New Jersey’s health care system works well, better than those in all but four other states and the District of Columbia, according to a well-respected new report. But New Jersey doesn’t do as well when it comes to Black and Hispanic residents, who are still less likely to access quality care and stay healthy.
The Commonwealth Fund, a century-old foundation dedicated to advancing health equity, released its annual report on state-level health disparities early Thursday. It assesses more than two dozen measures of health system performance that together impact access to care, quality of services and health outcomes for various populations.
For instance in New Jersey, while health insurance availability has expanded, nearly one in four Hispanic residents lack coverage. And Black and Hispanic residents die from preventable causes at rates that are significantly higher than white and Asian people, according to the report.
Social factors and community health
Fund president Dr. Joseph Betancourt said the findings for New Jersey underscore the roles that social factors like housing, food access, the environment and a history of discriminatory government policies have had on a community’s health.
“Knowing New Jersey as I do, we still have cities like Newark and Camden that remain very, very segregated” as a result of discriminatory housing policies, said Betancourt, a graduate of what is now Rutgers New Jersey Medical School.
The Commonwealth Fund report’s findings on New Jersey reflect a broader truth, the authors said, that even states with excellent health care systems don’t treat all patients the same.
Regional differences in a state like New Jersey can also exacerbate health care disparities, Betancourt said in response to questions from NJ Spotlight News.
“In some cities health care systems are more challenged,” he said. “But there are a whole series of social challenges that impact health care.”
Commonwealth has studied what it terms “persistent” racial and ethnic gaps in health care for nearly two decades. The new report, based on data from 2021 and 2022, is the first one the nonprofit has issued since the peak of the COVID-19 pandemic, which exacerbated disparities nationwide.
Not all patients are treated equally
In recent years, findings on New Jersey reflect a broader truth, the authors said, that even states with excellent health care systems don’t treat all patients the same.
The goal of the health-disparities report is to illustrate these gaps for state and federal policymakers, the authors said, and offer suggestions on how to create more equitable health systems. Looking at average performances alone can mask significant disparities, they said.
“If you don’t look under the hood, you won’t know where you are failing people,” Betancourt said.
The report includes “performance scores” for five ethnic and racial groups across the 50 states and the District of Columbia. The scores show that white people were best served by the health care system in all but 14 states — including New Jersey, where Asians fared even better. In all but four states (Arkansas, Mississippi, Oklahoma and West Virginia), care for white residents ranked above the national average for all people.
Performance scores for Black people, however, ranked below the national average for all groups in all but six states: Connecticut, Delaware, Massachusetts, Maryland, New York and Rhode Island, the report shows. Hispanic individuals faced similar scores, landing above average in just eight states and D.C.
New Jersey is now using this kind of data to shape its response to racial disparities in maternal health, which have persisted as among the worst in the nation.
Gaps in these health care performance scores are as high as 85 points in Washington state, where care for Native American and Alaskan Native residents ranked at 8 on a 100-point scale versus 93 for Asians. The lowest disparities were found in Virginia, where care for Black people was 8 versus 40 for white residents. (This doesn’t include Maine and Vermont, where Commonwealth could not quantify diversity.)
Disparities in New Jersey were above average at 61 points, with care ranked 36 for Black people and 97 for Asian. Care for Hispanic residents scored 38 points, compared with 91 points for white people, according to the report. Among the 10 states with the highest health care system performance, New Jersey had the fourth greatest gap in racial scores, following Washington, Maryland and Ohio, in that order.
What data delivers
“The reality is we can’t improve health care outcomes if we aren’t accurately measuring them,” said Dr. Laurie Zephyrin, a senior vice president at Commonwealth focused on health equity. “We need to be using data as a guidepost [to making change].”
New Jersey is now using this kind of data to shape its response to racial disparities in maternal health, which have persisted as among the worst in the nation, with Black women nearly seven times more likely to die before, during or after childbirth than white mothers.
First lady Tammy Murphy has made addressing this issue a priority and the state has taken multiple steps to improve access to pre- and post-natal care and elevate support services for women giving birth. The state plans to use $75 million in public funds to build a maternal health center in Trenton, run by a dedicated authority, to continue this mission in the years to come.
The Commonwealth report said the emergence of COVID-19 underscores the need to continue this kind of research. It said the pandemic’s impact on communities of color was profound, including the rise in avoidable deaths among Black and Hispanic people in many states, including New Jersey.
The pandemic “unveil(ed) the impact of racism and disparities in health care,” Zephyrin said.
The report urges states to find ways to expand health insurance coverage, which the authors agreed is a critical step to accessing care, although it can’t stand alone. The federal Affordable Care Act, or Obamacare, enabled millions more to qualify for Medicaid nationwide, the report notes, but the uninsured rate remains high in some regions and for some groups. About 40% of American Indian people lack health insurance in South Dakota, for example, as well as four in 10 Hispanic people in Tennessee and Georgia.
The report calls for efforts to expand primary care, a critical preventive-care practice that is in short supply in many states, including parts of New Jersey.
In New Jersey — which has embraced the Obamacare expansion — uninsured rates for residents are as follows: white (4%), Asian (5.5%) Black (9%), Hispanic (24%). Last year, the state launched “Cover All Kids,” a state-funded effort to provide health insurance to children who are not legal residents in this country. The program has enrolled tens of thousands of youngsters who were not previously eligible, state officials said.
“Coverage is essential to getting access to the health system,” said Sara Collins, a senior scholar and vice president at Commonwealth. “But the health system is broader than coverage.”
In addition, the report called for efforts to expand primary care, a critical preventive-care practice that is in short supply in many states, including parts of New Jersey. It recommends steps to increase the payment rates for primary care doctors and nurses — a growing issue in New Jersey, where many agree Medicaid reimbursements are far too low — as well as workforce development initiatives such as loan assistance for medical students.