Context: Voting is the central instrument of democracy, yet there are a number of impediments that affect citizens' ability to turn out to vote. Health is one such impediment.

Methods: This study draws on 2012 and 2016 election data from the Cooperative Congressional Election Study and the American National Election Studies and uses objective validated measures of voter turnout as well as postelection data on respondents' reasons for nonvoting to examine the relationship between self-reported health and voter turnout.

Findings: The results indicate poor health depresses turnout among low-income voters but not high-income voters. A low-income citizen in poor health is 7 points less likely to turn out to vote than a low-income citizen in excellent health is. In contrast, a high-income citizen in poor health is just as likely to vote as a high-income citizen in excellent health is. Moreover, low-income citizens in poor health are 10 points more likely to cite sickness as an impediment to voting than are otherwise similar high-income citizens who are also in poor health.

Conclusions: The findings have implications for health policy and unequal electoral engagement and suggest that health may narrow the scope of US democracy as poor health pushes low-income citizens out of the electoral sphere while high-income citizens continue to turn out to vote regardless of their underlying health conditions.

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Supplementary data