Community Health Centers and Voting, 2006–2022

Context: Community Health Centers, a key part of the health safety net in the United States, have a long tradition of promoting political participation, but few studies have examined this influence. This paper fills the gap by examining how health centers influence election participation and outcomes. Methods: This paper develops an innovative county-level dataset on health center coverage from 2006 to 2022 using ZIP code-level patient data and examines how health center coverage is associated with voter registration, turnout, and the Democratic presidential candidate's vote share. It also examines whether these associations are stronger in high-poverty counties, where voting is more challenging. Findings: In most election years, health center coverage is positively associated with voter registration rates(except in 2018 and 2020) and turnout rates (after the ACA) in high-poverty counties, but not in other counties. There is no consistent evidence showing that higher health center coverage is associated with a higher Democratic vote share. Conclusions: Health centers appear to play a more consistent role in facilitating election participation than in shaping electoral outcomes, with stronger effects concentrated in high-poverty counties. Health centers' influence may vary with the broader political environment, such as the passage of the ACA.