The analysis measured health equity for people of different races and ethnicities within and between each state and their health system’s performance for racial and ethnic groups.

The Commonwealth Fund released last week a comprehensive assessment of how each states’ health care system is performing for people of color. While the Commonwealth Fund has consistently tracked the functioning of states’ health care systems, the recent examination, Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance, was developed to gain a deeper understanding of underlying inequities that may have previously been overlooked.

The new health equity scorecard evaluates health equity across race and ethnicity both within and between states to inform how the health systems perform for Black, white, Latinx/Hispanic, American Indian/Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations.

To assess and score each state, researchers collected data for 24 indicators of health system performance, which were grouped into three performance domains: health outcomes, health care access, and quality and use of health care services.

Through the analysis, researchers found that:

  • Racial and ethnic inequities persist across all state health systems, with substantial disparities existing between white and Black, Latinx/Hispanic, and AIAN populations in almost all states.
  • In most states, Black people and AIAN people are more likely than white people to die early in life due to conditions that are treatable with timely access to quality health care.
  • In nearly all states, Black people and AIAN people are more likely than AANHPI, Latinx/Hispanic, and white people to die from complications of diabetes.
  • Black women are more likely than white women to be diagnosed with breast cancer at later stages and die from the disease, although it’s considered treatable when detected early.
  • State uninsured rates are higher and more variable for Black, Latinx/Hispanic, and AIAN adults compared to AANHPI and white adults.
  • White people are less likely than other populations to face cost-related barriers in most states.

To address the unequal access to care and unequal treatment within health care systems, the Commonwealth Fund called for federal and state policy changes to bridge the gap. Study authors grouped the policy priorities into four areas:

  1. Ensure universal, affordable, and equitable health coverage through policy options such as making marketplace premium subsidies provided by the American Rescue Plan Act permanent and closing the Medicaid coverage gap in the states that have yet to expand eligibility or reducing deductibles and out-of-pocket costs for marketplace insurance plans.
  2. Strengthen primary care and improve the delivery of services in communities of color, including maintaining telemedicine as an option, modernizing medical licensing, and developing community-based health care workforces.
  3. Reduce inequitable administrative burdens affecting patients and providers through improvements such as autoenrollment in state Medicaid programs.
  4. Invest in social services such as unemployment compensation, Earned Income Tax Credit and child tax credit programs, childcare, food security, and wealth-building programs.

“Too often in the U.S., race and ethnicity are correlated with access to health care, quality of care, health outcomes, and overall well-being,” wrote The Commonwealth Fund scorecard authors. “This is a legacy of structural, institutional, and individual racism that predated the country’s founding and that has persisted to the present day, in large part through federal and state policy. By pursuing new policies that center racial and ethnic equity, expand access to high-quality, affordable care, and bolster the primary care workforce, we as a nation can ensure that the health care system fulfills its mission to serve all Americans.”