Akshay Swaminathan

Apr 6, 2021

8 min read

Do we suppress health care the way we suppress voting?

A comparison of restrictive voting and health care policies

Photo by Unseen Histories on Unsplash
  1. Voter purges vs. health insurance purges
  2. Automatic voter registration vs. auto-enrollment in health insurance
  3. Criminal disenfranchisement vs. Medicaid Inmate Exclusion
  4. Voter ID laws vs. ID requirements for health services

Voter Purges and Health Insurance Purges

Voter purges are when election officials remove the names of ineligible voters from registration lists. As the Brennan Center describes, “When done correctly, purges ensure the voter rolls are accurate and up-to-date. When done incorrectly, purges disenfranchise legitimate voters (often when it is too close to an election to rectify the mistake), causing confusion and delay at the polls.” Inaccurate voter purging can affect many people. During the 2016 presidential primary, for example, the New York City Board of Elections improperly deleted the names of 200,000 registered voters.

Automatic Voter Registration and Auto-Enrollment in Health Insurance

Automatic voter registration is a policy designed to increase registration rates by automatically registering eligible citizens who interact with government agencies (like the DMV). By making registration opt-out as opposed to opt-in, and by linking voter records to electronic government records as opposed to paper forms, automatic voter registration saves money and helps clean up the voter rolls. To date, 19 states and DC have approved the policy. When automatic voter registration was implemented in Vermont, voter registration jumped 62% in the first six months.

Source: Blumberg LJ, Holahan J, Karpman M, Elmendorf C. Characteristics of the remaining uninsured: an update, Washington (DC): Urban Institute; 2018 Jul 11.

Criminal Disenfranchisement and Medicaid Inmate Exclusion

Criminal disenfranchisement laws strip voting rights from ~6 million Americans with past criminal convictions. These laws are in effect in twenty nine states. To make matters worse, election officials who misunderstand their states’ disenfranchisement policies mistakenly bar hundreds of thousands from voting by disseminating misinformation.

Voter ID laws and ID policies for health services

Laws that require a government-issued photo ID for voting are designed to minimize voter impersonation fraud, but numerous studies have found that this type of fraud is exceedingly rare (rarer than getting struck by lightning). Voter ID laws are a blunt policy instrument that inappropriately disenfranchises up to 11% of voters (25% Black and 8% White) who do not have the right form of ID.

Source: Brennan Center
  • performing frequent risk assessments to quantify the risk that the policy is intended to prevent
  • expanding the list of acceptable ID documents to include foreign driver’s licenses, school transcripts, lease agreements, and signed affidavits
  • allow all applicants to submit online applicants


Can insights from the voting and health fields inform efforts to pass equitable policy across the board? To what extent are voting policy and health policy even comparable? Having discussed the four policy areas above, here are some takeaways:

  • Tie auto-enrollment to interactions with government agencies. Automatic voter registration is implemented by registering anyone who interacts with government agencies (like the DMV). Louisiana implemented a similar system where any resident who was claiming SNAP benefits was automatically enrolled in Medicaid. Tying auto-enrollment to interactions with government agencies may be an effective way to implement opt-out voting and Medicaid registration.
  • Inmate exclusions are discriminatory policies that need to be abolished. Policies that limit access to voting or health care for incarcerated populations are a reflection of racist values, not of logistical barriers.
  • Improvements to ID requirement policies can apply to both voting and health services. There are scenarios where ID requirements are warranted, but those requirements need to be carefully designed to not mistakenly exclude eligible individuals. Quantifying the risks of applying or not applying such requirements is critical (and in the case of voting, shows that strict ID requirements are not warranted). If requirements are needed, expanding the list of acceptable documents and allowing for online verification may lead to a more equitable verification process.