A new report from the Commonwealth Fund finds that Arkansas has some of the worst health quality and access for Hispanics in the United States. The data shows that Arkansas ranks 49th out of 50 for health care access for Hispanics and 50th out of 50 for health care quality.
Kristen Kolb is a research associate for the Commonwealth Fund. She lays out two opposite ends of the spectrum in the report.
More than 9 in 10 Hispanic children in Vermont had timely preventive care visits, compared to only about half of Hispanic children in Arkansas. Preventive care is needed to monitor children's growth and development, screen for any physical or mental health conditions and administer recommended immunizations.
But one number tells a different story. Arkansas ranks 6th in the nation on health outcomes for Hispanic residents.
Dr. Joseph Betancourt is the president of the Commonwealth Fund. He says the gap between low health care quality and access and high health outcomes is a long-standing observation in public health research.
"It's called the Hispanic health paradox. And fundamentally, what we understand is that Hispanic and Latino populations tend to have better health outcomes despite having lower income, less access to care and other socioeconomic disadvantages."
Dr. Betancourt says there are a few hypotheses as to why this paradox exists.
"I'll just mention three.”
One, the American Hispanic population on average is younger than other racial groups.
“And so fundamentally, when we think about these outcomes related to chronic disease morbidity and mortality, they just may not be playing out quite yet.”
Two, there's a hypothesis around the impacts of social and behavioral norms.
“Perhaps greater family cohesion, addressing social isolation, lower smoking rates. So is there something socially or culturally that is leading to this paradox?”
And lastly, an unexpected one.
“There has been evidence to support the fact that there is often misclassification of individuals on their death certificates, and this might be disproportionately high among Native Americans and actually Hispanic Latinos. In that case, there would be an undercount in some of these health outcomes, particularly mortality statistics that we see."
In addition to being the president of the Commonwealth Fund, Dr. Betancourt is a primary care physician. He says that he understands firsthand what happens when health care access is out of reach.
"Conditions that are manageable become crises, and people have poor health outcomes and ultimately live shorter lives. This is unacceptable and completely addressable."
Sara Collins is a senior scholar with the Commonwealth Fund. She says over time, the research indicates a clear difference between states that have expanded Medicaid coverage and those that have not.
"Zero in on people earning less than 200% of poverty. You see a narrowing of racial and ethnic differences in those groups and a persistent wide disparity in states that haven't expanded Medicaid. Coverage is — again, not the only thing that matters, but it is really the first thing that matters."
Arkansas has expanded Medicaid, but with strings attached through a more restrictive private insurance model. The state is also in the process of seeking federal approval to add work requirements that could further limit access to Arkansans who qualify.
The uninsured rate for all racial groups in Arkansas is above the national average, but once again, the largest gap is with Hispanic Arkansans. 35% of adults — more than 1 in 4 — went without care because of cost, and only 59% have a usual source of care. By comparison, the national average for Hispanics in the U.S. is 67%.
And when it comes to preventive care for Hispanic children in Arkansas, the numbers don't look good either. Data shows that just over half of Hispanic children in Arkansas have had an age-appropriate medical and dental preventive care visit. The national average is 12 percentage points higher.
Now, a radio story that is heavy on statistics can be hard to follow, but this level of detail in the data continues to drive home the point of the overall report: Hispanics who call Arkansas home are largely missing out on routine and preventive health care services, and leaders with the Commonwealth Fund say that current federal policy changes are likely to make things even worse.
Dr. Betancourt says the data for this report is from 2024.
"We do know that some of the more drastic immigration actions are taking place now and really began in '25. There's no doubt that, as a provider, I know — we've heard — that there's an incredibly significant chilling effect for all individuals, documented or not, as it relates to these actions and their comfort with pursuing health care, sending kids to school and a variety of other issues, but health care falls within that bucket."
Remember that line earlier when Dr. Betancourt says, “this is unacceptable and completely addressable,”? So let's address it with some policy recommendations.
Dr. Laurie Zephyrin is the senior vice president for achieving equitable outcomes at the Commonwealth Fund, and policy recommendations are her expertise. She says there are five policy areas that could make a major impact.
“Coverage, primary care, prevention, social needs and responsible digital health.”
Those first four build on existing policy frameworks, but responsible digital health — emphasis on responsible — could shrink the care gap in a fascinating way. Let's go back to Hispanics in Arkansas. Perhaps one of the reasons nearly 60% of them do not have a usual source of care is a language barrier. Dr. Betancourt says one way to alleviate that could be through digital health resources.
"AI and technologies have the capacity to eliminate those language barriers and allow me to speak very directly to patients and have that language barrier eliminated. Patients face a very significant information gap. The capacity for some of these tools to, in a person's language, in a way that they could understand at a low level of health literacy, for as long as it takes, to be explaining things to patients — everything from how to enroll in coverage, to how to keep your coverage, to how to take care of yourself. There's ample — I think — great examples of how these technologies, when created in a bespoke fashion, we believe can particularly help address some of the disparities that we see."
Dr. Zephyrin says AI is already showing up in health care widely.
"So how can we use technology to improve access and coordination, and also require transparency, bias testing and accountability, and ensure that we are engaging communities in its expansion? For example, building on models like Colorado's notice requirements for high-risk AI applications can be an excellent example. Together, actions to expand coverage, strengthen frontline care, prevent disease earlier, stabilize essential needs and ensure that innovation is accountable is really critical, so that gaps can be narrowed and not continue to grow."
Ozarks at Large transcripts are created on a rush deadline and edited for length and clarity. Copy editors utilize AI tools to review work. KUAF does not publish content created by AI. Please reach out to kuafinfo@uark.edu to report an issue. The audio version is the authoritative record of KUAF programming.
