Healthcare systems across the US deliver the worst quality of care to Native communities than to any other demographic. That’s according to a new report examining health outcomes and healthcare delivery among racial groups in the U.S.
Published yesterday, the Commonwealth Fund 2026 State Health Disparities Report covers the 2-year period 2022- 2024 and draws on the most recent data on state-by-state healthcare performance. Researchers measured 24 indicators of health system performance grouped into three categories: health outcomes, health care access, and quality and use of health care services.
American Indian and Alaska Native people ranked in the first percentile for healthcare quality, with outcomes, care, and access varying dramatically across regions.
States with the best healthcare quality for Native people include New York, California, and Wisconsin, with the worst being North Dakota, Arizona, and South Dakota — states with high populations of Native people.
States with the best health outcomes for AI/AN included Florida, Texas, and Missouri. The worst outcomes occur in North Dakota, Alaska, and South Dakota, also states with high Native populations.
Native people are among the most likely to be uninsured and to go without healthcare due to costs, following closely behind the Hispanic community.
The report points to the culmination of a lack of access and low-quality care, amounting to cavernous health disparities.
Native people die of preventable diseases and treatable conditions more than any other demographic, and AIAN infants have the highest mortality rate, double the rate for the white population. South Dakota ranked as the worst infant mortality rate for Native people, at 15.9 deaths per live births, comparable to the rate for developing countries like Honduras and Nicaragua.
Data also showed systemic failure in preventative care delivery in Native communities: only 33% of AI/AN received the flu shot, 56% had a colon cancer screening, and 65% of women had a mammogram — all lower than most other demographics.
While the data is bleak, the Commonwealth Fund noted that the picture is incomplete: data for Native people in more than 30 states was unavailable, inhibiting, the report said, efforts to increase quality of care and reduce negative outcomes.
The nonprofit noted that the disparities will likely worsen after the implementation of sweeping Medicaid funding cuts, restricted eligibility, and expiration of enhanced premium tax credits in the marketplace.
