Norma Crosby remembers when she relied on blind faith to cast her vote.

The 64-year-old Texan was born virtually without sight, a side effect of her mother catching rubella while pregnant with her. Friends and relatives stood beside her and filled out her ballot at polling precincts for more than half of her voting life. Then, accessible voting machines rolled out around the year 2000, enabling her to vote in person on her own.

Now, the COVID-19 pandemic makes going to the polls a risky proposition for Crosby. She also has a condition called sarcoidosis that requires her to take immunosuppressant drugs, she said. However, the state does not have a mail-in voting system that accommodates Crosby’s visual impairment.

“It communicates to me that I’m not valued as much as other citizens,” said Crosby, president of the National Federation of the Blind of Texas, “that I’m a second-class citizen.”

A projected 7 million Americans who are eligible to vote in the presidential election live with visual impairments, according to researchers from Rutgers university. For those, like Crosby, who also deal with illnesses that place them at a higher risk of falling seriously ill with COVID-19, voting this year will be especially difficult.

The pandemic exposed glaring holes in absentee and mail-in voting systems around the nation. In some jurisdictions, voters who have what’s known as print disabilities — conditions that make it difficult to process printed content, such as blindness, low vision or learning or physical disabilities — could not cast a ballot remotely without asking for help, thereby compromising their privacy.

Outcry and lawsuits from disability advocates prompted at least 11 states to update their mail-in and absentee ballot systems in an attempt to accommodate these voters. Some changes enable voters to use text-reading software with their ballots and submit them online through a secure portal.

However, some states have been slow to address these needs. In Iowa, voters cannot vote confidentially using the mail-in system because the state requires the use of paper ballots. Texas residents like Crosby must find someone to fill out their ballot and mail it in or take it to the sole drop box in the county — all during a pandemic that has required people to physically distance themselves to stay safe.

“We should not have to choose,” said Chris Danielsen, director of public relations for the National Federation of the Blind, “between endangering our health and going to the polls in person, or not voting at all.”

Several federal laws affirm the right of all people, regardless of disability, to vote in an accessible manner. The Americans with Disabilities Act, passed in 1990, requires state and local governments to make the voting process user-friendly to voters of various abilities. This includes providing accessible parking spaces and placing voting machines where people using wheelchairs have enough space to move and at a height reachable by all.

In 2002, Congress passed the Help America Vote Act. The law built on the previous legislation by requiring every polling place to have at least one voting machine available during federal elections that accommodates a range of disabilities. These gadgets vary in features by manufacturer, but they can include touch screens, buttons labeled in Braille and audio capabilities. Voters using them must have the same privacy and independence enjoyed by people who don’t have such challenges.

However, states largely retained the power to decide how to comply with these federal mandates, said Lisa Schur, co-director of the Program for Disability Research at Rutgers. The result, she said, is an uneven patchwork that voters with disabilities must navigate.

With COVID-19 creating a reason to avoid in-person voting, some states, such as Texas, still failed to take steps to make it possible for a voter with visual or print impairments to fill out a mail-in ballot without assistance. The state government is also embroiled in a lawsuit regarding its decision to limit ballot drop-off boxes to one per county.

Harris County, where Houston is located, covers more than 1,700 square miles and is home to 4.7 million people. The distance becomes an added hardship for voters who opted to vote remotely and would prefer to drop off their ballot to make sure it is counted.

The state declined to comment due to the pending litigation.

Iowa also has fallen short in making systemic changes to improve access, according to disability advocates. Like Texas, the state provides only paper ballots for voters wishing to vote absentee.

Scott Van Gorp, president of the National Federation of the Blind in Iowa, said he initially felt resigned to his lack of privacy when he started voting. He was born three months early, leaving him with little more than light perception for sight. As a college student in the 1990s, Van Gorp rallied his friends to help him cast his vote.

“I kept thinking, ‘That’s not a secret ballot. Why?’”

In a written statement, a spokesperson for the Iowa secretary of state said it has made efforts to even the field by creating a large-print voter registration form and how-to videos on using accessible voting machines at polling locations. It cannot unilaterally make a change to improve accessibility without legislative approval, he added.

Election officials in several other states, though, including the battlegrounds of Nevada, Pennsylvania and Michigan, adopted changes this year to their mail-in ballot systems to accommodate people with visual disabilities.

In Maine, voters with impairments can request, fill out and submit their votes electronically through a new online platform. The ballots are compatible with various types of screen-reader software and will be counted through the same system used for absentee and overseas military voters.

This option became available in early October after the state was notified of confidentiality issues with paper ballots and sued by disability advocates.

Kristen Muszynski, a spokesperson for Maine’s secretary of state office, said some of the plaintiffs named in the lawsuit helped test the system. Litigation is now on hold, she said, and she is hopeful the new voting option will help resolve some of the issues.

“We’re hopeful that the word is starting to get out,” Muszynski said.

A few jurisdictions around the nation offer Braille ballots. However, said Douglas Kruse, co-director of the Program for Disability Research at Rutgers, voters may still need someone to help them fill one out and submit it. These ballots would also need to be counted separately, compromising the voter’s privacy.

One of the few states that have not needed to make drastic changes to accommodate voters with disabilities during the pandemic is Oregon, where mail-in ballots have been the primary form of voting for years.

Voters with disabilities can access and fill out ballots electronically using assistive technology like screen readers and sip-and-puff systems — through which a person with limited mobility controls the device using their breath and a straw — to vote. Then, the ballots must be mailed in.

Sean Carlson, 42, president of the Portland Central Chapter of the National Federation of the Blind, said he has never encountered issues while voting in his home state. He and his colleagues are focused on bringing awareness to the importance of “having a say in our democracy,” he said.

“It should not be that if someone has a disability that they should be locked out of that process.”

For now, Norma Crosby, who lives outside Houston, plans to vote in person, and she will need to bring a sighted friend to make sure she maintains social distance. After all, she can’t see whether other people are wearing masks.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Carmen Heredia Rodriguez, Kaiser Health News

Kaiser Health News

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.