Ballot Duplication Technology: What Is It and How Does It Work?

Our first post in this series on ballot duplication served as an explainer to demystify this term, which refers to the process used to transcribe a damaged or unreadable ballot so that it can be counted.

In our second blog post, we shared the Overseas Voting Initiative’s (OVI) latest recommendations for ballot duplication in light of the COVID-19 pandemic.

In this post, we will define ballot duplication technology solutions and give a general overview of how these solutions work.

What is ballot duplication technology?

Ballot duplication technology solutions are comprised of software and hardware used to automate the transcription of damaged or otherwise machine-unreadable ballots efficiently and accurately within a transparent and verifiable environment. Ballot duplication hardware components are usually commercially available scanners, printers and computer workstations.

What specifically happens during the ballot duplication process?

Two specific actions are performed during the duplication of a damaged or machine-unreadable ballot:

  1. The interpretation of the ballot style — an elections official determines the version of a ballot within a jurisdiction that an individual voter is eligible to vote
  2. The voter’s marked responses to those specific ballot style choices are preserved onto a new tabulation-ready ballot

How does ballot duplication technology work?

The process for transcribing a damaged or machine-unreadable ballot  — we’ll use the term “damaged” in this article for simplicity — using ballot duplication technology varies according to the specific provider and technology used. However, the transcription process typically follows steps similar to these:

  1. The damaged ballot is digitally scanned, either individually or as part of a “batch,” or group of damaged ballots requiring duplication. A duplicate ID number, distinct marking or barcode is physically printed on the scanned damaged ballot by the scanner simultaneously.
  2. The ballot style of the damaged ballot is recognized and a “clean copy” of the appropriate ballot style is retrieved from the electronic repository of available ballot styles for that jurisdiction and a duplicated ballot image is created.
  3. This same duplicate ID number, distinct marking or barcode that was printed on the damaged ballot as it was scanned is produced and associated as a digital overlay on the new duplicated ballot image. Having the same duplicate ID number on the damaged ballot and the newly created ballot results in a duplicate ID match and allows these two ballots to be associated providing a chain of custody of the duplication process for auditability.
  4. After being electronically matched, the scanned damaged ballot image and the duplicated ballot image are displayed side-by-side on screen and reviewed for approval by a team of bipartisan election workers, often called a “ballot board.” These boards are tasked with approving all ballots requiring duplication following the jurisdiction’s election laws and procedures.
  5. Upon approval by the ballot board, the new duplicated ballot image is printed — if required — and routed for tabulation.
  6. The new duplicated ballot is counted by the jurisdiction’s tabulation system.

Do all election jurisdictions use ballot duplication technology?

Not all election jurisdictions use ballot duplication technology. Most election jurisdictions that duplicate ballots use a manual process for a variety of reasons including budget constraints, the number of ballots duplicated in a typical election, physical size of a jurisdiction’s post-election processing area and state election laws.

Next up, we will share our observations on innovation in ballot duplication technology since 2016 and provide an overview of the marketplace landscape. In September, we’ll share frequently asked questions (with answers!) to help in discussing ballot duplication with external stakeholders. Finally, we’ll wrap up our ballot duplication blog series with two posts highlighting what our OVI Working Group members and other state and local election officials are doing in their jurisdictions around ballot duplication innovation, communication and remote observation of post-election processes.

Read the other articles in our Ballot Duplication series:

Ballot Duplication: What it is, what it is not and why we are talking about it in 2020

Ballot Duplication: New Recommendations for Contingency Planning in the time of COVID-19 and Beyond

Continued Advancement in Ballot Duplication Technology Solutions: Pilots in the Field

Contingency Planning During COVID-19: Ballot Duplication in the States

Frequently Asked Questions (and Answers) About Ballot Duplication

Election officials are planning for remote observation of post-election processes, including ballot duplication, due to COVID-19 pandemic

Election 2020: What Did We Learn?

