When Daniel Francis enters a voting booth, ballot measures can be very anxiety-inducing: many are above his reading level.

“If it’s using words that I don’t understand, I just kind of rush on to answer, whether I know what it means or not,” says Francis, who lives with mental disabilities including autism and ADHD. Francis likes voting at the polls without assistance, as it’s a way for him to feel independent.

A Ballotpedia analysis of ballot measures voted on in 2023 found that, on average, they required a graduate-school reading level to understand. That can be a challenge for most people who haven’t pursued higher education, let alone people with intellectual disabilities or symptoms that affect their cognition, like those experiencing brain fog from the chronic illness fibromyalgia.

Having accessible ballots “would empower more people to be able to vote without assistance,” says Alexia Kemerling, who helps coordinate efforts to make voting more accessible at the American Association of People with Disabilities. 

This past April, Francis was part of a group of disability self-advocates who met with Maine Secretary of State Shenna Bellows to discuss the possibility of making ballot measures more accessible to disabled voters—which can also be helpful to other groups, such as English language learners.

In 2023, lawmakers in both North Dakota and New York passed legislation to put ballot measures in plain language, which is designed to be easier to understand on a first reading, and often includes active voice, shorter sentences and paragraphs, and the use of common words. In New York, ballot measures now can’t exceed an eighth-grade reading level. 

“I think having that reading level stipulation, and actually having something to measure it against, is going to be really impactful in New York,” Kemerling said. 

The impassioned push for more accessible ballots in Maine started last November, after the failure of a measure to remove language from its constitution barring people with mental disabilities under guardianship from voting. (People in Maine under guardianship for mental disabilities nevertheless have the right to vote due to a 2001 federal court ruling—the measure would have removed the defunct language.)

In discussions with other disabled people after that 2023 election, Francis found that several hadn’t understood exactly what the Maine measure was asking:

Do you favor amending the Constitution of Maine to remove a provision prohibiting a person under guardianship for reasons of mental illness from voting for Governor, Senators and Representatives, which the United States District Court for the District of Maine found violates the United States Constitution and federal law?

“For the vast majority of voters,” said Molly Thompson, a voting access advocate with Disability Rights Maine, “that’s really confusing to understand—if something was deemed unconstitutional, why was it not immediately removed from Maine’s constitution?”

Writing in plain language doesn’t necessarily mean being concise, which Maine’s constitution requires for ballot measures written by the secretary of state (measures written by the legislature do not have this requirement). In fact, when ballot measures are written in plain language, they tend to run longer, Kemerling says, which is a challenge to getting some election officials on board. “It’s important that election officials are willing to ask for and allocate [the] costs to having more accessible elections,” she said, suggesting the compromise of a separate, plain-language sheet explaining ballot measures on request.

Some other states also have plain language requirements, though they’re not as far-reaching as New York and North Dakota’s. Alabama requires a plain language summary of state ballot initiatives to be available online, and in Texas, ballot initiatives that specifically touch on debt are supposed to be written in plain language.

Francis hopes that politicians in Maine will also get on board with more understandable ballots, so more disabled people feel confident voting. The way ballot measures are written now, Francis said, can lead to disabled people like him feeling “like they’re being discouraged to vote.”

On June 3, jury selection for the federal trial of President Joe Biden’s son Hunter on gun charges is expected to begin. Hunter Biden allegedly lied about past drug use when purchasing a gun in 2018, during a period in which he has since shared that he was struggling with crack cocaine addiction. He has pleaded not guilty.

The debate around gun control and mental health is very heated in the US, especially in conversations about mass shootings. Research does show that there is no link between mental illness and mass shootings, but gun-related suicides are on the rise, especially among men.

Biden’s case opens the question of whether and when someone with a history of mental illness, including addiction, should have their Second Amendment rights taken away. A fairly recent federal court ruling, Tyler v. Hillsdale County Sheriff’s Department, could offer some insight.

In 2016, the Sixth Circuit Court of Appeals, which generally covers the Midwest, ruled that someone who has been “adjudicated intellectually disabled” or “committed to a mental institution” couldn’t be barred outright from owning guns on those grounds alone. The case surrounded a Michigan man, Clifford Tyler, who was permanently barred from owning a gun because he had been institutionalized once, 25 years prior, due to a risk of suicide

I spoke with Dr. Paul Appelbaum, Columbia University’s Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law, and former president of the American Psychiatric Association, about the Tyler decision, Biden’s case, and psychiatric ethical dilemmas at the intersection of gun ownership and mental illness.

What did the Tyler case establish when it comes to gun ownership and having a history of mental illness?

