Healthcare Business News

Debate centers on whether exchanges should offer voter registration

By Jessica Zigmond
Posted: August 20, 2013 - 7:45 pm ET

Policy and election experts are debating whether the new public insurance exchanges should offer voter registration as well as enrollment in health insurance plans. Some say the exchanges are required by federal law to offer voter registration, while others say the law is unclear and that combining voter registration with insurance sign-ups would add major political difficulties to implementing the already-controversial healthcare reform law. The issue could wind up in court.

The 1993 National Voter Registration Act, known as the motor voter law, requires states to offer voter registration at government offices that offer public assistance. R. Doug Lewis, executive director of the National Association of Election Officials, said some groups argue that the exchanges should be considered registration sites under the 1993 law, while others say that's not the case, and that designating exchanges as such would serve as a distraction from their intended purpose. Opponents say that people might think they have to register to vote in order to qualify for insurance coverage and federal premium subsidies.

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California, New York and Vermont have indicated they will offer voter registration through their state-run exchanges, while other states such as Colorado are considering it. Millions of Americans are expected to sign up for insurance coverage through the exchanges across the country, so this could be a powerful means of signing up unregistered voters.

According to HHS, which is operating insurance exchanges in 25 states, Section 7 of the motor voter law requires states to offer voter registration to all offices that provide public assistance, which includes Medicaid applications. Consequently, the HHS position is that it is required to offer voter registration in cases where it's determined that individuals are eligible for Medicaid or exchange coverage.

The motor voter law requires that Department of Motor Vehicles offices, state welfare offices and armed forces recruitment centers be designated as voter registration agencies, said Hans von Spakovsky, a senior legal fellow at the conservative Heritage Foundation and former member of the Federal Election Commission. Any other agency that provides the service does so voluntarily, which means states can decide if they will choose to offer voter registration, he said. If the Obama administration decides to provide this service through the federally run exchanges, von Spakovsky said the administration will have to train the people running the exchanges to also provide assistance for voter registration.

“I think it's easy for applicants to get the impression that if they don't register to vote, they're not going to get the government benefit they applied for,” von Spakovsky said. “People in federal agencies have to be really well trained to make it very clear that whether or not you get the benefit doesn't depend on whether you register to vote.”

But many liberal observers say there's little doubt that the exchanges are government offices and are required by law to offer voter registration.

Lewis of the National Association of Election Officials said the issue is partisan, with Democrats favoring the voter registration at the exchanges and Republicans opposing it. A significant percentage of younger people signing up for coverage on the exchanges are likely to be lower-income, minority—and unregistered. And a high percentage of that demographic group voted for Barack Obama in 2008 and 2012.

Lewis and von Spakovsky say they are waiting to see if the Obama administration will offer more guidance on the matter. Some observers expect the issue to be litigated.

But some worry that this volatile political debate could get in the way of launching the exchanges and having them effectively enroll people in health plans.

“I think the process of getting these exchanges established and working is going to be a major effort,” said Marjorie Hershey, a political science professor at Indiana University in Bloomington. “It's going to take an awful lot of organization and time. To add voter registration to that is another layer of challenges.”

Follow Jessica Zigmond on Twitter: @MHjzigmond

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