Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study

Area of Science:

• Public Health
• Health Policy
• Socioeconomic Determinants of Health

Background:

• Many US states enact voting barriers targeting socio-economically disadvantaged groups.
• These barriers may reduce political representation and access to essential services like health insurance.

Purpose of the Study:

• To investigate the association between state-level voting barriers and health insurance status among US adults.
• To examine disparities in this association across racial/ethnic, income, and age groups.

Main Methods:

• Utilized cross-sectional data from 242,727 adults in the 2017 US Behavioral Risk Factor Surveillance System (BRFSS).
• Employed the Cost of Voting Index (COVI) to measure state-specific voting barriers.
• Applied multilevel modeling, adjusting for individual and state covariates, with stratified analyses by race/ethnicity, income, and age.

Main Results:

• A one standard deviation increase in COVI was associated with a 25% increase in the odds of being uninsured (OR=1.25).
• Significant associations were observed for Non-Hispanic Black, Hispanic, and Asian adults, and adults from low-income households.
• No significant association was found for White Non-Hispanic or Native US adults, or adults with incomes over $75,000. The association was present in younger adults but not those aged 45-64.

Conclusions:

• Voting restriction laws disproportionately impact insurance access for low-income, minority, and young populations.
• Wealthier, White, or older individuals' insurance status is not significantly affected by the level of voting restrictions.