Background: In the 2016 United States presidential election, only 55.7% of eligible voters participated in the general election. Illness and disability were the most commonly cited barrier to election participation among Americans making less than $30,000 (20%) and Americans 65 years and older (42%). In the week leading up to election day, millions of Americans are hospitalized, often due to an unforeseen illness. In 38 states, emergency absentee voting is permitted for voters with a medical emergency or hospital admission. In these states, hospitals and healthcare providers have a unique opportunity to facilitate voter participation during elections.
Purpose: The goal of this hospital-wide initiative was to facilitate emergency absentee voter participation in the 2020 general election for inpatients, family members, and staff at a 397-bed urban safety-net and Level 1 trauma center in San Francisco, CA.
Description: A group of trainees including internal medicine residents and medical students designed a program to facilitate emergency ballot requests from patients, family members, and staff at the hospital. In the weeks preceding the election, the leaders collaborated with the Department of Elections on workflow, recruited and trained volunteers, and advertised the voting drive. On the day before election day, volunteers screened all hospitalized patients for eligibility and interest in requesting an emergency ballot. Family members of patients and staff were also permitted to participate. Ballot authorization forms were available in four languages and medical interpreters were available to assist with ballot requests in additional languages. Ballot requests were submitted to the Department of Elections who delivered and collected ballots on election day from the hospital.Sixty four emergency absentee ballots were requested and 47 completed ballots were returned to the Department of Elections. Among the 17 ballots that were not completed, 8 people were discharged or left before ballots were completed, 4 decided not to submit, 3 had other barriers to competition, and 2 had already voted. Among the 47 completed ballots, 83% were hospitalized patients, 8% were family members of patients, and 9% were hospital staff. All participants who completed ballots were English speaking and approximately half (53%) were under 50 years old. Voters who requested ballots included first time voters, individuals who reported they had barriers to obtaining an absentee ballot, and patients who reported they had planned to vote in person before their unplanned hospitalization.
Conclusions: Hospital-led initiatives to facilitate participation in elections are a feasible mechanism to increase voter participation during elections. Voter assistance programs at safety-net hospitals can increase voter turnout from vulnerable patients who otherwise would not participate in an election owing to illness and structural barriers. To increase voter participation among hospitalized patients in eligible states, healthcare systems can coordinate with local elections offices to promote emergency absentee voting.