Voting Rights in Jeopardy: Implications for Health Care Disparities

Health care is consistently ranked among the top concerns of the nation’s voters. A special issue for health care voters is electing candidates who are committed to making high-quality health care accessible and affordable to all. A 2025 article reported that restrictive state electoral environments resulting in barriers to voting were associated with lower self-reported health outcomes. The association was especially pronounced among Black Americans. Although this research cannot establish a causal relationship between voting restrictions and poorer health, the strong association suggests that causation is at least plausible. 

Recent political issues on which health care voters may be aligned include state Medicaid expansion, Medicaid spending reductions in the One Big Beautiful Bill Act, and the threat to the extension of the Affordable Care Act premium tax credits now in the hands of the Senate. Each of these important health care issues may especially affect minority populations.

The Voting Rights Act of 1965 (VRA) was enacted to prevent racial discrimination in the voting process. The VRA is now in the crosshairs of the U.S. Supreme Court in a case that may limit the VRA’s reach and have sweeping implications for voters who are concerned about health care accessibility and cost.

The legal case, Louisiana v. Callais, alleges racial gerrymandering — the practice of drawing district lines in state voting maps to dilute minority voting power. Racial gerrymandering is prohibited by Section 2 of the VRA. Section 2 effectuates the Fifteenth Amendment, which provides that the right of U.S. citizens to vote cannot be denied or limited based on race. Following the 2020 census, the Louisiana state legislature drew an electoral map consisting of six districts, only one of which was a majority Black district (referred to as a minority opportunity district). Black voters in this single district, but not in the other five white majority districts, had enough representation to elect a candidate of their choice, even though one-third of Louisiana’s citizens statewide are Black. 

A group of minority voters filed a lawsuit against Louisiana claiming that the state legislature engaged in racial discrimination in drawing a vote dilution electoral map, in violation of Section 2 of the VRA. Discriminatory practices causing vote dilution include “packing,” in which large numbers of Black voters are concentrated in a single district, reducing the total number of state districts in which they may have enough voters to elect candidates of their choice. Another practice is known as “cracking,” i.e., distributing Black voters among multiple voting districts so there are insufficient numbers in any one of them to elect a political candidate of their choice.

The lower court judge ruled that the minority challengers were likely to succeed in their claim of racial gerrymandering against Louisiana. The judge required the state legislature to draw an alternative electoral map that would include two majority-minority districts, approximating the proportion of Black voters in the state. Instead of drawing a “compact” map, as it could have done, the Louisiana legislature drew a sprawling salamander-shaped map, SB 8, that extended from Baton Rouge all the way to the northeast section of the state. The legislature claimed that the district was drawn to help several incumbent candidates (including House Majority Leader Mike Johnson) stay in office. Some partisan gerrymandering, in contrast to racial gerrymandering, is not illegal.

A new group of non-minority challengers then brought a separate lawsuit (Louisiana v. Callais) against Louisiana for discriminating against them in drawing the second majority-minority map. The challengers claimed that Section 2 of the VRA, in allowing a race-based map, is unconstitutional because it violates the Equal Protection Clause of the Fourteenth Amendment. This clause requires that all persons receive equal protection of the laws. The Supreme Court agreed to review the case but, on its own accord, re-cast the legal questions to be addressed by the parties: First, whether Louisiana’s intentional creation of a second majority-minority congressional district violates the Fourteenth or Fifteenth Amendments to the U.S. Constitution; and second, whether Section 2, which protects the minority vote, itself violates the Constitution. 

A ruling that eliminates or curtails the protections of Section 2 could jeopardize minority voting districts across the country and result in Black voters in many parts of the country being unable to elect candidates of their choice. Given the well-documented racial disparities in health care access and quality, Black voters aim to elect candidates who will support their need for quality health care — but would no longer be able to do so. Voting is a tool that minoritized populations use to help mitigate health care disparities. If their votes can be legally diluted by “packing” or “cracking” voting districts in electoral map drawing, this valuable tool could be rendered useless.  

Voters concerned about quality health care arguably comprise a political community of interest, and traditionally, communities of interest may be considered in drawing voting district maps. Voters comprising a health care community of interest are joined by the aggregation of their like-minded votes on health care issues. They need not be associated in other ways, and they are joined solely by the aggregation of their votes on matters of health care. The non-minority challengers argue that the presumption that racial groups will consistently vote as a bloc (i.e., racially polarized voting) is a form of stereotyping, in violation of the Constitution. The counterargument is that this is not stereotyping at all — but simply a political preference about access to quality health care that correlates with race. Voters participate as individuals, but their votes matter only when aggregated with the votes of other like-minded voters. Vote aggregation is not a form of stereotyping. It is the way in which vote counting functions to influence policy, in this case health policy to mitigate health care and health disparities.

The non-minority challengers in Louisiana v. Callais argue that the application of Section 2 as a remedy for racial gerrymandering, if it ever was constitutional, is now obsolete given that there is less segregation than in the past and less racially polarized voting. A similar argument was made in Students for Fair Admissions v. Harvard — that affirmative action in university admissions had reached an endpoint and was no longer necessary. The Callais plaintiffs now argue that race-based districting, as allowed by Section 2 of the VRA, exceeds the reach of the Fifteenth Amendment and is no longer congruent or proportional to the objective of preventing racial discrimination in voting. The Callais plaintiffs contend that times have changed. 

Regarding the issue of health care, however, the idea that minority groups no longer need Section 2 protection is not tenable. Disparities in health care may have lessened somewhat, but they are still much in evidence, and the health care community of interest must have the right to express that concern in the voting booth. Health and health care are still adversely affected by racial disparities, which may be mitigated by voters electing candidates who will work on their behalf to address those disparities.

The Callais plaintiffs also contend that for a Section 2 claim to be successful, it must be shown that there was intentional racial discrimination in drawing the voting district map. Yet, in 1982, Congress amended the VRA to assert that Section 2 applies if the effect is discriminatory, regardless of intent. The inability of Black voters to elect a candidate of their choice, irrespective of whether this outcome was caused intentionally or was simply the result of race-neutral map drawing, may still be a Section 2 violation. Regarding the issue of health care, an effects test is fitting — even if intentional discrimination cannot be proved, the result of health care disparities leading to poorer health for minority populations calls for a Section 2 remedy.

A ruling by the Supreme Court to weaken or even eliminate Section 2 may have broad and severe consequences for voting rights throughout the nation and will adversely affect health and health care disparities for minority populations. Racial disparities in health and health care stand as a preeminent example of why the country still needs Section 2 to protect citizens against racial discrimination in creating voting districts.