An Introduction to Redistricting and its Effects on Healthcare

August 13, 2021 by Kimberly Tsoukalas, LHC Program Coordinator

Following the 2020 census, the national and state legislatures are set to redefine the boundaries for congressional elections and representative districts. These districts determine the geographical areas for state and national elected officials including Representatives, State Senators, and Board of Education members. Due to the coronavirus pandemic, the process is running behind schedule but government officials are still working diligently to redraw new district lines in time for the 2022 election cycle. Below, we’ve broken down where the state of Alabama is in the redistricting process, what citizens can expect during the process, and how it can impact healthcare policy in our communities.

 AL Congressional Districts

Redistricting Timeline

Steps to Delivering Census Redistricting DataSteps to Delivering Census Redistricting Data. Visit “Timeline for Releasing Redistricting Data” on the Census Bureau website for more information!April 26, 2021
The United States Census released the apportionment counts to the public showcasing the general state population changes in the country. Some states gained seats in the House of Representatives while others lost seats. Alabama’s population increased to just over 5 million and will retain the same number of representatives (7) for the next redistricting cycle.

August 12, 2021
The US Census released the P.L. 94-171 Redistricting Data Summary Files, which includes information about housing occupancy status, population counts by race and ethnicity for the total population and voting-age population, and by group quarters type for the group quarters population. This information will be released on the Census Bureau’s FTP website using the same file format provided to state governments and requires additional software to extract the data. This information distribution is intended for experienced data users and will be re-released to the general public at a later date in a more digestible format.

Proposed – September 30, 2021
The Census Bureau will release the same data from August 12th in an easier format that allows the public to search for and understand local redistricting data, accessible at https://data.census/gov. Additionally, it will be delivered to the Reapportionment Committee in an interactive toolkit on a flash drive for further publication and reference.

Did you know? The term “gerrymandering” was first used in 1810 after the redistricting of Massachusetts. Elbridge Gerry, a prominent political figure of the time, drew district lines to facilitate political gain in a shape that was thought to look like a salamander. Hence, (Elbridge)Gerry(sala)mander. Today, the term is used to describe disproportionate district lines that give an unfair advantage for a political party or group. See below for a quick graphic on how this looks in a population of 60% blue squares and 40% yellow squares.

Redistricting Gerrymandering Explained

Proposed – January 28, 2022

While not an official Census deadline, January 28th is the official filing date for House of Representatives candidates. Redistricting borders are presumed to have been drawn by this point, though there may be delays this year due to the pandemic. Official verification comes by legislative vote which should occur later in the spring.

Proposed – May 2022
Based on previous years, we can expect the Alabama House of Representatives and Senate to approve the newly redrawn districts in May. However, prior to 2020 Census data was available in March, rather than August, allowing for a longer deliberation period. It is unclear how this approval will be affected by the pandemic. Once the lines are approved by the House and Senate, they are passed on to the Governor who has the ability to veto the districts, sending it back to the Alabama Permanent Legislative Committee on Reapportionment (APLCR) for redrawing.

Proposed – October 2022
The final stage in the redistricting process is called preclearance, a term you probably haven’t heard since your AP Government class in high school. The Voting Rights Act of 1965 provided additional protections against discrimination in the elections processes. Section 5 of the Act requires that the United States Department of Justice or a three-judge panel of the United States District Court for the District of Columbia approve any attempt to change any voting practices, including redistricting.

What happens next?

The data released on August 12 will allow the APLCR to begin redrawing districts. However, the committee must abide by certain rules and regulations to ensure the proposed districts are fair.

In addition to keeping each district relatively proportional to each other in terms of population, there are four main criteria for redistricting: Contiguity, Compactness, Community Interest and Political Boundaries. Contiguity simply means that all portions of the district must be geographically adjacent. Similarly, all portions of the district should live as near to one another as is practical to represent the collective interests of a portion of the state. Lastly, political boundaries references the geographical borders of county lines and city limits, allowing for proper representation for those citizens.

Did you know? Any citizen or group can submit a proposed redistricting map during public input meetings occurring through the month of September. Click here to try your hand at drawing your own redistricting lines. Full list of times and locations for public meetings is available here, along with Zoom links for individuals choosing to attend virtually.

The Reapportionment Committee will need to balance these needs when redrawing state lines to account for the population changes within the state. Additionally, they will need to abide by the guidelines enacted by the Voting Rights Act of 1965 to ensure that the districts are not disproportionate to certain populations based on race or other demographic factors.

What does this mean for health policy?

The process of redistricting will impact healthcare more than you might realize. In addition to national issues like universal healthcare or insurance reform which elected representatives could sponsor or support legislation for, redistricting and census data have local implications as well. Hospitals, health care clinics, and health care programs such as Medicaid and Medicare are among the many public health services included in annual budget proposals to be approved by Congress. Additionally, state and federally-funded community health centers are heavily impacted by the annual budget, which can determine where to build new hospitals and clinics or expand existing ones.

Access to rural healthcare continues to decline. The healthcare analytics firm Chartis Group recently released a report that 12 of Alabama’s 45 rural hospitals are considered “most vulnerable” to closing partly because the state has not expanded Medicaid. As quoted in an article by, Danne Howard, chief policy officer for the Alabama Hospital Association, stated “when a rural hospital has to cut services or close, residents have to travel and overload the urban facilities. It’s a domino effect when a rural hospital closes. It becomes an urban hospital issue. It becomes a health access issue.”

Redistricting is a critical part of our electoral process, paving the way for representation at the state and national level. Redistricting, as we’ve seen in the past, can potentially determine the outcome of major legislation. If we consider health as a human right and strive to improve population health through the enactment and enforcement of evidence-based public policy, it is imperative that we nominate leaders who prioritize healthcare access and affordability.