Health Equity & Access Weekly Roundup: February 20, 2026

Abortion Clinics Are Shuttering Even in Major Access States

A new report from the Guttmacher Institute finds that although the number of brick-and-mortar abortion clinics in states without total bans fell only modestly—by about 2%, from 765 to 753 between March 2024 and December 2025—the overall picture of access is far more unstable. Key access states such as New York and Illinois saw net clinic losses, while Florida experienced sharper declines following implementation of a 6-week ban. During the 21-month period, 51 facilities stopped offering abortion care while 39 began or resumed services, creating churn that complicates patients’ ability to find timely care. Funding pressures, including the withholding of federal Title X funds from some reproductive health networks, also contributed to closures. Although telehealth and online-only providers have expanded, particularly in states without telehealth restrictions and through states with shield laws that protect mailing abortion medication, approximately 80% of abortions in states where it remains legal still occur in physical clinics, which are essential for procedural and later-term care. The report underscores that legal protections alone do not guarantee access, as staffing shortages, financial strain, geography, and patients’ ability to travel all shape an increasingly uneven post-Dobbs abortion landscape.

New Sickle Cell Therapies Highlight Equity Gaps and Treatment Progress

Racial and ethnic disparities continue to shape access to care, quality, and research for sickle cell disease (SCD), a rare inherited blood disorder that largely affects non-Hispanic Black or African American individuals and shortens life expectancy by roughly 20 years. Although the first FDA-approved therapy, hydroxyurea (Droxia; Bristol-Myers Squibb), marked progress in 1994, treatment options have since expanded to include L-glutamine (Endari; Emmaus Medical, Inc), voxelotor (Oxbryta; Global Blood Therapeutics), crizanlizumab (Adakveo; Novartis), and, most recently, gene therapies approved in 2023, signaling a new era in SCD care. Researchers are also exploring therapies targeting thromboinflammation, reframing SCD as not only a hemoglobin disorder but also an inflammatory and thrombotic condition. However, experts such as Martin H. Steinberg, MD, of Boston University Chobanian & Avedisian School of Medicine, and Ted Wun, MD, of UC Davis Health, caution that high costs, particularly for gene therapies priced between $1 million and $3 million, have limited provider familiarity, and systemic inequities continue to hinder access. While professional groups like the American Society of Hematology are training multidisciplinary teams to improve care delivery, advocates stress that meaningful progress will require addressing both structural racism and the economic barriers that disproportionately burden patients with SCD.

The Sleep Crisis Is Increasingly a Social Issue

An analysis of 17,476 adults representing more than 109 million US residents in 2 cycles of the National Health and Nutrition Examination Survey found significant racial and ethnic disparities in sleep health, with non-Hispanic Black adults reporting the lowest healthy sleep scores and Hispanic and White adults scoring modestly higher. Researchers created a 5-point healthy sleep score based on sleep duration, sleep quality, snoring, daytime sleepiness, and nocturia, then used Blinder-Oaxaca decomposition to determine how much of the gap could be explained by measurable factors. Education level, age, food security, and body mass index (BMI) emerged as the strongest contributors to differences between groups. However, even after adjusting for 12 social, behavioral, and economic variables, non-Hispanic Black adults continued to have significantly lower sleep scores than non-Hispanic White adults, indicating that these factors did not fully account for disparities. The authors emphasized that race is a social construct and that inequities in sleep health stem from social determinants of health and structural racism, including unmeasured factors such as discrimination and neighborhood conditions. They concluded that reducing disparities will require addressing food insecurity, educational access, and obesity, while also confronting broader structural barriers that shape health outcomes.

Navigating GLP-1 Costs With Eric Levin: Insurance, Cash Pay, and the Oral Wegovy Shift

As the first oral version of semaglutide (Wegovy; Novo Nordisk) for weight loss enters the market, Eric Levin, CEO and cofounder of Scripta, says cost differences between oral and injectable glucagon-like peptide-1 (GLP-1) treatments depend largely on insurance coverage. While the oral option is generally a few hundred dollars cheaper per month on a cash-pay basis, prices are typically similar to injectables when covered by insurance. Coverage often hinges on employer benefit design, partnerships with weight management vendors, and how prescriptions are coded, as some plans cover GLP-1s for conditions like diabetes or obstructive sleep apnea but not for weight loss alone. Levin advises patients to consult their human resources departments or pharmacy benefit managers to clarify coverage and to seek income-based assistance programs if eligible. Looking ahead, Levin expects increased competition among oral GLP-1s and potential policy changes to drive prices down over time, predicting the market could eventually resemble the statin landscape, with widespread use and improved affordability—though he notes lower production costs do not automatically guarantee lower prices.

Produce Prescription Program Shows Limited Impact on Cardiometabolic Health in Diabetes

A 12-month produce prescription (PRx) program providing $80 per month for fruits, vegetables, and legumes to adults with type 2 diabetes at risk for food insecurity did not significantly improve cardiometabolic outcomes or reduce health care utilization compared with usual care, according to new clinical trial data. Conducted in the southeastern US within a single academic health system, the study randomized 2155 participants, most of whom were non-Hispanic Black and female, and assessed changes in hemoglobin A_1c (HbA_1c), emergency department visits, BMI, blood pressure, and inpatient visits. At 12 months, HbA_1c levels slightly favored the usual care group, and no meaningful differences were observed across secondary outcomes, including among those with higher baseline HbA_1c levels. Program adherence was moderate, with only 30% of participants using at least 80% of their monthly benefit, suggesting a limited impact. The authors concluded that while addressing food insecurity is critical for chronic disease management, standalone financial subsidies for produce may be insufficient to improve diabetes outcomes without stronger engagement strategies or broader policy interventions targeting the root causes of food insecurity.