ages 19-64 in Alabama, Georgia, Louisiana, Mississippi and Tennessee had the highest rates of uninsurance than any other ethnic or racial group among states.
The U.S. Hispanic population is highly diverse. On average, Hispanic people are younger and report lower rates of risk factors, such as smoking. That may explain lower rates of preventable, premature death despite the population's barriers to care, the authors said.
Uninsurance rates were also higher among Black and American Indian and Alaska Native people than among white and Asian American, Native Hawaiian and Pacific Islander people.
Black and Hispanic communities faced additional barriers to accessible quality care. Nationally, children and adolescents from the populations are less likely than white children to receive age-appropriate preventive care and dental visits.
Rates varied considerably across states, with 90% of Hispanic children in Vermont receiving timely preventive care visits, compared to only half of Hispanic children in Arkansas.
At the same time, the report points to progress on vaccinations. In 21 states, Black and Hispanic children had the highest vaccination rates compared with other groups.
The report identified a stark disparity for Black women. In 37 of the 40 states with available data, Black women had the highest age-adjusted death rates from breast cancer compared with other groups — even though screening rates are high, ranging from 63% in New Hampshire to 96% in Utah.
The difference could be from gaps in care after screening. Black women are more likely to face delays in follow-up testing after an abnormal mammogram and to be diagnosed at later stages, when treatment is less effective.
They are also more likely to report financial strain during treatment, such as job loss, and less likely to receive care aligned with clinical guidelines.
Despite gains in health coverage, researchers warn that access, quality and outcomes may be worsening due to changes to the ACA marketplace under the Trump administration and Republican-controlled Congress. Changes include the expiration of enhanced premium tax credits, changes to Medicaid and ACA marketplace rules, and limits on eligibility for many legal immigrants.
For more information and to download state-by-state profiles, visit www.commonwealthfund.org.
- Copyright The Nation’s Health, American Public Health Association
