And there seems to be no light at the end of a very long tunnel.

These are among the conclusions drawn by researchers for The Commonwealth Fund, a private U.S. foundation that lobbies for a higher-performing U.S. health care system. The Fund has just released its 2020 Scorecard on State Health System Performance, which evaluates 49 indicators of health care system performance. The scorecard is not encouraging.

The crisis is nationwide. But residents of some states are suffering more than others, including states that chose not to expand Medicaid services.

Those suffering the most across the board are minorities–Blacks and Latinx in particular. By any measure they are falling further behind whites when it comes to their health care. Health outcomes for Blacks are getting worse over time. Meantime, in 17 states, a widening gap has developed in the uninsured rate between Blacks and Latinx, and whites.

These trends are drawn primarily from 2018 data, including data from the U.S. Census Bureau, Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services. Some preliminary 2019 data was reviewed as well.

The Fund focused on four major conclusions from its review of the data:

1. Americans are living shorter lives than they did in 2014, and Blacks are twice as likely as whites to die from treatable conditions. The study reported that, in every state, Black Americans "were twice as likely as whites to die early from treatable conditions such as diabetes, heart disease, appendicitis, and certain cancers." Mississippi, Arkansas, and Oklahoma reported the highest rates of premature deaths among Blacks. At the same time, the study reported, Americans regardless of race "are dying in greater numbers, and earlier than expected, from treatable conditions." The highest increases were found in Oklahoma, Arkansas, New Mexico, Kentucky, and Mississippi.
2. Health coverage gains have stalled, while affordability of insurance and out-of-pocket costs have worsened. As the political battle over the details of Obamacare has raged, the American consumer has been the victim. More people now lack coverage than in 2016. Insurance plans generally include high deductibles and copays, which have been proven to discourage people from getting basic health care treatment. The report noted that skyrocketing unemployment is yanking employer sponsored coverage out from under millions. That trend, the Fund report said, is certain to negatively affect consumer health.
3. Heath care prices drive spending growth and rising consumer health care costs. In every state, commercial insurers paid more for inpatient care than Medicare prices. The result: Insurers pass the cost difference to employers in the form of higher premiums and deductibles. To manage the cost on their end, plan sponsors share more of the cost with plan members. "The economic contraction could make these costs even less affordable for workers if they suffer declines in income and wages and lose employer-sponsored insurance," the report said.
4. Public health dollars are being stretched thin at a time when states face unprecedented challenges from COVID-19. Between 2014–2015 and 2017–2018, per capita public health spending was flat in most states or increased only modestly. This trend, which occurred during a time of economic growth, hardly prepared states for the added demands, and uncertainties, of the pandemic.

In summary, the Fund said: "The state scorecard highlights serious deficiencies in the U.S. health care system that have left the nation far less prepared than other wealthy nations to deal with the COVID-19 pandemic. It also reveals wide geographic variation within the health care system. For example, uninsured rates ranged from 4 percent of adults in Massachusetts and the District of Columbia to 24 percent in Texas. These gaps are likely to widen if states are left to address the COVID-19 pandemic with little federal leadership."

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