Major public health and medical associations in the U.S., including the American College of Physicians, American Medical Association and the American Public Health Association have recognized voting as a social determinant of health and have called for equitable access to voting, including for people with disabilities.
A growing body of research shows that voting and health are intertwined. People affected by poor health or disabilities are less likely to cast a ballot than the general population, and as a result, have less sway over who gets to be in power and what policies are made.
When previously disenfranchised people, including people with disabilities, vote, policies that benefit everyone and better health outcomes follow, according to County Health Rankings & Roadmaps, a program of the University of Wisconsin Population Health Institute.
About 42.5 million Americans have disabilities, according to 2021 data from the U.S. Census Bureau. A disability is any condition of the body or mind that makes it more difficult for a person to do certain activities or interact with the world around them, according to the Centers for Disease Control and Prevention.
In the November 2020 election, individuals with disabilities voted at a 7% lower rate than people without disabilities, according to the Disability and Voting Accessibility in the 2020 Elections survey by the U.S. Election Assistance Commission and Rutgers University. More than 11% — nearly 2 million people with disabilities — said they faced difficulties voting.
Voters with disabilities face a range of barriers, including inaccessible voting places, lack of accessible voting machines, and state laws that restrict voting by mail or criminalize assisting a person in voting, according to the American Civil Liberties Union.
When the Government Accountability Office officials visited 167 polling places during the 2016 general election, only 17% were fully accessible for people with disabilities who wanted to vote in person. The most common barriers were steep ramps, lack of signs for accessible paths to the building, gravel parking lots or lack of parking options.
In 2023, at least 14 states enacted 17 restrictive voting laws, which will take effect for the 2024 general election, according to the Brennan Center for Justice, a nonpartisan law and policy institute at New York University. Most of the laws limit mail-in voting, shorten the window of requesting a mail ballot or ban drop boxes. Even though these laws don’t target people with disabilities, they create additional barriers for them.
People who live in institutions like nursing homes, those who are under legal guardianship and people with mental illness are also less likely to vote than the general population, research has shown. In some cases, these people are prohibited from voting by state law.
Several states bar individuals under guardianship or conservatorship from voting, according to a 2022 study published in the Election Law Journal.
“Out of 50 states and the District of Columbia, 35 have constitutional provisions that specifically do not allow mentally incapacitated individuals to vote and thirteen state constitutions are silent on whether an individual with limited capacity can vote. Most states require a court order to disenfranchise individuals with limited capacity either as part of the appointment of a limited guardianship or as part of the voter registration process,” according to a 2022 explainer by the American Bar Association.
Although federal elections are mainly conducted under state laws and policies, several federal laws specifically address accessibility issues for voters with disabilities in states and counties, according to a 2021 report by the U.S. Government Accountability Office. Those provisions are included in the Americans with Disabilities Act of 1990 and the Help America Vote Act of 2002. The U.S. Election Assistance Commission, which sets guidelines for counties and states, has a dedicated page for voting accessibility. And those guidelines can be enforced by the Department of Justice.
Below, we have gathered four studies that examine the relationship between voting in the U.S. and disabilities. The research roundup is followed by several story ideas and interview questions for journalists.
The findings show…
- People with disabilities are less likely to vote than people without disabilities and state laws that restrict voting further limit their ability to vote.
- Voting rates vary depending on the type and level of disability. For instance, people with hearing disability tend to vote at a similar rate as the general population while the voting rate among people with mental disabilities has been shown to be 18% lower than the general population. Also, people with more functional limitations, including difficulty speaking and reading, were less likely to vote than people who didn’t have those challenges.
- Compliance with disability access laws at polling sites is under-enforced. There is no national ADA certification or permitting process to ensure that voting locations are accessible.
- Some states have competency laws that prevent certain groups of people with disabilities from voting, such as people who have legal guardians, even though such arrangements might have nothing to do with the person’s ability to vote. In many states, only a judge may decide whether an individual shouldn’t have the ability to vote.
- People living in nursing homes and assisted living facilities are enthusiastic to vote but face numerous hurdles to cast a ballot.
