A new report from the Century Foundation investigates the effects of voting barriers on health care policy in the U.S. Citing several studies supported by the Russell Sage Foundation, including research in RSF’s special initiative on the social, economic, and political effects of the Affordable Care Act, the report states, “There is increasing evidence that barriers to voter registration in particular are powerful impediments to implementation of equitable health policy. Nothing illustrates this divergence between public policy and the public’s views better than the case of Medicaid expansion.”
A number of studies in RSF’s special initiative on the Affordable Care Act (ACA) examine how Medicaid expansions under the ACA have affected public opinion and political participation. Grantee Daniel Hopkins and Kalind Parish (University of Pennsylvania) find that Medicaid expansions in select states made low-income individuals in those states more likely to support the ACA. Grantees Michael Sances (University of Memphis) and Joshua Clinton (Vanderbilt University) find higher political participation in counties within states that adopted Medicaid expansions compared to otherwise similar counties in non-expansion states. They also show that the effects of Medicaid expansion on voter turnout were largest in counties with above-average poverty levels. However, at the same time, grantee Julianna Pacheco (University of Iowa) finds that politicians are more responsive to healthier constituents—who have higher rates of political participation—than less-healthy constituents. In another study, she also finds that disparities in voter turnout by health status are exacerbated in states with less generous Medicaid programs.
These findings and others cited in the Century Foundation’s report suggest that not only are programs like Medicaid popular among the public, but access to affordable health care also boosts political participation, particularly among low-income groups. As former visiting scholar Jonathan Nagler (New York University) has shown, non-voters have different policy preferences than voters, including higher support for government-provided health care and other social services. Increasing voter turnout by removing barriers to voting is therefore essential for ensuring that national health care policy is representative of the public’s interests. As the report concludes, increasing voting access for low-income people through measures such as same-day and automatic voter registration, expanding the number of polling places with disability access, and establishing mail-in voting are key for “reducing biases in turnout and creating a more representative electorate.”