In the spring of 2020, the members of the Sustainability of UOCAVA Balloting Solutions Subgroup(SUBSS) of The Council of State Governments Overseas Voting Initiative (OVI) developed  recommendations for duplication of damaged and/or machine unreadable ballots. Our Working Group of state and local election officials wanted to aid other election officials and inform the greater election stakeholder community as contingency planning for the 2020 election began to unfold. These enhanced, pandemic-era recommendations built upon the previous work of the OVI on ballot duplication.

After assessing the 2020 election cycle in relation to lessons learned regarding ballot duplication and other post-election processes, including how they were discussed in both social and mainstream media, the OVI SUBSS Working Group members developed the following recommendations:

Ballot Duplication Technology

  • In addition to continuously evaluating emerging ballot duplication-specific technology solutions, election officials could also explore the possibility of using dedicated ballot marking devices to aid in the ballot duplication process. In an effort to move away from completely manual ballot transcription processes, many jurisdictions reportedly did this successfully in 2020.

Ballot Duplication Observation

  • When broadcasting ballot duplication processes, captions, narrations and other explanatory information should be given by election officials to provide context for observers given their curtailed ability to ask clarifying questions in person. This will also help provide context to the media and aid in fighting attempts at video manipulation and disinformation.
  • Election officials should keep any recordings of the duplication or other post-election processes so that they have the original footage should a manipulated version show up online.
  • Officials should consider keeping a record of remote observers, either by having them agree to observer guidelines and collecting their information ahead of time, or by tracking observers’ internet service providers so they can be tracked down if they violate observer principals.
  • Educational materials on post-election processing, including ballot duplication, shared by election officials should include a spot for signatures of both in-person and remote observers indicating they have read and understand the materials and are trained or certified to begin observation.
  • Election officials should consider observer area signage and room layout with clear physical distancing markers. Additionally, cameras should be considered for both on-site and remote observers who must keep physical distance but find it hard to see the process when distant.
  • Election officials should provide staff availability for observer questions both on-site and via remote access as well as to implement a process for advance sign-ups, limiting the number of observers at one time.
  • Chain of custody and security processes and procedures for ballot duplication and post-election processing should be reviewed by election officials and strengthened as appropriate to address evolving risk mitigation needs.

If you have any ballot duplication questions or suggestions for additional recommendations based on your experience, please reach out to us at [email protected]. We’d love to hear from you!

How COVID-19 Changed the Ballot Box

How COVID-19 Changed the Ballot Box

The 2020 election cycle was one of adaptation and innovation. Election administrators were tasked with ensuring that people could vote without jeopardizing the well-being of administrators, staff or poll workers. To accomplish this, they had to use contingency protocols that would have seemed implausible before the pandemic. These contingency protocols have made public officials rethink the ways elections have traditionally been conducted — and some of them may be here to stay. Contingency protocols ranged from the expansion of vote by mail to the proliferation of secure ballot drop boxes, early voting and curbside or“drive-through” voting. Voter satisfaction with these procedures runs high. According to a 2020 survey conducted by the Massachusetts Institute ofTechnology Election Data and Science Lab, 60% of by-mail voters indicated that they were very likely to vote by mail in the future. Election administrators also utilized pandemic relief funding to facilitate remote observation of key election procedures. These procedures were intended to maintain transparency while also limiting staff and voter exposure to COVID-19. Although contingency protocols were authorized on a temporary basis, their positive perception among voters has served as the impetus for permanent change.

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State Civic Education Toolkit

State Civic Education Toolkit

This Civic Education Toolkit is intended to help stakeholders from all three branches of government, as well as other members of the civic education community in their mission to improve state civic education. There are many unique strategies stakeholders can use to effectively engage students. To effectively use this guide, the icons below denote methods and examples that may be particularly useful to leaders from each branch of government, leaders in the K-12 education community, leaders in the higher education community, and leaders working with non-governmental organizations.

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Achieving Balance Between Security and Ballot Access when Serving Military and Overseas Citizen Voters

Members of The Council of State Governments (CSG) Overseas Voting Initiative (OVI) recently released a position paper titled, “Electronic Ballot Return for Military and Overseas Voters: Considerations for Achieving Balance Between Security and Ballot Access.”

