Barriers to Voting in Elections Linked to Increased Odds of Being Uninsured

Individuals commonly targeted by voting restriction laws—those with low incomes, racial minorities, and young people—are also less likely to have health insurance in states with more voting restrictions, according to a study by researchers at Columbia University Mailman School of Public Health and the University of Alberta School of Public Health, Edmonton, Canada. Conversely, individuals who are wealthier, white, or older are no more likely to be uninsured irrespective of the level of voting restrictions.

The study is one of the first to show the relationship between barriers to voting in elections and access to health insurance in the United States. The findings are published in The Lancet Regional Health—Americas.

The findings underscore how to access, or the lack of access, to power is associated with disparities in access to health care. The findings also provide indicate the need for laws that assist rather than hinder minority and underserved groups in voting. 

“An often overlooked social determinant of health is access to power. When access to power is disproportionately distributed, health inequities develop. The right to vote is one of the most basic forms of access to power. By voting, citizens elect representatives who advocate for their interests,” noted Roman Pabayo, PhD, University of Alberta School of Public Health, and first author.

The researchers analyzed data collected from 242,727 adults in the 50 states and District of Columbia participating in the U.S. 2017 Behavioral Risk Factor Surveillance System. To quantify voting accessibility, they used the Cost of Voting Index, a global measure of barriers to voting within a state during a US election. Results were adjusted for racial/ethnic identity, household income, and age group.

Examples of state-level voting restrictions include photo ID laws, no early voting, and bans on same-day registration. These laws are similar to Jim Crow-era voting restrictions such as voter suppression that reduced minority representation in legislative bodies. Today, these same disadvantaged groups are less likely to have representatives who advocate for their interests and critical support, such as health insurance.

In order to decrease health inequities, such as the disparities in health-care access, voting restrictions that disproportionately affect racial and demographic groups, should be removed, according to the researchers.

“At the core of any democracy is the notion that we elect leaders to serve our best interests. When some groups are excluded from the democratic process, their voices are not heard, and the consequences can be deadly,” said Peter Muennig, MD, professor of health policy and management at Columbia Mailman School, and senior author. “The next step in this process is to explore other, broader consequences of voter restriction laws. Are they associated with shootings? Incarcerations for possession of substances that are legal in other states? Overall mortality?"

“When restrictions are more likely to prevent racial minorities, younger adults, and those from low socioeconomic backgrounds from voting, legislation and policies that benefit their health are less likely to be enacted. Thus, ensuring the right to vote for all citizens may be one way to reduce population health inequities,” said Pabayo.

Co-authors are Sze Yan Liu, Montclair State University; Erin Grinshteyn, University of San Francisco; and Daniel Cook, University of Nevada.