There’s a list of conditions that result in exclusion from being able to legally possess a firearm, and one of those exclusions is involuntary admission to a psychiatric facility. But Tyler was, by virtue of that exclusion, entered into the national database, and unable to purchase a firearm based on a hospitalization that had occurred 25 years before.

The act that created the NICS [National Instant Criminal Background Check System] created a requirement for centralized record-keeping with regard to who was excluded, and a provision that allows the restoration of firearms rights at the federal level. But in the early 1990s, Congress barred the expenditure of any appropriated funds to implement that process.

So there’s essentially no mechanism to go to the federal government and say, I want my firearm rights back. States not only can set up a process for restoration of firearm rights, but under what’s called the NICS Improvement Act, they were actually incentivized to do that. Michigan, where the Tyler case came from, was one of those states that had no mechanism for restoration of firearms rights.

In his 70s by now, and according to any conceivable measure, at very low risk of committing violence with firearms, nonetheless, Tyler couldn’t purchase [one]. The federal district court disagreed with that argument, saying, No, the state has a sufficient interest in keeping people who have ever been involuntarily hospitalized from ever obtaining a gun.

The Sixth Circuit disagreed. [It] said, No, there’s got to be some mechanism in place to allow people to at least make an argument that they are no longer so situated as to present a risk, and therefore they should be allowed to purchase a firearm.

What ethical dilemmas are involved in deciding that someone shouldn’t have a gun due to a history of mental illness, including potential substance abuse?

Beginning in 1968, federal law established these exclusionary criteria, but there was no centralized mechanism for knowing who met any of [them]. Federally licensed gun dealers were left taking the person’s word for it. In the ’90s, when gun violence was heightened, Congress authorized the establishment of a centralized registry, and that’s the NICS.

There haven’t been data breaches to my knowledge, and moreover, if you go to a gun dealer and try to buy a firearm, the gun dealer has to query the NICS. In some cases, they query a state-level database. When an answer comes back, that this person is disqualified, because they’re in the NICS, it doesn’t reveal to the gun dealer, for example, [that] you use controlled substances, or you were involuntarily hospitalized. Now, that’s not to say—you know, we all know that there’s no database that’s 100 percent secure, but so far that has gone well.

When you’ve got a process for restoring gun rights, at some point down the road, these will frequently involve evaluation by a psychiatrist or another mental health professional to assess the extent to which an individual remains sufficiently dangerous to themselves, or to other people, that it would be unwise to restore their gun rights.

There are no good assessments of approaches that provide certainty with regard to a person’s likelihood of using a gun in an inappropriate way in the future, so mental health professionals are often in a difficult situation.

Could someone’s recent misuse of drugs, as with Hunter Biden, be a reason to take away gun rights—given that the court seemed to suggest a ban based on past mental health issues would be unconstitutional?

Another one of the federal exclusion criteria is the following, in addition to involuntary hospitalization: any person who is an unlawful user of or addicted to any controlled substance.

So as I understand the charges in the Hunter Biden case, the government is alleging that he was, at the time that he purchased a firearm, an unlawful user of a controlled substance, and therefore was not legally entitled to purchase that firearm, even if he was not listed in the NICS as being ineligible. If he actually lied, that suggests arguably a greater level of culpability than if he was disqualified but never was asked about it.

Both Clifford Tyler and Hunter Biden had a documented mental health history. Could someone’s fear of losing their gun rights deter them from seeking mental health treatment?

I think that’s a real concern. In most states, the only people who are reported to the NICS are people who have been involuntarily hospitalized, and in most states that doesn’t include short-term emergency detentions.

Nonetheless, we have heard concerns within psychiatry, particularly in parts of the country where gun ownership appears to be an essential part of a person’s identity—particularly a man’s identity—that people at least say that they would not seek mental health treatment because of this concern. When push comes to shove, how much of a role that actually plays in keeping people from treatment is not at all clear.

This interview has been lightly edited for length and clarity.

Covid-19 continues to kill people in the United States, with at least 20,000 confirmed deaths linked to Covid infections since the start of 2024. Millions more are developing Long Covid, the risk of which increases with every subsequent infection. Immunocompromised patients are at particular risk of death: besides their underlying conditions, immunocompromising medications can reduce the efficiency of Covid vaccines and boosters. Masks, specifically N95 and KN95s, are very effective in stopping its spread, and wearing one in a crowd can allow immunocompromised people like recent transplant recipients to participate in civic life and political action. Mask-wearing is more effective in stopping transmission in crowds when more people do it. 

“These patients have active reasons to want extra layers of protection,” Dr. Cameron R. Wolfe, an infectious disease specialist with Duke University Health System in North Carolina, told Mother Jones. “If my lung transplant recipient wants to be able to keep him or herself protected in the act of a protest, they must be allowed the freedom to do that.”

