BackgroundMillions of Americans live with chronic health conditions and disabilities. While disability and disabling conditions are common in the United States, the number of politicians and candidates with disclosed disabilities or chronic health conditions remains extremely low.ObjectivesThis study examines what drives the lack of descriptive representation of individuals with disabilities or chronic health conditions. In particular, it examines whether disability bias, or more specifically ableism, drives voter bias against politicians with health challenges and disabilities.MethodsThe analysis relies on two original surveys with samples of American respondents that match Census quotas on key indicators. The first survey was administered to more than 1800 U.S. respondents in 2018. The second survey was administered to 6345 U.S. respondents in 2020. The approach combines observational and experimental data, as well as quantitative and qualitative analysis.ResultsThe findings reveal that voters are significantly less likely to support candidates with disclosed disabilities or health conditions. Mental illness and HIV face the strongest discrimination, while physical challenges due to birth conditions like wheelchair usage and dwarfism are the least penalized. A combination of prejudice, negative character assessment, and electability concerns drive voter bias.ConclusionUnderstanding the barriers to the election of politicians with disabilities and chronic health conditions is crucial to improve the representation of marginalized communities, as descriptive representation improves public policy outcomes for marginalized communities.