Created by 14 state and local election officials comprising the Sustainability of UOCAVA Balloting Systems Subgroup (SUBSS), this set of recommendations was issued in response to the current state of change within the states regarding election policy. As states grapple with how to best serve their voters, SUBSS members are seeking to make clear that military and overseas voters face novel challenges when participating in elections. These challenges may necessitate the consideration of additional voting solutions such as electronic return of voted ballots. These recommendations are targeted towards key stakeholders within the elections community, such as election officials, state legislators, researchers and election-centered federal agencies.

Electronic ballot return poses unique advantages to military and overseas voters via its ability to serve highly mobile citizens and/or those in highly austere environments. This is a complex issue that requires balance between accessibility, security, and a level of acceptable risk.

Through these recommendations, SUBSS members shared further information on ways to mitigate the risks inherent to electronic return and the need for a fresh evaluation of all ballot return methods for military and overseas voters.

This is the second set of recommendations issued by OVI members within the past year regarding how states can best serve their voters covered by the Uniformed and Overseas Citizens Absentee Voting Act (UOCAVA). In July 2020, these election officials also put forth best practices on how states could overcome barriers posed by international mail disruptions experienced throughout the COVID-19 pandemic. Those recommendations are found here: https://ovi.csg.org/wp-content/uploads/2020/07/FailSafeRecommendations.pdf.

Since 2013, the OVI has worked collaboratively with the U.S. Department of Defense Federal Voting Assistance Program (FVAP) and our Working Group of state and local election officials to ensure election access for military and overseas citizen voters. The recommendations recently issued by the OVI are a culmination of these efforts and demonstrate the unique position of Working Group members to provide expertise and resources on electronic ballot return for UOCAVA voters.

Improving Ballot Processes for Overseas Citizens

As of late June 2020, the United States Postal Service (USPS) lists 103 international mail disruptions as a result of COVID-19pandemic-related complications, with the number of disruptions and specific locations changing regularly.1 There are 20 states that only allow military and overseas voters to return their voted ballots to their local election officials by mail, and these voters will struggle to find a way to cast a ballot.

For example, consider the hypothetical case of Mary, an American citizen living abroad. She is registered to vote in a state that only allows voted ballots to be returned by mail. Mail service is suspended to and from the country where she is living, so she cannot return her ballot by mail to her local election office in the U.S. Mary is informed that her only other option is to take her ballot to the U.S. Embassy for transport though diplomatic mail. As a result of the COVID-19 pandemic many cities such as Rome, Italy and Santiago, Chile, have placed significant travel restrictions on its residents, only allowing them to leave the house for trips to the grocery store or pharmacy. Mary lives in a city with such restrictions and is not permitted to travel across the city to the embassy to access diplomatic mail. Therefore, Mary has no way to return her ballot in order for it to be counted.

For the 20 states that only allow ballot return via mail, there are limited options to ensure that overseas voters like Mary have access to federal election ballots. While the number of voters who may fall into this category could be relatively small, these individuals have the right to vote and each of their votes matter and could change the outcome of an election.

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The Impact of COVID-19 in State Veterans Homes

by Laura Hinkle

“State Veterans Homes” are facilities that offer nursing home, domiciliary and adult day care operations for approximately 33,000 veterans. There are 158 homes nationally, with at least one located in every state. These facilities are owned and operated by states but are subject to federal oversight from the U.S. Department of Veterans Affairs (VA).

Veterans Homes were among the first facilities in the nation to face high rates of infection from COVID-19, and consequently, they faced criticism from families of veterans, the American Legion and the federal government for their lack of an effective response to the virus.

Family members of veterans in these homes cited instances of neglect and miscommunication that often led to their loved ones dying of the virus before their family even learned they were sick. In September, state attorneys in Massachusetts announced they were pursuing criminal charges against two former managers of the Soldiers’ Home in Holyoke for severe neglect of veterans that contributed to the death of at least 76 people in the home.