Lucky Tran, a science communicator with Columbia University and health equity organizer, said that folks encouraging others to wear masks that protect against the spread of Covid-19 is good community care.

“By providing and encouraging people to wear masks at protests, activists are demonstrating community care and public health leadership, which by contrast, most governments and institutions are failing to do,” Tran said.

Most transplant recipients are advised to wear masks, guidance that predates the Covid pandemic. Research has shown that even the common cold can be dangerous or deadly for transplant recipients. Not being able to wear a mask in public could limit their participation in society—from participating in protest to going to the grocery store. The CDC also reports that getting an infection during chemotherapy for cancer can also lead to hospitalization.

At a hearing on the legislation, Democratic State Sen. Sydney Batch, a cancer survivor, said the bill goes too far: “There are people that are walking around every single day that are immunocompromised…It is meaningful to them. They could die.” 

Dr. Diana Cejas, a University of North Carolina pediatric neurologist who survived cancer and a stroke, told Mother Jones that “it has been an incredibly difficult time to be a North Carolinian who actually cares about public health and safety.” Cejas asserts that it is her “right to protect myself” against Covid by wearing a mask—and her duty to protect the medically complex, vulnerable children she works with every day. 

Cejas is also doubtful of claims from some North Carolina Republican officials that people won’t be arrested for wearing a mask in their daily lives for health concerns. 

“Some of our legislators have made the argument that this ban won’t apply to those of us who mask for medical reasons, but I think that we all know that won’t be true,” Cejas said. “We already face scrutiny and outright harassment at times for the ‘crime’ of trying to protect ourselves from illness, particularly us disabled and chronically ill people of color and those with other marginalized identities.”

North Carolina is not the only state to move to crack down on protestors wearing masks. Earlier this month, Republican Ohio Attorney General Dave Yost said that pro-Palestinian student protestors wearing masks could face felony charges under a law that was originally created to go after the Ku Klux Klan. 

Though villainized and potentially criminalized, masks continue to be an effective way to limit the spread of infections. “We would see a lot less disease if masks were accepted as a socially reasonable thing to wear in public for at-risk individuals,” Wolfe said, “or anyone worried about illness.”

Between 2016 and 2020, only 12 percent of United States–based GoFundMe medical fundraising campaigns met their goals, according to a 2022 study. More than that, 16 percent of campaigns received no donations at all. One of the study’s authors, University of Washington professor Nora Kenworthy, has taken a dive into the landscape of US medical fundraising in a new book, Crowded Out: The True Costs of Crowdfunding Healthcare. 

Kenworthy talked to Mother Jones about how the US private health insurance model fuels medical debt, biases that shape who people consider worthy of donations, and what medical fundraising could look like in the future—even if Congress did listen to its constituents and pass legislation enacting a more socialized healthcare system.

How has the American private insurance model contributed to the rise of medical fundraising sites like GoFundMe? 

Crowdfunding for healthcare expenses exists in lots of parts of the world—there are places like the UK and Canada, that have better health systems than we do, where people still rely on crowdfunding for a lot of uncovered healthcare and expenses associated with [it], like child care, that are still hard to pay for. But in the United States, we have a tremendous amount of crowdfunding. That seems to really arise from either things that are not covered by insurance, are covered inadequately, out-of-pocket costs that are incredibly high, or from people who are not insured, or underinsured, when they experience illness or accidents.

We live in a very capitalistic country. How does that shape people’s feelings about their own medical debt, asking for help with it, and contributing to other people’s medical expenses? Is it a source of shame, or has it been normalized?

Some of the kinds of social norms that really are deeply rooted in the United States both push people towards crowdfunding and also make it a really difficult thing for people who most need it to use successfully. We have a very extreme idea of individualism, like, “If you can’t fix it, you’re kind of on your own.” Or that the person with the most merit should win out, even when a lot of the ways that we measure merit are very much linked to privilege and racial identity and class identity and things like that. I write about the way that all these play out in the marketplace of crowdfunding, and get projected onto people’s crowdfunding campaigns.

Feelings of shame, particularly about having to start a campaign for yourself,  are exceedingly common. In interviews, I’ve also talked with people about the very acute shame that they felt in terms of having to ask for help. On the other hand, starting campaigns for other people is seen as less shameful. If someone starts a campaign for you, then that taps more into this idea of wanting to help each other, and we are also a very charitable society. That is also a result of our very capitalist and neoliberal systems: we rely a lot on each other in order to meet basic needs because so many of us are made vulnerable by these economic systems.

