The 2026 State Health Disparities Report examines 24 measures and finds gaps in access, affordability, and outcomes in every state. Authors say the disparities could widen as recent federal policy changes take hold.
A new state-by-state report from the Commonwealth Fund finds that racial and ethnic health disparities persist in every state, spanning coverage, affordability, access to care, and health outcomes. The report also warns that recent federal policy changes—such as Medicaid funding cuts and eligibility tightening, limits affecting coverage for many legal immigrants and asylees, and the expiration of enhanced marketplace premium tax credits—could deepen inequities.
The analysis examines how state health systems are functioning for Asian American, Native Hawaiian and Pacific Islander (AANHPI), American Indian and Alaska Native (AIAN); Black, Hispanic, and white populations using 24 indicators grouped into health outcomes, health care access, and quality and use of services.
Key findings
- Skipped care due to cost is on the rise, especially for Hispanic and AIAN members. After record lows in 2021 to 2022, the share of people skipping needed care because of cost is increasing, with the steepest rises among Hispanic and AIAN communities. In 43 of 50 states with available data, Hispanic adults were most likely to go without needed care they couldn’t afford; in most states, they were also most likely to lack a regular source of care.
- Black and AIAN people die from preventable and treatable conditions at far higher rates than other groups. In every state where data are available, Black people were more likely to die early from avoidable causes than white, AANHPI, or Hispanic people. AIAN residents of Alaska, Arizona, Minnesota, Montana, New Mexico, North Dakota, and South Dakota had the highest rates of any group in any state. Even as U.S. life expectancy hit an all-time high in 2024, mortality rates for Black and AIAN people far outpaced the rates in other groups.
- Despite high screening rates, Black women still die from breast cancer at the highest rate of any group in almost every state. In 37 of 40 states with data, Black women had the highest breast cancer death rates despite comparatively high mammography rates, a pattern the report links to factors such as delays in follow-up care after an abnormal mammogram, later-stage diagnosis, and health insurance that may not offer no-cost coverage or follow-up imaging or biopsies after an abnormal result.
- Racial and ethnic disparities persist even in top-performing systems. Connecticut, Maryland, Massachusetts, New York, and Rhode Island stand out for delivering comparatively better care across racial and ethnic groups. However, even in those states, gaps remain in access, quality, and health. Health systems in Arkansas, Mississippi, Oklahoma, and West Virginia perform particularly poorly across all groups measured. The report finds that health system investments and state policy decisions including whether to expand coverage—are linked to how large these disparities are and whether they are narrowing or widening.
Implications
The report argues that federal, state, and local policy choices—as well as health system commitments to high-quality care—shape disparities in meaningful ways.
“Looking at health care at the state level makes visible what too often gets lost in national health statistics—the profound differences in whether people can get high-quality care when they need it, afford to follow through on treatment, and live healthy lives,” said Laurie Zephyrin, M.D., senior vice president for Achieving Equitable Outcomes at the Commonwealth Fund, in the study announcement. “Those differences are not random. They track along racial and ethnic lines in every state, and the federal policy changes now underway will make it harder to improve health for everyone. But this report also shows that state policy choices matter: when states invest in coverage and care, people benefit.”
To address the disparities, the analysis suggests policymakers consider the following actions:
- Devote resources to address health-related social needs such as housing, economic stability, and paid family leave.
- Ensure affordable, accessible, and equitable health coverage for all.
- Strengthen primary care and improve care delivery in communities with fewer health care providers.
- Protect access to preventive services.
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Ensure that digital health tools and artificial intelligence are designed and deployed equitably.