Other major factors that contributed to the rapid spread of COVID-19 in Veterans Homes during the pandemic include:

Testimony from the president of the National Association of State Veterans Homes in July 2020 explained that these homes were hit particularly hard by the pandemic because of the demographic makeup of their residents. Most are older men with disabilities, and research has shown older men with underlying health conditions are disproportionately affected by COVID-19.

Additionally, many Veterans Homes were ill-equipped to handle COVID-19 because of largescale institutional issues that have been ongoing for years. Several concerns surfaced from restimony to Congress by the Government Accountability Office (GAO) in 2020 about accountability and oversight of State Veterans Homes:

  • The VA’s inspection contractors are not required to report all failures of Veterans Homes to meet quality standards
  • VA contractors can cite such failures as recommendations rather than deficiencies
  • The VA does not conduct performance reviews of their contractors
  • The VA fails to share information on the quality of Veterans Homes on its website
  • The VA does not always follow up to make sure homes remedy deficiencies

The GAO also reported approximately one-third of State Veterans Homes do not participate in Medicare and Medicaid because they do not receive these payments from residents, and thus lack additional oversight from the U.S. Centers for Medicare and Medicaid Services (CMS) that most nursing homes receive. However, even the Veterans Homes that receive additional inspections from CMS had those quality inspections put on hold when COVID-19 emerged, as they were replaced with inspections focusing solely on control of the virus. As cases continued to skyrocket in the facilities over the past year, federal oversight dwindled.

The one-third of homes that do not receive oversight from CMS were not required to report COVID-19 infections and deaths until Jan. 5, 2021. This lack of accountability of the number of cases within each home was especially concerning for the families of residents in these facilities. To address this concern, Congress passed the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020, which mandates that all Veterans Homes provide weekly reports to the federal government regarding their COVID-19 cases and deaths. Additionally, the VA now is required to publicly post data (beginning of February 2021). As of April 15, 2021, 1,143 residents and 37 staff of Veterans Homes reportedly have died from the virus. Since the beginning of the pandemic, 8,838 residents and 6,656 staff members have been infected by COVID-19.

The passage of this Act was an important first step in increasing the accountability of Veterans Homes during the pandemic, but 15 homes still are not reporting. The reason for this is not entirely clear. However, VA officials stated they are working with the 15 homes to help them begin reporting as soon as possible in the National Healthcare Safety Network — an infections monitoring system.

Currently, the VA is not responsible for providing vaccines to facilities because the homes are state-run. However, facilities can request help in distributing their available vaccines through the Federal Emergency Management Agency (FEMA). Then, the VA could provide help under its Fourth Mission, which includes serving as a backup to the American medical system. No facilities have requested help through FEMA. Veterans Homes are receiving vaccines from their respective states and are continuing to educate their staff and residents on the effectiveness of the vaccine. An increase in vaccination is a crucial next step in mitigating the spread of COVID-19.

As these homes continue to receive more PPE, more accurate COVID-19 testing and more vaccines, the spread of COVID-19 will likely decline. The VA also will continue working with Veterans Homes to ensure all 158 are reporting data on infections and deaths as soon as possible. This increase in accountability, along with better oversight from the VA, will contribute to the mitigation of the virus.

In the bigger picture, the struggle these homes have had in handling COVID-19 has many implications for the future of the relationship between the VA, states and Veterans Homes. The Vietnam Veterans of America (VVA) analyzed this relationship in a report last August, noting, “There is a sense that VA does not embrace the care of these veterans as being part of its mission.” The report echoed many of the findings from the GAO regarding lack of accountability and transparency. According to the GAO and VVA, there are several options policymakers and VA leadership should consider:

  • Ensure annual inspections are documented transparently and corrective actions are taken
  • Mandate corrective actions are completed within an established timeline
  • Require all documented deficiencies to be listed as deficiencies rather than recommendations
  • Edit the VA website to include quality ratings of individual homes
  • Ensure states are using federal per diem funding on homes, specifically rather than placing them in the state’s general fund
  • Review federal per diem rates
  • Train staff members regularly with timely briefings on new protocols and equipment
  • Encourage regular communication between the National Association of State Directors of Veterans Affairs and the National Association of State Veterans Homes so that best practices and current challenges can be discussed openly.