As you note in your book, white people’s medical campaigns tend to go viral more often than people of color’s. Can you speak to that? 

It’s important to say that the top level of racism that’s operating here is really structural racism, and the racial wealth gap, which is enormous in the United States. The way that that comes into play is that campaigns started by or on behalf of people of color, but particularly Black people, tend to do less well than campaigns for other people. There’s also an interpersonal racism and racial bias element that is playing out here, particularly with campaigns that go viral or get lots of exposure. That’s the kind of internalized biases and overt racism that we might bring to the way that we regard and read and look at campaigns that can translate as people viewing campaigns with more suspicion, more tendency to think about them as fraudulent, or more likely to blame the person who’s in need.

We see that especially with viral campaigns. I did a research project with some amazing researchers, Aaron Davis and Shauna Elbers Carlisle. What we looked at the top most viral medical campaigns in GoFundMe’s history, and so that was about 900 campaigns that had raised over $100,000. In that group of 900, we found only five were on behalf of Black women, and of those five, two had been started by white people. That, to us, speaks to these incredibly huge disparities that are happening at that more viral level of campaigns, and how people’s campaigns are being treated very differently by the crowd.

Genetics, environmental exposure, and poverty can all contribute to the development of chronic health conditions. Yet, it can be harder to fundraise for conditions where some people blame the patient, like those who have Type II Diabetes. How does that shape crowdfunding efforts?

The really large structural factors—the neighborhood you live in, or how much money you have, or the air around you—shape the the likelihood of your becoming ill over your lifetime. Particularly when it comes to chronic health conditions, whether that’s diabetes, or congestive heart disease, or cancer; these chronic conditions are very much shaped by big factors that are out of our control. When we’re crowdfunding, we’re often looking for the solvable problem, right? For an individual, [that means] “If I can just give you this one thing, then you’ll be okay.” That’s really hard to deal with in chronic conditions.

I talked to a lot of people with diabetes, both Type I and Type II, who are reliant on insulin to survive. It’s really hard to crowdfund for insulin every month. Even when we know that the cost of insulin is absurdly high, and we understand that people need it, and if they don’t get it, they’re truly not going to survive. It’s really hard for people to find ways to use crowdfunding to solve those kinds of ongoing chronic issues. People talk to me about exactly what you’re describing: feeling blamed for their conditions, and feeling like they’re being judged by the crowd for what has happened to them. We see crowdfunding reinforcing and amplifying, and almost kind of fueling, these individual-level judgments of who’s deserving and who’s not. 

Legislation like Medicare for All could reduce further medical debt—but would it get rid of the need for medical fundraising? Where could we still see it?

What we think of as a universal health coverage system not only reduces future medical debt, but could also reduce the amount that people have to pay for certain things like insulin. A more universal system can protect people better in those periods of vulnerability. But we know that illness, particularly acute or severe illness episodes, requires lots of different kinds of social support. There are things that even very well-funded universal health systems do not cover, whether that’s experimental treatments, childcare, or perhaps specialized foods that you might be forced to take. I don’t think we should think of all crowdfunding as bad. It has the potential to meet some important needs that fall outside of formal systems.

At the same time, I think we need to remain aware of the ways that crowdfunding in its current form in the US is actually undermining the efforts that are being made to move towards more universal healthcare systems, because it’s reinforcing these ideas that not everyone deserves the same thing. That we’re all individuals, and we’re on our own when we get sick, or the idea that a marketplace mentality can be the best option for fixing these kinds of societal challenges.

All of those ideas really run completely counter to the moral ideas that undergird a more universal medical coverage system. Medicare for All is based on the idea that when people are sick, they deserve help, regardless of how good a person they are, what the color of their skin is, or how much they make. It’s the idea that we have a safety net that actually catches everyone. And that idea is just not there in crowdfunding. Crowdfunding is really kind of undermining our commitment to some of these more universal ways of supporting each other.

This interview has been lightly edited for length and clarity.

That includes many people living under guardianships or conservatorships, in which a person’s civil rights are placed under the control of a guardian, often a family member. There are more than a million people living under guardianship in the United States, which can extend to people living with intellectual disabilities as well as those with mental health disabilities. 

States have different rules on whether people under guardianship can vote, but most fall into the following categories: No restrictions, as in states like Illinois; the power for judges to suspend voting rights, as in California and Florida; no voting rights by default (people under guardianship need a judge’s approval to vote), as in Arizona and Delaware; and, in seven states—Louisiana, Missouri, South Carolina, Tennessee, Utah, Virginia, and West Virginia—no voting rights at all.

The new DOJ guidance, however, gives disabled people under guardianships some recourse to try and get their voting rights back—through ADA lawsuits. "There needs to be litigation now where the government, or other organizations, take the states to court and say that the [guardianship] laws violate the ADA," Zoe Gross, advocacy director of the Autistic Self-Advocacy Network, told Mother Jones. She also says it's important that disabled people don't assume their right to vote has been taken away; the network has a plain-language guide that explains each state's policies. 

A lack of transparency in guardianship and conservatorship—which Sens. Elizabeth Warren and Bob Casey asked DOJ and Department of Health and Human Services for data on in 2021, in part due to attention around Britney Spears' conservatorship battle with her father—means it's hard to tell just how many people nationwide have had their voting rights taken away on those grounds, or even how many people are currently under guardianship in each state. Gross believes that disenfranchising disabled people in guardianship "is one of many ways that our legal system discriminates against people with disabilities."

Disenfranchising people with disabilities also impacts their right to support politicians and policies that could improve their quality of life, at all levels of government. "We should be able to vote for the people who make the policies that affect our lives," Gross said. "It can mean the difference between a state expanding Medicaid or rejecting Medicaid expansion, which is something that has huge implications for people with disabilities."

On April 1, it was confirmed that H5N1 had spread to at least one person who worked with cattle—as of April 30, 36 dairy herds have been confirmed to have had cases of bird flu, although that’s a likely undercount based on limited testing. On April 25, the FDA announced its finding that one in five milk samples from grocery stores had trace amounts of H5N1. Colombia has restricted the import of beef from US states where the virus has been detected in cows, and the USDA is now testing ground beef for H5N1. The World Health Organization reported that between January 2003 and March 2024, 56 percent of bird flu cases detected in humans were fatal. Half the domestic cats on a Texas farm also recently died after drinking raw milk from cows infected with H5N1.

Pasteurization eliminates this risk. “Raw milk does not go through this process, so consuming [it] could unknowingly place you at risk of infection with H5N1,” said Brian Labus, a University of Nevada, Las Vegas public health professor and epidemiologist. There are still other ways that H5N1 can spread besides drinking raw milk, such as to dairy workers (human-to-human transmission hasn’t been detected in the US yet). But according to the Conversation, that’s not a common vector. And if other animals drink unpasteurized cow’s milk, they also risk contracting H5N1, just like any human would. 

Raw milk influencers have a sizable following, including some whose content doesn’t center solely on diet. Take model Liz Siebert, who has over a million followers on TikTok, and who made videos last year on how she gets her raw milk from a nearby Amish farm, claiming raw milk was helping get her health back on track and reduced her allergy symptoms (most of these clips have now been deleted, but the reaction videos debunking her claims have not). Raw milk is also a big hit among fitness influencers and “crunchy” moms—parents who want food that’s “natural,” like in the good old days, when viruses killed a lot more people.

“People are seeing more influencers talk about raw milk over the last year or more,”  said Jessica Gall Myrick, a Pennsylvania State University health communications professor. Myrick says that trend “follows the changes in state laws allowing more retail and on-farm sales.” As a result, more and more people are buying raw milk: Ambrook Research reports that sales “jumped 27 percent, from $12 million in 2021 to $19.4 million” in 2023. 

Dubious claims about raw milk predate social media (as does research debunking the supposed benefits), but it’s given those claims a new life. A 2022 research paper estimates that around four and a half percent of Americans are consuming raw milk at least once annually. In videos on TikTok, some influencers do acknowledge that there are people who think their raw milk obsession is bizarre—but they still claim that they’re drinking it because it improves their health. Which is ironic: besides bird flu, raw milk consumption has been linked to cases of the diseases salmonella and listeriosis. But you’re not going to hear about that in a podcast clip on TikTok of Gwyneth Paltrow talking about unpasteurized milk. 

“Seeing an attractive influencer claim to be healthier and happier thanks to drinking raw milk can inspire people and give them hope for a similar outcome,” Gall Myrick said. “We remember anecdotes better than statistics about risk, too.” But Gall Myrick does think that people with significant online platforms can also be helpful in dispelling health misinformation about raw milk in a clear and engaging way, pointing to a video of author John Green talking about its dangers as an example.

 

 

 

 

 

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A post shared by John Green (@johngreenwritesbooks)

It also doesn’t help that social media feeds quickly become echo chambers by design. “The more people see of this type of pro-raw-milk content in their social media feeds, algorithms will keep giving them more of it, and then they are less likely to see stories about people harmed by raw milk,” Gall Myrick said. 

Many states still do not allow raw milk to be sold in stores, with some exceptions for farms, meaning that people inspired by raw milk influencers may have to go through more hurdles to buy it. “You can’t find raw milk in most grocery stores, and social media likes and shares are not going to change that,” Labus said. For now, that is.