Research roundup
Disenfranchisement and Voting Opportunity Among People With Intellectual and Developmental Disabilities
Sarah Nelson Lineberry and Matthew Bogenschutz. Journal of the Society for Social Work & Research, Winter 2023.
The study: The paper examines predictors of voting among people with intellectual and developmental disabilities who received state-funded disability services in Virginia. The authors used data from the state’s 2017-2018 and 2018-2019 National Core Indicators In-Person Survey — a collaborative project of the National Association of State Directors of Developmental Disability Services and the Human Service Research Institute. The sample included 1,620 people.
The findings: People with more severe intellectual and developmental disabilities, those with guardians, and those who have not attended advocacy events are less likely to vote than their peers, the study finds. Having a key to one’s home and being able to lock one’s bedroom door were associated with an increased likelihood of voting. Social workers have the opportunity to help increase voting opportunities for people with intellectual and developmental disabilities, the authors write.
In the authors’ words: “Results suggest that people with severe or profound levels of [intellectual and developmental disabilities] have a particularly limited voice in American democracy, which should serve as a call to action for advocates to do more to ensure that voting opportunity the most fundamental of democratic rights — is accessible to all people.”
Also: Voting Rights for Persons with Serious Mental Illnesses in the U.S., published in 2019 in the Psychiatric Rehabilitation Journal provides a detailed overview of the issues.
Defending Voting Rights in Long-Term Care Institutions
Nina A. Kohn and Casey Smith. Boston University Law Review, 2023.
The study: Nearly 2.2 million Americans live in long-term care facilities in the U.S., including nursing homes and assisted living facilities. There’s a growing consensus among scholars and policymakers that “a person has the cognitive capacity to vote so long as they can somehow express a voting choice,” the authors write. And contrary to common assumptions, most long-term care residents don’t have substantial cognitive disabilities. Researchers reviewed nursing home inspection reports from 2016 to 2021 to better understand barriers to voting.
The findings: The authors’ review of nursing home inspection reports finds evidence that residents are enthusiastic about voting. But they identified more than 100 documented instances of nursing homes violating residents’ voting rights. Long-term care residents face systemic disenfranchisement, including “burdensome election procedures, profound isolation, and widespread failure by facilities to provide required assistance prevent long-term care residents from voting,” they write.
In the authors’ words: “Indeed, even a few, targeted cases defending the voting rights of long-term care residents could undermine the harmful assumption that this population does not have the ability to vote and that their voting rights are — as some states suggested amid the COVID-19 pandemic — ‘non-essential.’”
Designing Accessible Elections: Recommendations from Disability Voting Rights Advocates
Ihaab Syed, et al. Election Law Journal, March 2022.
The study: The article analyzes some of the main reasons why barriers to voting for people with disabilities persist and offers insights into how local and state election officials can improve election policies, practices and procedures.
The findings: One of the main reasons for voting inaccessibility is a complex and decentralized system of administering elections. Laws are under-enforced and there’s a failure to ask for the perspective, preferences and needs of people with disabilities. Most states don’t have a deadline for counties to designate polling places, let alone require an audit of the site for accessibility. The DOJ, which has the authority to issue regulations and litigate actions, has not been very active, researchers write. Also, policymakers must account for the fact that some people with disabilities will prefer or need to receive in-person assistance, and electoral policies must not interfere with their ability to get assistance from the person of their choice, they write.
In the authors’ words: “In closing, we urge election officials (and policymakers at all levels of government) to take seriously a slogan that has become a powerful rallying cry in the disability rights movement: ‘Nothing about us without us.’”
Disability and Voting Accessibility in the 2020 Elections: Final Report on Survey Results Submitted to the Election Assistance Commission
Lisa Schur and Douglas Kruse. February 2021.
The study: This paper is based on a nationally representative survey of 2,569 U.S. participants: 1,782 with disabilities and 787 without disabilities. The survey was conducted by SSRS, a well-established survey firm.
The findings: The 52-page report is filled with data, but here are some highlights.
- People with disabilities are more likely to be older and non-married, less likely to have high school or college degrees, and less likely to be Hispanic or Latino, compared with people without disabilities.
