A new report found that although racial and ethnic health disparities are pervasive in every state, Oklahoma’s healthcare system is performing poorly across all groups. Health research and policy nonprofit the Commonwealth Fund warns that federal cuts and restrictions to Medicaid and the Affordable Care Act Marketplace could worsen outcomes.
The group’s 2026 State Health Disparities Report includes data from 2022 to 2024 on 24 different indicators, gauging healthcare access, outcomes and quality in every state and the District of Columbia. Those indicators were applied to five racial and ethnic groups and used to calculate a health system performance score of up to 100 for each population.
Asian American, Native Hawaiian and Pacific Islander Oklahomans had the best rankings, with a score of 56 out of 100. Hispanic Oklahomans had the worst rankings, with a score of six out of 100. White Oklahomans earned a 54, Black Oklahomans a 36 and American Indian and Alaska Native Oklahomans a 16.
Although Oklahoma’s health system scored low in serving American Indian and Alaska Native populations, it placed 9th among the 21 states the Commonwealth Fund was able to rank, making it “better than average” in comparison.
The source of health disparities is multifactorial, said Commonwealth Fund President Dr. Joseph Betancourt in a Tuesday media briefing.
“[They’re] rooted in coverage differences, differences in the quality of care people receive, and also different experiences of the conditions that shape health long before someone ever walks into a hospital or doctor's office: housing, education and economic opportunity, among others.”
In 2024, Oklahoma’s uninsured rates among children and adults were above the national average in almost every racial and ethnic category. Hispanic adults and American Indian and Alaska Native children in Oklahoma were the most likely to be uninsured.
Nearly 27% of Hispanic adults in Oklahoma went without care in 2023 through 2024 because of cost.
Nationally, the share of adults who said they skipped out on necessary care hit an all-time low between 2021 and 2022, when a pandemic-era policy prevented states from removing people from Medicaid unless they moved, died or asked.
Kristen Kolb, a Commonwealth Fund research associate, said these gains have eroded as this policy expired, with Hispanic and American Indian and Alaska Native communities seeing the highest growth of individuals who don’t seek out care because of cost.
The Commonwealth Fund notes that shifts in national policy have likely worsened and are on track to further impact existing disparities. This includes billions of dollars in reductions to federal Medicaid spending over a decade, Medicaid work requirements and the expiration of enhanced premium tax credits, which left individuals to cover a larger share of their ACA Marketplace health coverage.
What policy changes could help reduce disparities?
The report recommends several policy changes to bridge the gap. Those include:
- Extending the ACA enhanced premium tax credits.
- Simplifying Medicaid and Marketplace enrollment and renewals.
- Improving primary care and service delivery.
- Expanding the availability of community health workers.
- Strengthening diverse workforce pipelines.
It also recommends the 10 states that haven’t expanded Medicaid eligibility for adults with incomes up to 138% of the federal poverty level do so. The report notes that in states that expanded Medicaid coverage, racial disparities in preventable hospitalizations and emergency department visits decreased between Black and white adults.
In 2020, Oklahomans voted to expand Medicaid eligibility, and it went into effect the following year. Oklahoma is one of three states that enshrined expansion in its constitution, meaning an amendment is needed to make changes.
Oklahoma lawmakers are considering legislation that could send Medicaid expansion, which currently covers healthcare for 233,530 Oklahomans, back to voters.
House Bill 4440 by Speaker Kyle Hilbert, R-Bristow, and Senate President Pro Tem Lonnie Paxton, R-Tuttle, would ask Oklahomans to decide whether to remove Medicaid expansion from the state constitution and add it into statute, where it can be adjusted, if federal financial participation drops below 90%.
House Joint Resolution 1067 by Rep. Ryan Eaves, R-Atoka, and Sen. Julie Daniels, R-Bartlesville, would create an additional state question that, if approved, would allow future legislatures to choose not to fund Medicaid expansion if the federal match rate falls below 90%.
Sara Collins, the Commonwealth Fund’s senior scholar and vice president for healthcare coverage and access, said one of the key outcomes the nonprofit has looked at is self-reported health. She said people who have insurance, and in particular Medicaid, have higher self-reported health status than those who don’t.
“That's an example of where health insurance coverage really does matter in terms of health outcomes,” Collins said. “… It is really the necessary ingredient to get access to healthcare. People would just be swimming in medical debt, as would their hospitals, if they didn't have health insurance coverage.”
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