Schedule I drugs, according to the DEA’s website, have “no currently accepted medical use and a high potential for abuse”; other Schedule I drugs include heroin and ecstasy. If the proposal moves along, its public comment period would need to be followed with approval by an administrative judge, and marijuana could then be reclassified alongside ketamine and testosterone on Schedule III. Just three states—Idaho, Kansas and Nebraska—currently do not have any laws that let residents use cannabis or cannabidiol for medical purposes.

The move follows a letter from FDA researchers submitted to the DEA in August, which argued that there’s enough scientific research to support the established medical uses of cannabis. On the potential for abuse, they wrote that “evidence exists showing that the vast majority of individuals who use marijuana are doing so in a manner that does not lead to dangerous outcomes to themselves or others.” Marijuana has been found to be helpful in easing pain, controlling nausea, and helping people regain their appetite after treatments like chemotherapy. 

People still need prescriptions for Schedule III drugs, meaning that people in states where marijuana is illegal or only allowed for medicinal use could still get in trouble for recreational use. Some have raised objections to keeping the drug scheduled at all: “Rescheduling would allow for the criminal penalties for recreational and medical marijuana use to continue—disproportionately impacting Black and Brown communities,” House Rep. Barbara Lee (D-Calif.) said in a press release that followed the announcement.

President Biden has repeatedly said he’d take steps to decriminalize marijuana—at a speech in Wisconsin, when asked what he would do to stop people from being imprisoned for possessing pot, he said, “I’m taking care of that.”

“It caused me great physical pain and anxiety, which made me angry and sad,” Underwood said. “It communicated to me that my vote doesn’t matter and I shouldn’t bother.” Extreme fatigue, pain, nausea, and headaches followed. 

Polling locations are supposed to be accessible to all voters, including disabled and aging ones. But nearly one in five polling locations in the United States is a church, and religious entities are exempt from the Americans with Disabilities Act, key civil rights legislation that helped establish that protection. A 2022 survey by Detroit Disability Power and the Carter Center found that only around 10 percent of church polling places in Detroit, where Underwood voted, and its suburbs, were considered fully accessible. The prevalence of inaccessible polling places is particularly alarming for disabled and aging people in states that have moved to quash mail-in voting—including Oklahoma and Arkansas, where churches make up over 50 percent of voting locations.

“A lot of times, a bill trying to prevent [alleged] vote fraud will have a disproportionate impact on people with disabilities by saying ‘You can’t actually submit an absentee ballot,'” said University of Pennsylvania disability law scholar Jasmine Harris.

When a church becomes a polling place, it's acting on the government's behalf, Harris said. In those situations, according to Harris, religious buildings need to follow the ADA, and the district's election officer has a responsibility "to make sure preemptively that it has general accessibility."

Election officials "should be striving for locations that are already completely ADA compliant," Michelle Bishop, the National Disability Rights Network's voter access and engagement manager, told Mother Jones, but it also the case that "a lot of the places that are willing to serve are churches." 

Accessibility isn't just helpful for the roughly 60 million American adults who have a permanent disability; though permanent disabilities are also increasing in part due to Long Covid. "You can become injured and not be able to go up steps," said Mia Ives-Rublee, who directs the Center for American Progress' disability justice initiative. "Making polling locations accessible isn't just going to affect the people who have permanent disabilities." 

Counties are responsible for choosing the locations where their residents vote. The right response to inaccessible voting locations is not to have fewer of them—polling place closures disproportionately impact voters of color—but to find more locations that are accessible. The Department of Justice also provides guidance on temporary solutions to make sure disabled people can vote, such as installing a ramp and keeping doors propped open. 

The ADA is not the only federal legislation that protects disabled people’s right to vote—there's also the Voting Rights Act, the Voting Accessibility for the Elderly and Handicapped Act, and the national Help America Vote Act, which all should support disabled people's right to vote. Bishop said that disabled voters can submit complaints under the Help America Vote Act, which requires state officials to respond by a deadline, although exact procedures can vary by state. 

But not all disabled voters want or have the energy to file complaints about access issues. For Underwood, it didn't seem worth it: they felt that "nobody listens or cares."

As of now, no state mandates that poll workers be trained in accommodating disabled voters. That kind of training could help some disabled people vote more easily, Bishop said, regardless of their polling place.

Those resources do exist: the US Election Assistance Commission,  established by the Help America Vote Act, offers a series of short videos on accessible voting, covering accommodations as straightforward as offering a chair to voters who have trouble standing for long periods of time—whether or not they disclose a disability. 

