Abstract: Mitral valve transcatheter edge-to-edge repair (mTEER) has proven to be a valuable treatment for mitral regurgitation (MR), yet racial and ethnic disparities in its adoption remain underexplored. This retrospective study analyzed mTEER utilization and outcomes within the U.S. Veterans Affairs (VA) Healthcare System from 2013 to 2022, where barriers like insurance coverage are mitigated. A total of 458 mTEER recipients were studied, categorized by race and ethnicity (White, Black, and Hispanic). Findings revealed significantly lower mTEER uptake among Black and Hispanic patients compared to White patients, despite similar quality of care and 1-year mortality outcomes. Adjusted odds ratios for receiving mTEER were 0.64 (95% CI, 0.42–0.97) for Black patients and 0.43 (95% CI, 0.21–0.89) for Hispanic patients. Time from MR diagnosis to mTEER did not differ significantly between groups. Mortality rates post-mTEER were comparable, with no significant disparities observed in adjusted relative risks. The study underscores that insurance-independent barriers, such as structural inequities or implicit biases, may influence the lower uptake of mTEER among minoritized veterans. These findings highlight the urgency of addressing non-insurance-related factors to ensure equitable access to advanced cardiac care for all populations.