- The incidence of voting difficulties for people with disabilities dropped markedly, from 26.1% in 2012 to 11.4% in 2020. However, the overall rate of difficulties for voters with disabilities in 2020 was almost twice the rate for voters without disabilities (11% compared to 6%).
- 30% of people with cognitive impairment and 24% of people with vision impairment reported difficulty in voting at a polling place, compared with 9.8% of people without a disability.
- Mobility limitations were most common (48%) among people with disabilities, followed by cognitive (24%), hearing (18%), and vision (12%) impairments. (Some respondents fell into more than one category.)
- 49% of people with disabilities voted at a polling place or election office in 2020, compared with 56% of voters without disabilities.
- 55% of people with disabilities, including those with mobility limitations and those needing help with daily activities used mail ballots, compared with 44% of voters without disabilities.
- 74% of people with disabilities used early voting and voting by mail, compared with 69% of voters without disabilities.
- 53% of people with disabilities said they follow politics most of the time, compared with 42% of people without disabilities.
In the authors’ words: “The results show significant progress has been made in voting accessibility since 2012. This reflects well on the efforts of the EAC, election officials, policy-makers, and disability organizations. Nevertheless, voters with disabilities remain significantly more likely than those without disabilities to experience voting difficulties, indicating that more work needs to be done to improve accessibility.”
Also: The authors conducted another survey during the November 2022 elections, finding comparable results to 2020 but better accessibility than in 2012.
Disability and Election Administration in the United States: Barriers and Improvements
April A. Johnson and Sierra Powell. Policy Studies, November 2019.
The study: The authors examine whether lower voter turnout among people with disabilities is directly related to voting procedures, including voter registration, voter identification regulations and methods of ballot submission. They analyzed data from the 2012 and 2016 Cooperative Congressional Election Study, a survey of more than 50,000 Americans conducted by polling firm YouGov before and after presidential and midterm elections.
The findings: Overall, 30% of people with disabilities in 2016, and 37% of people with disabilities in 2012 specifically cited “disability or illness” as the main reason why they did not vote. Registering oneself to vote was a substantial barrier for people with disabilities. Also, voting by mail, instead of early voting or same-day registration, may be more inclusive for people with disabilities.
In the authors’ words: “One of the most disturbing discoveries presented here is that election administration also affects one’s psychological state. Electoral systems which impose or magnify perceptions of intimidation at the polls among any group of persons should garner both serious attention and pointed remedies,” the authors write. “We agree and believe that poll workers may benefit from more specialized training, specifically with regard to accommodations for those with cognitive, physical, or emotional limitations. Such administrative efforts may serve to reduce the ‘chilling effect’ of perceived hostile voting conditions.”
Suggested story ideas and interview questions
- Are your area’s polling places accessible to people with disabilities? To start, read GAO’s 2021 and 2017 reports to understand barriers, laws and solutions. The U.S. Department of Justice has an accessibility checklist for polling places. Also, the National Institute of Standards and Technology within the Department of Commerce examines technological barriers to the voting process for people with disabilities.
- Ask your local election officials how they are making voting places more accessible to people with disabilities. Do they have data on what percentage of polling places are fully accessible and how that rate has changed over time?
- Speak with advocacy groups and disability rights activists about barriers to voting in your state and county.
- What barriers do people in nursing homes, assisted living facilities and other institutions face in voting in your state or county? The National Disability Rights Network has a helpful explainer to get you started.
- What are your state’s voting laws for people under guardianship? Start with this 2022 explainer from the American Bar Association and this 2023 report by the National Disability Rights Network. This 2018 guide for voters with mental disabilities by the Bazelon Center for Mental Health Law also explains the basics.
- Are your area nursing homes assisting their residents who want to vote? You may be able to find past violations in nursing home inspection reports.
- Also, don’t forget to use proper style. The National Center on Disability and Journalism has a language style guide. The Arc, an advocacy organization for the rights of people with intellectual and developmental disabilities has a Journalist’s Guide to Disability for Election 2024.
Expert Commentary