Even with trained poll workers at an ADA-compliant polling place, disabled people can still face issues with in-person voting, Ives-Rublee said, since the ADA's voting accessibility guidelines "doesn't include things like accessible transportation." Counties should involve people with lived experience with disability, and those knowledgeable about the ADA, when taking steps to improve accessibility, Ives-Rublee said. Accounting for accessibility from the start could help poll workers keep voting locations like churches accessible without altering the building drastically, Bishop, of the National Disability Rights Network, said. Poll workers new to a building might not know about options as easy as "an accessible entrance around the corner," Bishop said, "so they never set it up, and they never put up signage, so the voters don't know."

What may be accessible to some disabled people may not be for others. That's why it's crucial to move towards more accessible options both in-person and by mail—mail-in voting with paper ballots isn't accessible, for example, to people who are Blind and have low vision, the subject of a lawsuit filed in Wisconsin this month arguing that disabled voters should be able to vote electronically. 

Whatever they do, counties should involve people with lived experience of disability as well as ADA experts when taking steps to improve voting accessibility in-person or by mail. Whether that's one person, separate people, or a group, Ives-Rublee said, "it's important to have both factors when addressing accessibility." 

Not all solutions on offer are favored by disabled voters. One contentious issue is proxy voting, where a poll worker votes on a person's behalf—a concern for voters who can't verify that the poll worker didn't alter their voting decisions. That's what Jermaine Greaves had to do. Greaves, who uses an electric wheelchair and lives with cerebral palsy, went to a Manhattan church to vote for Barack Obama in 2012. He ended up not even being able to enter the building. "Somebody had to end up voting for me," Greaves said. "I filled out the [paperwork that] they had to submit." That took away Greaves' ability to vote confidentially, a fundamental right for American voters.

"That just is the least private, least independently secure way to get the job done," Bishop said. "There should be good options in place that voters are comfortable with." 

Currently, Republicans control New Hampshire’s state House, Senate and governor’s office—but that isn’t a guarantee that the bill will be signed into law, with GOP Gov. Chris Sununu seemingly flip-flopping when it comes to disease control. Sununu did sign a bill in 2021 allowing people to use public places and services even if they did not receive the Covid-19 vaccine. But the next year, the governor vetoed a bill that would bar schools from implementing mask mandates. 

The polio vaccine, first offered in 1955, and the MMR shot, which treats the highly infectious measles, mumps, and rubella viruses, are two very crucial vaccines both in the US and internationally. Since the year 2000 alone, vaccines against measles are estimated to have saved over 55 million lives around the world. 

The CDC recommends that kids get their first dose of MMR vaccine between 12 and 15 months of age, and a first dose of the polio vaccine at around two months old. All states currently require children to have at least started vaccination against measles and polio in order to enroll in child care, according to the nonprofit Immunize.org. A CDC report found that for the 2021-2022 school year, around 93 percent of children had received the MMR and polio vaccines by the time they entered kindergarten. That figure drops to less than 80 percent for both vaccines—the lowest rate in the country—in Alaska, where a measles outbreak could be devastating. 

Rises in anti-vaccine sentiments have largely been linked to concerns that vaccines cause health issues, like the debunked claim that the MMR vaccine leads to kids being autistic. What parents may want to keep in mind is that polio and measles themselves are disabling conditions: according to the World Health Organization, 1 in 200 polio infections leads to irreversible paralysis. Children who get measles can experience symptoms including swelling of the brain. Death is always a possibility, too. 

“Childhood vaccines have helped protect generations of Americans from potentially devastating vaccine-preventable diseases,” S. Wesley Long, a professor of pathology and genomic medicine at the Houston Methodist medical center, told Mother Jones. “Many of these diseases still exist around the world, and we rely on our collective immunity, often from childhood vaccines, to prevent these diseases from circulating in our population.”

The bill would strike language requiring that immunization records be submitted to child care agencies, but would keep those requirements for students enrolling in kindergarten through 12th grade. As of 2022, according to the nonprofit ChildCare Aware of America, there are some 700 licensed child care centers and homes in New Hampshire (which doesn’t require the Covid-19 vaccine for enrollment in child care, either, despite its efficiency in reducing both death rates and acute symptoms). 

Vaccine hesitancy is rising among parents of young children. A 2023 survey from the Pew Research Center found that around half of parents with kids four or younger thought that not all standard childhood vaccines—a list that also includes hepatitis B, rotavirus, DTaP and chickenpox—may be necessary. Anti-vaccine misinformation plays a role in this phenomenon, which began before the Covid-19 pandemic, but has certainly increased since. In a 2019 UK report, about 50 percent of parents of young kids encountered false information about vaccines on social media. 