These recommendations indicate a lack of involvement and accountability from the VA when it comes to the approximately 33,000 veterans living in Veterans Homes. There is an ethical and moral responsibility for states, the VA and Veterans Homes to work together in innovative ways to address the deficiencies which COVID-19 has so drastically underscored.

Analysis for States: The Coronavirus State and Local Fiscal Recovery Fund

The American Rescue Plan Act of 2021, a $1.9 trillion economic relief package, was signed by the president on March 11. Part of this package includes the Coronavirus State and Local Fiscal Recovery Fund, which provides approximately $350 billion in new federal fiscal assistance for states, territories, tribes, counties and municipalities. An additional $10 billion is available to states, territories and tribal governments for critical capital projects that directly enable work, education and health monitoring in response to COVID-19.

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MENTAL HEALTH INSURANCE PARITY: STATE LEGISLATIVE AND ENFORCEMENT ACTIVITIES

MENTAL HEALTH INSURANCE PARITY: STATE LEGISLATIVE AND ENFORCEMENT ACTIVITIES

ABSTRACT

Issue: Treating mental health conditions and substance use disorders as equivalent to other health conditions in insurance plans (“mental health parity”) continues to be a priority policy concern at the federal and state levels. Measures approved by Congress and state legislatures have established methods for assessing mental health parity on a regular basis. But other issues that have long challenged the nation’s health care system, such as trans-forming payment and delivery of services, may need to be addressed to ensure parity becomes a reality.

Goal: Provide mental health insurance parity policy options for state leaders.

Methods: Review policy challenges, statutes, regulations, and enforcement efforts, and identify future policy avenues.

Key Findings: States continue to address gaps in parity through legislation and through regulatory, enforcement, and compliance efforts. They are requiring 1) insurance companies to demonstrate compliance; 2) insurance departments to report on compliance; 3) coverage of a fuller range of mental illnesses and substance use disorders; and 4) greater transparency by insurance providers. They are attempting to correct the negative outcomes of insurance practices such as prior authorization for services, provider networks, and formulary design.

Conclusion: States have led the way in addressing parity issues with legislation to 1) shape coverage; 2) provide a model for federal legislation; 3) facilitate implementation of federal laws; and 4) ensure insurance market compliance. Bigger challenges lie ahead when it comes not only to ensuring all individuals have access to quality services but also in equipping the overall health care system and other systems to address mental health needs. Numerous factors have generated various successful strategies and solutions with opportunities for expansion in government and practice.

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SOCIAL DETERMINANTS OF MENTAL HEALTH: STRATEGIES FOR STATE GOVERNMENT

Issue

Social determinants of health are non-medical factors that influence health outcomes. They encompass the conditions under which people are born and live and societal forces that shape lives. While the underlying social determinants of mental health may be similar to determinants of physical health, policy solutions designed to address mental health may require a slightly different lens.
Goal

Provide multi-level state policy options for addressing the social determinants of mental health.
Methods Review existing challenges, statutes, policies, programs, interventions, potential avenues for action, and international solutions.
Key Findings

Policy challenges include adequate measurement of social determinants, resource limitations, and problem scope. Legislative policy solutions address medically underserved areas, cultural competency, data collection, and health disparities. Other large-scale initiatives can address unstable housing, adverse childhood experiences, the mental health of school-age children, and healthy community design. Future policy avenues can focus on health care payment policy, shared assets, participation in public programs, integration of social services and mental health care, and urban planning. International perspectives highlight health in various contexts and the consequent diversity of policies and multi-sector collaborative approaches.
Conclusion

Keys to addressing social determinants at the state level include:
• Facilitating collaboration
• Strengthening data collection and analysis
• Sustaining resources
• Providing access to care
• Addressing complicated economic challenges
• Eliminating health disparities
• Shaping healthier communities

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