Voting rights are health rights. That’s why California must reject the SAVE Act

As the U.S. Senate debates the SAVE America Act, the national conversation has focused on voting rights. But for California’s communities of color — and for those of us who study what makes people sick and what keeps them well — this legislation represents something more insidious: a direct assault on public health.

As public health researchers at San Francisco State University, we recently hosted focus groups of Asian American Californians in the Bay Area, and Fresno and Orange counties. We asked them about their neighborhoods, health and relationship to civic life. 

What they told us was sobering.

Again and again, participants described how being shut out of political life — through language barriers, mistrust of government and a lack of safe, centralized community spaces — translated directly into unmet health needs: Clinics that didn’t speak their language, mental health services that didn’t exist, health policies that ignored them entirely. 

One participant put it simply: when your community has no political voice, nobody fights for your health.

This goes beyond anecdotes; this is science. Political participation is an established social determinant of health and racial equity. Politically engaged individuals report better health and lower rates of physical disability. 

Studies of African American communities in racially segregated neighborhoods found that where voter participation was higher, birth outcomes were better. States with higher voter turnout invest more in health infrastructure and Medicaid. The ballot box, it turns out, is a public health intervention.

Now consider what the SAVE Act would do to California.

According to a recent University of Southern California report, nearly 21% of Asian Americans who voted in 2020 did not return to the polls in 2024, the second highest dropout rate of any racial group. 

And in the 2024 general election, just 54% of Asian American eligible voters in California cast a ballot — 8 percentage points below the statewide average. Latino eligible voter turnout was even lower, at just 46%. 

These communities are already politically marginalized. The SAVE Act would cement that marginalization into law.

Approximately 146 million Americans lack a valid passport. Only 21% of Americans earning under $50,000 possess one, compared to 64% of those earning over $100,000. 

Naturalized citizens — disproportionately immigrants of color who have gone through the very legal process supporters of the SAVE Act claim to protect — often lack easy access to birth certificates or naturalization papers. 

Kansas enacted a similar proof-of-citizenship requirement and blocked 31,000 eligible citizens from registering to vote, far more than any noncitizens ever identified. 

Meanwhile, noncitizen voting is already illegal and exceedingly rare:  Utah’s exhaustive review of over 2 million voter registrations found exactly one confirmed case.

Proponents of the SAVE Act argue this is election security, but this is history repeating itself.

Poll taxes, literacy tests, grandfather clauses — every generation of voter suppression has arrived dressed in the language of protection and common sense. The SAVE Act is no different. It narrows the electorate by making participation costly, complicated and frightening — particularly for immigrant communities already wary of federal anti-immigration enforcement.

When those communities are pushed further from the ballot box, the consequences reach into every clinic, every school health program, every community health center that depends on political champions to survive. 

Silencing votes doesn’t just change elections. It changes health outcomes.

California’s senators must vote no. And the rest of us — researchers, clinicians, community members — must say clearly that voting rights are health rights. Fighting the SAVE Act is not just about democracy. It’s about who gets to be healthy in America, and who does not.