While it’s nice when a beloved celebrity makes a comeback, comebacks of the very infectious measles and polio epidemics are less welcome. As New Hampshire’s state epidemiologist, Dr. Benjamin Chan, said during a state Senate hearing on the bill, “as vaccination levels decrease, this is putting our children and our communities and our childcare agencies at risk.”

Georgia’s politics are fractious, with attacks by state Republicans on LGBTQ+ rights and voting rights driving divisions with state Democrats. Georgia Republicans hold majorities in both the state Senate and House of Representatives. Yet the bill to end subminimum wage in Georgia isn’t completely partisan. The bill’s lead sponsor is GOP state Rep. Sharon Cooper, who said at a committee hearing that she “just couldn’t believe that we are still allowing” the subminimum wage. One Democratic representative is co-sponsoring the bill, and none opposed its passage through the state House.

By contrast, multiple attempts to appeal the subminimum wage law at the federal level have stalled, most recently in 2023. When the United States established a federal minimum wage in 1938, it made an exception for disabled workers, allowing employers to pay them less than minimum wage—some just 22 cents an hour—through a certificate system.  Many such certificate holders also operate sheltered workshops, effectively segregated workplaces that often exclusively hire disabled people earning subminimum wages, most with intellectual and developmental disabilities. There are currently just eight of these certificate holders in Georgia as of 2024, each employing as few as four to as many as 77 disabled workers.

“It frustrates me to see that a number of these sheltered workshops have executive directors or CEOs that make five-, six-figure salaries while paying people with disabilities pennies per hour,” said Dom Kelly, CEO of nonprofit New Disabled South, who also noted that the governmental entity Georgia Council on Developmental Disabilities has led the charge in advocating for the change.

What makes the Georgia legislation different from other state bills, according to Julie Christensen, executive director of the Association of People Supporting Employment First, is its phase-out formula, which planned to get rid of 50 percent of certificates by the first anniversary of when the law is enacted, then all by the following year. That’s quicker than the three to five years Christensen said has been “typical” of such laws.

Disability rights used to be a bipartisan issue, with civil rights legislation like the Americans with Disabilities Act signed into law by a Republican president. But this has changed, Christensen says, with disability rights policies now being viewed as a more progressive cause. 

“In the current climate, if you look at any of the legislation at the federal level, it is all almost all completely Democrat-led, and because of partisan politics, it’s been hard to get Republicans to engage,” Christensen said. But both Christensen and Kelly hope that Georgia’s example of a Republican-led state disability rights initiative could change the tune of other GOP politicians at both and federal levels. 

The loudest argument against subminimum wage, largely made by non-disabled people purportedly advocating on behalf of disabled people, is that people with intellectual and developmental disabilities just won’t get hired elsewhere. Christensen says it’s important for those proxy voices to keep in mind that subminimum wages weren’t originally meant for workers with intellectual and developmental disabilities—in fact, the policy was largely meant to support disabled war veterans.

“It was always intended to be a sort of low-risk way to get businesses to be willing to retrain people to reenter the workforce,” she said.

Disabled people across the United States are more likely to live in poverty than non-disabled people. In 2021, around a quarter of disabled Georgians between the ages of 18 and 64 lived below the poverty line. For disabled people who can work, a living wage is a step to address disabled poverty—but making a few dollars or even cents an hour is not. Being paid a subminimum wage, Kelly says, “hinders and prevents disabled people from having autonomy in their lives.”

Kelly also believes that living wages for disabled workers could positively impact the care economy, which is stretched very thin, by helping them afford to live and receive services in their community, “rather than an institutional setting.” It could also mean not having to “linger on a waiting list” for a paid caregiver, which could help parents and other unpaid carers in their lives.

In addition to subminimum wage repeals, a growing number of states have passed or are considering employment-first legislation, which—though the contents vary—is supposed to help disabled workers integrate into the workforce and secure services they need to succeed. Some states like Colorado have also recognized that “transportation is a barrier” for workers with disabilities, Christensen says, and are working to make sure these workers have the infrastructure they need to get to their jobs. 

But Georgia, which already passed an employment-first bill in 2018, needs “a reset on Employment First,” Kelly told me. Georgia made the state’s Vocational Rehabilitation Agency responsible for implementing the law; Kelly says the agency has “been an absolute abysmal failure to disabled people” that hasn’t “improved the realities for disabled employment.” 

A growing number of states, in addition to Georgia, have introduced bills to stop disabled workers from being paid less than others, including a New York state bill that recently got a stamp of approval from its senate labor committee. Illinois is also reviving its effort to pass a subminimum wage repeal—a first try in 2023 didn’t even get a vote, and Republican state senators are still vocally opposed.