WASHINGTON — As 2025 comes to a close, health equity remained both a policy priority and a point of contention across the U.S. healthcare system. From insurance coverage debates and drug pricing to vaccine policy and research funding, the year underscored how deeply access to care in the United States is shaped by race, income, and geography. For communities of color, the headlines of 2025 reflected a familiar pattern: incremental progress alongside structural barriers that continue to limit who benefits from medical advances and public health protections.

One of the most consequential storylines of the year involved health insurance coverage and affordability. National data from the Centers for Disease Control and Prevention and the Commonwealth Fund showed that uninsured rates remained near historic lows following years of Affordable Care Act expansions, particularly benefiting Black and Latino adults. At the same time, policy debates in Washington raised alarms about whether those gains would hold. The future of enhanced ACA marketplace subsidies, which have helped millions afford coverage, became increasingly uncertain, with health policy analysts warning that their expiration would disproportionately affect communities of color, who are more likely to rely on marketplace plans and less likely to have employer-sponsored insurance.

Medicaid policy also dominated health equity coverage in 2025. Federal and state proposals to tighten eligibility rules, add work requirements, or increase administrative checks sparked concern among advocates who view Medicaid as a cornerstone of equitable access to care. Medicaid covers a disproportionate share of Black, Latino, Native American, and rural residents, and research consistently shows that even modest administrative hurdles can lead to coverage losses. “When people lose coverage, it’s rarely because they no longer qualify—it’s because the system becomes harder to navigate,” Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured, said in a briefing earlier this year.

At the same time, rising healthcare costs continued to strain households. Surveys conducted in 2025 found that millions of adults delayed or skipped care because of cost, with Black and Hispanic adults reporting higher levels of cost-related barriers than White adults. These financial pressures shaped nearly every major health equity issue of the year, from prescription drug access to preventive care utilization.

Medical innovation brought both promise and tension. The rapid growth of GLP-1 medications for diabetes and weight loss captured national attention, with new approvals and pricing negotiations signaling a potential shift in how obesity is treated. Yet access to these drugs highlighted familiar inequities. Studies published this year showed that Black and Latino patients were less likely to be prescribed GLP-1 medications, even when clinically eligible, reflecting disparities in insurance coverage, provider bias, and access to specialty care. Federal efforts to explore broader Medicare and Medicaid coverage for these drugs were welcomed by equity advocates, but many cautioned that without consistent implementation, new therapies could widen, rather than narrow, gaps in care.

Vaccine policy and access were another defining health equity issue in 2025. As COVID-19 moved further into an endemic phase, federal health officials updated booster recommendations, emphasizing risk-based vaccination for older adults and people with underlying conditions. The rollout of RSV vaccines for seniors and infants marked a major public health milestone, yet uptake revealed persistent disparities. CDC data released throughout the year showed lower vaccination rates among Black, Latino, and Native populations for several adult vaccines, even as these groups experienced higher rates of hospitalization and severe illness. Public health researchers pointed to a mix of factors, including declining trust in institutions, inconsistent provider recommendations, limited access to primary care, and financial pressures on safety-net clinics caused by low Medicaid reimbursement rates. State-level debates over vaccine mandates and exemptions further complicated the landscape, prompting warnings from medical groups that policy decisions were increasingly influencing who receives protection from preventable disease.

Health equity in research also faced challenges. Reports of disrupted or delayed federal research funding in 2025 raised concerns about the stability of studies focused on prevention, behavioral health, and community-based interventions—areas often critical to reducing disparities. Researchers warned that interruptions in clinical trials and public health studies risk slowing progress on conditions that disproportionately affect communities of color, including cardiovascular disease, maternal mortality, and infectious diseases.

Across healthcare systems, equity increasingly moved from rhetoric to measurement. Hospitals, insurers, and state agencies expanded efforts to collect race and ethnicity data, screen for social needs, and tie equity metrics to quality improvement programs. These efforts reflected a growing consensus that disparities cannot be addressed without better data and accountability. Still, experts cautioned that data collection alone is insufficient without sustained investment in community-based solutions and policy changes that address housing, food access, and economic stability.

What to expect in 2026

Looking ahead, 2026 is shaping up to be a pivotal year for health equity in the United States. Decisions about extending ACA subsidies, finalizing Medicaid policies, and implementing new drug coverage models will have immediate consequences for access to care. Vaccine policy is likely to remain a flashpoint, as public health officials seek to rebuild trust, improve adult vaccination rates, and respond to ongoing misinformation. The implementation of expanded coverage for high-cost medications, including treatments for obesity and chronic disease, will test whether the healthcare system can translate innovation into equitable access.

Advocates and researchers also expect growing attention to maternal health, mental health, and chronic disease prevention, particularly as new federal data continue to document stark racial gaps in outcomes. The challenge, many say, will be sustaining political and financial commitment in a polarized environment. “Equity isn’t a single program or policy,” said Dr. Georges Benjamin, executive director of the American Public Health Association, in remarks earlier this year. “It’s a continuous effort to make sure systems work for everyone, especially those who’ve been left out for generations.”

The health equity stories of 2025 made one reality clear: progress is possible, but fragile. As the nation enters 2026, the question is not whether the tools to reduce disparities exist, but whether policymakers, health systems, and communities will align to ensure that access to care, prevention, and protection from disease is determined by need—not by race, income, or ZIP code.