Gerrymandering in North Carolina Is Creating Real Barriers to Basic Health Care Access

A new study from the University of Massachusetts Amherst is drawing attention for a surprising and unsettling finding: gerrymandering in North Carolina is linked to reduced access to essential health care services. While debates about district maps often focus on elections, voting power, and political fairness, this research suggests that redrawing political boundaries can quietly shape something far more immediate—how easily people can get medical care.

The study, published in the American Journal of Public Health, examines an 18-year window from 2004 to 2022 and looks specifically at access to federally qualified health centers (FQHCs). These centers provide primary and preventive health services regardless of a patient’s ability to pay—making them crucial resources for low-income and underserved communities. According to the researchers, areas that experienced more severe gerrymandering ended up with fewer health centers, fewer patient visits, and longer travel distances for residents who did manage to access care.

This offers a direct, measurable way to understand the real-world impact of political map manipulation—something courts have struggled to define clearly when evaluating gerrymandering challenges.

The Core of the Study: What the Researchers Examined

The research team—led by Auden Cote-L’Heureux and Dr. David Chin—analyzed extensive electoral, demographic, and health-center data to understand how district boundaries affect health-care access.

They used ZIP codes as a proxy for communities. A ZIP code that fell entirely or mostly inside a single legislative district was considered less gerrymandered. A ZIP code split between two or more districts was labeled highly gerrymandered. This method made it possible to understand how political boundaries overlap with the places people live and seek services.

The team didn’t stop at map shapes. They also used new analytical techniques to measure how much individual voters were “dislocated” from like-minded communities—another indicator of map manipulation. This allowed the researchers to go beyond surface-level district analysis and really capture how representation fractures on the ground.

They then compared these measurements against two key outcomes:

The number and growth of federally qualified health centers in each area.
The number of patients using those health centers.

The results painted a consistent picture: more political fragmentation, fewer health-care resources.

What the Study Found: A Clear Impact on Health Care Access

Across all analyses, the researchers found the same pattern—gerrymandering correlates with diminished access to essential medical services. Some of the most important findings include:

ZIP codes that were more severely gerrymandered between 2004 and 2022 had fewer FQHCs in 2022.
These communities were also less likely to gain new FQHCs during the 18-year period.
The number of patients visiting FQHCs was lower in highly gerrymandered ZIP codes.
In ZIP codes split evenly between two state senate districts, residents had to travel about 30% farther to get to the nearest health center.
Greater gerrymandering severity in state senate districts was linked to up to a 29% reduction in the number of available FQHCs.

These effects aren’t minor inconveniences. A 30% increase in travel distance can make the difference between receiving proper preventive care and skipping appointments altogether. Losing health-care access doesn’t happen in a dramatic sweep—it erodes quietly, often without people realizing why.

The researchers interpret this as evidence that gerrymandering weakens local political representation. When a community’s political influence is diluted, lawmakers may be less responsive to its needs, including the need for adequate funding and siting of public health resources.

Why This Matters: From Political Maps to Public Health

The idea that gerrymandering harms democracy is familiar. What’s new here is the argument that it also harms public health. The study demonstrates that political manipulation can have structural effects far outside the voting booth. When maps sever communities, their ability to advocate for resources becomes fractured as well.

This is especially serious in states like North Carolina, where many rural and urban communities rely heavily on FQHCs. These centers often serve populations that lack reliable insurance coverage or transportation. Less availability means less access to primary care, preventive screenings, chronic-disease management, and mental-health services.

Reduced representation isn’t just about whose party wins. It’s about who gets what resources—and who doesn’t.

Legal Implications: A New Path to Challenge Gerrymandering?

One of the most interesting outcomes of this study is its potential use in future court cases.

In 2019, the U.S. Supreme Court ruled that partisan gerrymandering cannot be challenged in federal courts, calling it a “non-justiciable political question.” That decision closed the door on many traditional legal arguments against partisan map manipulation.

But the authors of the new study believe their findings could provide a new route. Instead of arguing that gerrymandering harms voters abstractly, lawyers could argue that it causes quantifiable harm to communities, such as reduced access to health care.

By showing clear evidence of how political boundaries correlate with health-care availability, the study offers plaintiffs something courts have long said was missing: a measurable definition of harm.

That makes this research not just academically interesting—it could be strategically important.

What Federally Qualified Health Centers Are and Why They Matter

Since this study revolves around FQHCs, it’s worth understanding what they are and why they are vital.

FQHCs are community-based clinics that provide:

primary care
preventive care
dental services
mental-health services
substance-abuse treatment
and other essential medical support

These centers treat all patients regardless of income or insurance status. Many also offer discounted care based on ability to pay. For rural areas and lower-income neighborhoods, FQHCs are often the only accessible option for consistent medical treatment.

Losing or failing to gain new FQHCs means entire communities miss out on lifesaving and preventive care, which can worsen long-term health disparities.

This is why the connection between gerrymandering and FQHC availability is so significant: it directly links political representation with public health outcomes.

Why Gerrymandering Can Influence Health Resources

Gerrymandering weakens a community’s political power by splitting its voters across multiple districts. When political representation is diluted:

lawmakers pay less attention to the community
its needs fall lower on priority lists
advocacy becomes harder because the community doesn’t have a strong, unified voting bloc
resources—including health-care funding—may be allocated elsewhere

It’s a structural issue, not a one-time decision. And over decades, the harms accumulate quietly but powerfully.

This study highlights that health-care access is one of those harms.

What This Means Going Forward

The researchers emphasize that the findings are not just about North Carolina. Other states with aggressive or highly partisan redistricting practices may be experiencing similar outcomes. The methods created for this study—especially the use of ZIP code splits and voter dislocation metrics—can easily be applied elsewhere.

As redistricting battles continue across the U.S., this research could shape: