In the 2018 U.S. midterm election, voters turned out at levels not seen in 100 years. Although this striking departure from the trend of falling turnout is something to celebrate, we as a country must make more progress in expanding the electorate: the voting populace in the U.S. remains older, whiter, richer, and more educated than the country as a whole. While traditionally underrepresented groups also saw participation gains in 2018, the gap remains: individuals in households making more than $50,000 a year (in 2017 median income was $61,372) turned out at rates 20 percentage points higher than households making less than $50,000.

Currently, the groups most likely to vote are made up largely of individuals benefiting from the status quo policies. A lack of representation means that policies will continue to cater disproportionately to these groups, rather than accounting for the needs of everybody.

Moving forward, to build a more just democracy, we must work not only to sustain this recent boost in turnout but also to focus explicitly on policies and interventions that enable underrepresented communities to participate.

There is now a thorough body of research documenting the strategies that move voters to the polls, from voting report cards that publicize individual voting behavior to plan-making prompts that help voters follow through on their intention. Campaigns, activists, and nonpartisan turnout organizations have taken up these behaviorally informed tactics to varying degrees and with varying success.

Currently, the groups most likely to vote are made up largely of individuals benefitting from the status quo policies.

This is a good start. However, without an eye toward who is most affected by these interventions, we risk widening the participation gap. Often, these interventions work best for individuals who already look like the “typical” voter, and can struggle to improve turnout among traditionally underrepresented groups.

So how can we close the participation gap?

Two recent working papers offer evidence that we might already know how close the gap. But it requires us to rethink what counts as a voter turnout intervention.

Political scientists have long known that voter turnout is highly correlated with income, and that inequality in voter participation distorts the representativeness of government. But the direct impact of wealth on low- and middle-income individuals’ likelihood to vote became more clear in a new paper that examines the effects of unconditional cash transfers on voter turnout in North Carolina. The researchers found that an average annual transfer of $4,700 increased voter turnout among the children of low-income families once they reached adulthood by eight to 20 percentage points. This is a massive effect, especially when compared to high-impact voting reforms and get-out-the-vote strategies: same day voter registration increases turnout by three to seven percentage points, and social-pressure mail leads to a 2.3 percentage point increase.

Similarly, there is new evidence for the effect of Medicaid on voter participation. Researchers found that being selected in the Oregon Medicaid lottery between March and September 2008 increased voter turnout in the November 2008 election by 2.5 percentage points overall, and by 5.4 percentage points for men (it’s unclear why it had a higher impact on men, though it could be because baseline turnout for women was higher to begin with).

Why do cash transfers and access to health care increase participation at the ballot box?

New evidence suggests that poverty alleviation and health care provision have the potential to improve the health of our democracy too.

Voting in the U.S. can be a time-consuming, hassle-filled experience, regardless of income and access to health care. For traditionally underrepresented groups, it’s also not always clear whether “people like us” are participating, especially in a climate of suppressive voter ID laws. Further, the process of casting a vote has multiple steps, and the benefits are ambiguous and potentially far in the future. For people in poverty, who live in a context of chronic scarcity—consistently lacking key resources like time, food, and money—the administrative barriers of civic engagement can be serious deterrents when it comes to making hard choices like prioritizing voting (including registering and waiting in line on election day) versus work responsibilities, child care, and looming bills.

The authors of the Medicaid study suggest that having health care can prompt more people to vote because of “interpretive” and “resource” effects. Access to government-provided health care can change individuals’ relationship with and perception of government (interpretive effects), which may make the consequences of elections and subsequent policy decisions feel more psychologically close and urgent. But the benefits transferred through Medicaid, such as better health and saving on out-of-pocket medical expenses (resource effects), could also help to create slack for those living in chronic scarcity, which can indirectly boost participation by reducing the tradeoffs of voting.

The authors of the North Carolina paper offer a human capital interpretation of their result: that cash transfers help children develop more robust social connections, and that those social connections reinforce the importance of voting. Similar studies have also highlighted the importance of deep social ties on civic behavior. One group of researchers noted the unintended negative consequences on civic participation for low-income families who relocated and lost social ties with their community. In the North Carolina cash transfer study, the effects were strongest among children from families below median income and did not leave the state, further supporting the human capital model.

This emerging evidence underscores the need to expand the traditional voter turnout toolkit beyond direct tactical interventions.

Efforts to alleviate poverty and give people health care are critical priorities—and perhaps it shouldn’t be surprising that improving access to basic needs increases the value people see in voting, or that it enables more people to cast a ballot. But this new evidence suggests that poverty alleviation and health care provision have the potential to improve the health of our democracy too.

If the U.S. is going to realize the goal of a healthy, fully representative democracy, we should employ every tool available to increase turnout. Raising incomes and providing better access to health care, while not voter turnout interventions in the traditional sense, are among the most effective solutions identified so far. This emerging evidence underscores the need to expand the traditional voter turnout toolkit beyond direct tactical interventions and integrate interventions that have the potential to improve the lives of citizens 365 days a year, not just in the lead up to election day.

Disclosure: The authors are employees of ideas42, a founding partner of the Behavioral Scientist.