By  Leah Waters

Hispanic Texans experience some of the most profound inequities in health care compared to Hispanic people living in other states, according to a new report released Thursday. The study measures racial and ethnic disparities in the nation’s health care systems.

Meanwhile, Asian Americans living in Texas had better access to high quality health care and experienced better outcomes of any racial or ethnic group, ranking in the 74th percentile among Asian Americans nationally.

White Texans ranked in the 64th percentile among the same population nationally. In stark contrast, Black and Hispanic residents experience some of the worst health system performances in the nation.

Texas ranks 44th out of 47 states calculated in the report for health care system performance for Hispanic people. For Black residents, Texas ranks 32nd of 39 states calculated for health system performance.

The periodic study by Commonwealth Fund, a national independent health care research firm, reveals deep-seated racial and ethnic disparities continue across the nation in health care access, quality and outcomes, with a stark racial divide in premature deaths.

The 2024 disparities report offers a comprehensive analysis of how well health care systems are functioning for people in every state by evaluating disparities in health and health care across racial and ethnic groups.

The Commonwealth Fund uses 25 measures to evaluate states on health care access, quality, service use, and health outcomes for Black, white, Hispanic, American Indian and Alaska Native and Asian American, Native Hawaiian and Pacific Islander populations.

“Quite simply, and on average, our report shows that disparities exist in every state in our nation. Even in states that have strong overall health systems, racial and ethnic health disparities can be dramatic,” said Joseph Betancourt, president of The Commonwealth Fund.

Decades of policy choices at the federal, state and local levels, along with inequitable investment in health care systems, has had a discriminatory impact on people of color, leading to poorer health outcomes than white Americans, Betancourt said.

The longstanding inequities found in the study are intertwined with people’s socioeconomic status, said David Radley, a senior scientist at the Commonwealth Fund.

Texas health outcomes

Texas is one of several Southwestern and Mountain states — including New Mexico, Arizona, Colorado, Oklahoma, and Wyoming — in which premature death rates for Hispanic residents are higher than other U.S. regions where Hispanic rates more closely align with rates for white residents, the report found.

Nationally, Hispanic people generally have lower premature mortality rates compared to Black and white people, despite having higher uninsured rates and worse access to health care than these groups.

The researchers noted that the U.S. Hispanic population is highly diverse, and health care access and outcomes can vary, particularly by immigration status.

Lower rates of premature death could also stem from the relative youth of Hispanic populations and their lower rates of risky health behaviors, such as smoking, the report explained.

Recent research nevertheless shows rising mortality and prevalence of chronic conditions over time within Hispanic populations.

A report published this month by Episcopal Health Foundation, a Texas nonprofit addressing health disparities, found preventable health differences for people of color and those with lower incomes in Texas.

Black and Hispanic children are more likely to grow up in neighborhoods with high poverty levels, and families with lower incomes are less likely to say they’re in good health, the report said. These families are more likely to be uninsured and have higher rates of diabetes and obesity, the report found.

The differences in health outcomes in Texas’ 254 counties are driving up health care costs and reducing work productivity across Texas, and the state’s economy is suffering more than $7 billion in annual losses because of it, the report found.

More findings

Black, Hispanic and American Indian or Alaska Native people are also less likely than other groups to have health insurance, more likely to delay care because of costs, and more likely to incur medical debt, the Commonwealth Fund study found.

Black and American Indian or Alaska Native people are more likely, in most states, to die early in life from conditions that are treatable with timely access to high-quality health care, the report found.

“Health system performance is particularly worse for Black, Hispanic and Native American populations, meaning these groups have more problems accessing care, the quality of care they get is lower and they have worse health outcomes compared to white people in many states,” said Arnav Shah, a senior research associate at the Commonwealth Fund.

Even in states that have historically performed well in Commonwealth Fund state rankings, racial and ethnic health disparities can be dramatic.

Massachusetts, Minnesota and Connecticut stand out in the report for their relatively high performance for all racial and ethnic groups.

Yet these states still have considerable health disparities between white and nonwhite residents when it comes to access to care, the quality of care people receive and health outcomes, the report found.

Policy solutions

Closing the gap between racial and ethnic groups in health care outcomes requires robust policy solutions, according to Laurie Zephyrin, a senior vice president at the Commonwealth Fund.

“This report lays bare the persistent disparities people of color experience in accessing and receiving quality care across the U.S. We must do better — and we can start by rooting out pervasive racial and ethnic bias and inequities in our health care system to ensure everyone gets the care and coverage they need,” Zephyrin said.

While health inequities are driven by various factors, they are largely rooted in both past and current policies at the federal, state and local levels, the Commonwealth Fund study found.

The authors of the report suggest pursuing four broad policy goals to create an equitable health system: expanding health insurance coverage for all; strengthening primary care; lowering the administrative burden for patients and providers; and investing in social services

“Insurance coverage is a key part of this,” Zephyrin said. “It is, however, the floor in terms of ensuring that everyone has access to health care.”

Texas is one of 10 states that have not yet expanded Medicaid coverage to its residents, a policy decision that health experts say contributes to poorer outcomes for Texans, especially ones of color, Zephyrin said.

This story, originally published in The Dallas Morning News, is reprinted as part of a collaborative partnership between The Dallas Morning News and Texas Metro News. The partnership seeks to boost coverage of Dallas’ communities of color, particularly in southern Dallas.