June 27, 2023

ICYMI: Douglas R. Hess: Medicaid AVR can help the NVRA achieve its full potential by generating millions of new and updated registrations each election cycle

For Immediate Release:
June 27, 2023


WASHINGTON — This week, the Institute for Responsive Government published a white paper authored by Douglas R. Hess, PhD, about why automatic voter registration (AVR) expansion to Medicaid offices is a promising innovation in election administration policy. He discusses how states can introduce AVR expansion to Medicaid to address problems created by voter registration record maintenance and curb registration disparities among young, non-white, and low-income citizens.

Dr. Hess writes, “The U.S. voter registration system produces persistent inequalities in who is registered and problems with accuracy in the registration lists that can reduce turnout. Section 7 of the NVRA has design flaws that significantly reduce its effectiveness in addressing these problems. […] Medicaid AVR can be designed to significantly improve Section 7 performance. Based on program logic, the size of Medicaid, characteristics of Medicaid participants, and evidence from best practices in DMV AVR, Medicaid AVR should substantially increase Section 7 performance.”

Read the full white paper HERE


  • “Persistent and avoidable inequalities in access to voter registration undermine the norms of democracy. Moreover, citizens may lose confidence in elections if they encounter, or hear of others encountering, obstacles to the ballot box related to the accuracy of registration lists.”
  • “Without significant changes in state practices, millions of citizens each year will not benefit from their rights under the NVRA. As a result, voter registration rolls will continue to lack both coverage and accuracy.”
  • “Based on the size of Medicaid, the characteristics of the population Medicaid serves, and results from states that adopted best practices in motor voter AVR, Medicaid AVR, if adopted nationally, could generate millions of new and updated registrations each election cycle.
  • “Medicaid reaches a large population with a low registration rate. In recent years, more than 25 to 30 million adult citizens annually participated in Medicaid and related health services. While there are no national surveys on the voter registration rate for Medicaid participants, from the CPS we know that the registration rate for citizens in households participating in SNAP is not only below average generally but also below that of other low-income citizens.”
  • “AVR programs are well situated to improve monitoring by automatically collecting data on the registration process and various Medicaid transactions. If this data is used to ensure that Medicaid AVR is functioning properly, AVR would help protect citizens’ rights under the NVRA and reduce the exposure of states to NVRA-enforcement litigation.”

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The Institute for Responsive Government is a nonpartisan nonprofit dedicated to ensuring state and federal governments work effectively for the very people they serve. IRG provides data, research and expertise to elected officials in order to find practical policy solutions that make government systems more efficient, accessible, and responsive.