Building a Healthy Democracy

Building a Healthy Democracy

November 4, 2013

For our democracy to thrive, the freedom to vote must be fiercely protected for all citizens, regardless of class or privilege. Our representative form of democracy only works as intended when all citizens, across the social and economic spectrum, are able to participate and have a say in the policies that affect their lives.

Much work remains to be done to bring under-represented voices into the political system to ensure a government that reflects America.

Today, in the 21st century, too many bureaucratic barriers still block the ability of eligible persons to register, which in most states remains a prerequisite to voting. Our antiquated system puts the burden of registration on each individual, with unnecessarily restrictive registration deadlines.

The numbers tell the tale of how far we have to go in making sure all eligible persons can register:

  • Leading up to the 2012 elections, approximately 51 million eligible Americans were still not registered to vote. This represents almost one in four eligible persons, disproportionately low-income voters, people of color, and younger Americans.1

  • In the 2008 elections, the voting rate for all eligible persons of voting age was only 64 percent, while the voting rate for people who were registered to vote was 90 percent—showing that registration is key to turnout.2

  • In the 2008 election, 2 to 3 million registered voters were prevented from voting because of various administrative problems, and 9 million eligible Americans were not registered because of residency rules or registration deadlines.3

  • The number of people barred from voting in 2008 because of such problems exceeded the popular vote margin of the 2000 and 2004 presidential elections.4

The National Voter Registration Act of 1993 aimed to reduce the barriers to voter registration by making voter registration available through government agencies that serve the public. Work by Demos and its partners shows that the NVRA can bring millions of Americans into the political process by providing the opportunity to register to vote through state offices that interact with the public on a daily basis.5

The new health care law, the Patient Protection and Affordable Care Act (ACA),6 now provides an additional opportunity to register millions of new voters. Because the Health Benefit Exchanges established under the ACA provide access to subsidized health benefits,7 the NVRA’s requirement for providing voter registration services at public agencies applies.

Successfully integrating the NVRA voter registration requirements into the ACA enrollment process will mean millions of additional Americans people will get the opportunity to register to vote and thus to participate in our political process.8 This Policy Brief provides guidance on why and how Health Benefit Exchanges should incorporate the NVRA’s requirements for providing voter registration opportunities. 


  1. The Pew Center on the States, Inaccurate, Costly and Inefficient: Evidence That America’s Voter Registration System Needs an Upgrade (February 14, 2012), available at

  2. Id., Table 1.

  3. Stephen Ansolabehere, Testimony before the Senate Rules Committee at 19 (March 11, 2009), available at

  4. Ian Urbina, Hurdles to Voting Persisted in 2008, The New York Times (March 10, 2009), available at

  5. Youjin B. Kim and Lisa Danetz, 1 Million New Voters Among the 99%: How Agency-Based Voter Registration Gives Low-Income Americans a Voice in Democracy, Demos (Nov.2011), available at

  6. The Patient Protection and Affordable Care Act, Pub. L. 111-148, 124 Stat. 119 (Mar. 23, 2010).

  7. Subsidized health benefits are generally called “Insurance Affordability Programs” in the ACA. Each of the Insurance Affordability Programs – Medicaid; CHIP; the Basic Health Plan; and the insurance premium tax credits refunded to the insured, advance payment of the premium tax credit, and cost-sharing reductions in connection with the Qualified Health Plans – is “public assistance.” Beyond the Medicaid and CHIP programs, which are well-established as public assistance, the cost-sharing reductions and advance payment of tax credits are conceptually similar to SNAP and TANF, two other well-established “public assistance” programs, in that private vendors are reimbursed by the government for providing goods and services to low income individuals. See NVRA House Conference Report, H.R.Conf.Rep. No. 103-66, at 19 (1993); Valdez v. Squier 676 F.3d 935, 938 (10th Cir. 2012) (recognizing Food Stamp Program, Temporary Assistance to Needy Families, and Medicaid constitute “public assistance” under the NVRA). And, though courts have not specifically considered the ACA’s premium tax credit, 26 U.S.C. §35B , similar tax credits under the ACA have been deemed to constitute public assistance because they –like the premium tax credit-- are: (1) intended to serve as financial assistance to moderate or low-income individuals; (2) available only to filers below a certain income; and (3) refundable, i.e. could result in a credit being paid to the filer. In re Johnson, 480 B.R. 305, 312-316 (Bankr. N.D. Ill. 2012) (federal adoption tax credit as modified by the ACA constitutes “public assistance”); see also In re James, 406 F.3d 1340, 1344-1345 (11th Cir. 2005) (earned income tax credit constitutes “public assistance” under ordinary meaning doctrine, because enacted “to provide relief for low-income families”).

  8. Implementation of the NVRA reduces the income-based gap for both voter registration and turnout in the electorate. David Hill, A two-step approach to assessing composition effects of the National Voter Registration Act, Electoral Studies 22, no. 4, 703-720 (2003).