Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study
Journal / Book Title
The Lancet Regional Health Americas
Background: Many states in the United States (US) have introduced barriers to impede voting among individuals from socio-economically disadvantaged groups. This may reduce representation thereby decreasing access to lifesaving goods, such as health insurance. Methods: We used cross-sectional data from 242,727 adults in the 50 states and District of Columbia participating in the US 2017 Behavioral Risk Factor Surveillance System (BRFSS). To quantify access to voting, the Cost of Voting Index (COVI), a global measure of barriers to voting within a state during a US election was used. Multilevel modeling was used to determine whether barriers to voting were associated with health insurance status after adjusting for individual- and state-level covariates. Analyses were stratified by racial/ethnic identity, household income, and age group. Findings: A one standard deviation (SD) increase in COVI score was associated with an overall increased odds of being uninsured (OR=1.25; 95% CI=1.22, 1.28). This association was also present for Non-Hispanic Black (OR=1.18; 95% CI=1.13,1.22), Hispanic (1.18; 95% CI=1.15,1.21), and Asian (OR=1.45;95%CI=1.27,1.66), and other Non-Hispanic (OR=1.12, 95% CI=1.06, 1.18) US adults, but not for White Non-Hispanic and Native US adults. Likewise, a one SD increase in COVI among adults from low-income households was associated with an increased odds of being uninsured (OR=1.32; 95% CI=1.26,1.38) but there was no association among individuals with incomes greater than $75,000. This association was similar for younger US adults (OR=1.22; 95%CI=1.20,1.24) but not among those aged 45 to 64. Interpretation: Groups commonly targeted by voting restriction laws—those with low incomes, who are racial minorities, and who are young—are also less likely to be insured in states with more voting restrictions. However, those who are wealthier, white or older are no more likely to be uninsured irrespective of the level of voting restrictions.
MSU Digital Commons Citation
Pabayo, Roman; Liu, Sze Yan; Grinshteyn, Erin; Cook, Daniel M.; and Muennig, Peter, "Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study" (2021). Department of Public Health Scholarship and Creative Works. 193.
Pabayo R, Liu SY, Grinshteyn E, Cook DM, Muennig P. Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study. The Lancet Regional Health-Americas. 2021 Jul 30:100026.