The last time you renewed your driver’s license, you likely had the opportunity to register to vote at the same time. As former administrators at the Centers for Medicare & Medicaid Services in the Department of Health & Human Services, we believe Americans should have a similarly frictionless opportunity for voter registration when they submit an application for health insurance on HealthCare.gov, the federal government’s online health insurance marketplace. While no legal change is needed to make this a reality, HHS would have to make technical upgrades to the HealthCare.gov platform and workflow. These changes would create a new opportunity for voter registration in the 33 states that rely on the federal marketplace for health insurance. The result: An estimated 1.2 million people each year would register to vote or update their registration information through HealthCare.gov, according to the think tank Demos.
HHS has already endorsed the goal of providing a seamless opportunity for people to register to vote at the same time they apply for health coverage, in line with President Biden’s March 2021 Executive Order calling on federal agencies to “expand citizens’ opportunities to register to vote.” While recognizing all that HHS has on its plate, we urge the department to implement this simplification in time for the next open enrollment period this fall. This makes sense for at least three reasons.
First, we believe that the government, if it is to serve the people well, has a duty to facilitate civic engagement. And yet, today, fewer than three out of four eligible adults are registered to vote, and fewer than half actually voted in the most recent federal election. Government should do whatever it can to make it possible for every American to make their voice heard and make their vote count.
Second, as former administrators of Medicare and Medicaid, we understand the relationship between accessibility and participation. One explicit goal of the Affordable Care Act is to make it as easy as possible to apply for health coverage, including on HealthCare.gov. We have seen with respect to health insurance that the more opportunities there are to apply, and the simpler and smoother the application process is, the more eligible people will actually end up enrolling. That same principle holds true for voter registration. Continued progress in both sectors is needed.
Third, civic engagement generally, and voting specifically, are important upstream influences on health and well-being. Study after study, including the Health and Democracy Index, demonstrate that expanded voting and political representation help people advocate for the policies that support their well-being. In fact, Healthy People 2030 — a 10-year roadmap from HHS for improving health in the United States — defines increasing voting rates among eligible voters as a key strategy for individuals to “help build healthier communities.”
Integrating voter registration into HealthCare.gov is a commonsense idea. HHS itself proposed this reform more than a year ago, as discussed in a new report titled “Strengthening Democracy: A Progress Report on Federal Agency Action to Promote Access to Voting,” written by a coalition of more than 50 civil rights, health, immigration, and other progressive organizations.
That progress report examines how 10 different agencies, including HHS, have implemented President Biden’s Executive Order. Although HHS made “a strong initial commitment to integrate voter registration into HealthCare.gov,” the report notes that the administration “has not yet followed through on that promise,” and recommends that HHS “immediately take steps to ensure” that voter registration on HealthCare.gov is “fully operational by the open enrollment period starting in the fall of 2023.”
Although we recognize that HHS faces multiple demands for the HealthCare.gov platform, we join the report’s authors in urging HHS to prioritize this work so that voter registration on HealthCare.gov is available when Americans begin applying for health insurance this fall, ahead of Election Day 2024.
This important reform would align HealthCare.gov with operations already in place in state Medicaid offices and state-based health insurance exchanges. With the National Voter Registration Act, passed 30 years ago, Congress directed all state agencies offering public benefits, including Medicaid, to offer assistance for registering to vote whenever someone applies for benefits, renews their benefits, or changes their address.
Voter registration is similarly integrated into the broader health insurance marketplace in the 18 states (including Washington, D.C.) that operate their own state-based health insurance exchanges. Because state exchanges accept applications for Medicaid and other benefits, they are required under the National Voter Registration Act to facilitate voter registration. In fact, many states have innovated and expanded online voter registration, including streamlined or automatic registration processes through their exchanges, DMVs, and other platforms, resulting in greatly increased registration rates.
This same opportunity, however, is not available in the 33 states that rely on the federal HealthCare.gov platform, even though HealthCare.gov is intended to fulfill the same functions as a state-based exchange. In other words, HealthCare.gov is not fully meeting its job description. This is a missed opportunity.
Through updates in HealthCare.gov, HHS can help powerfully to strengthen our democracy this year and beyond. HHS has already expressed support for incorporating voter registration into HealthCare.gov. To echo President Biden’s refrain from the State of the Union, now is the time to “finish the job.”
Andy Slavitt served as President Biden’s Senior Advisor for COVID-Response and, from 2015 to 2017, President Obama’s head of Medicare and Medicaid as administrator of the Centers for Medicare & Medicaid Services, including overseeing the turnaround, implementation and defense of the Affordable Care Act and HealthCare.gov. He is the host of the In the Bubble with Andy Slavitt podcast. Donald Berwick, M.D., MPP, FRCP, a pediatrician by training, is president emeritus and senior fellow at the Institute for Healthcare Improvement, a nonprofit that he co-founded and led for 19 years. From July 2010 to December 2011, he served as administrator of CMS. He is a lecturer in the Department of Health Care Policy at the Harvard Medical School. Cindy Mann, JD is a partner at Manatt, Phelps & Phillips who works with clients to develop and implement strategies around federal and state health reform, Medicaid, the Children’s Health Insurance Program, and delivery and payment system transformation. She served as deputy administrator of CMS and head of Medicaid and CHIP from 2009 to 2014.