In the 2016 United States general election, only 58.6% of eligible voters cast ballots. Particularly among poor and elderly voters, poor health impedes electoral participation: nearly 42% of eligible voters over 65 years and 20% with an annual income below $50,000 cited illness or disability as reasons for not voting. Within 5 days of the election, an estimated 1.86 million people visited an emergency room and 322,000 were hospitalized nationwide. While most states allow voting by absentee ballot due to medical emergency, many patients and their caregivers lack information on how to submit such a ballot when sick or hospitalized. 


Design and implement a program to assist hospitalized registered voters in a 418-bed urban safety-net hospital in submitting an absentee ballot for the general election on November 8, 2016.


We recruited a multi-disciplinary team including hospitalists, nurses, social workers and hospital leadership. The program leader, an internal medicine resident, educated members on the absentee ballot process, authorization of a hospital representative as proxy, and submission of completed ballots (Table 1).

Ballot authorization forms in four languages were distributed to hospital units on November 8, 2016. There were 194 eligible patients: patients in surgery or immediately post-operative, critically-ill, skilled-nursing patients, research patients, and psychiatric inpatients were excluded. Bedside nurses asked all patients about their interest in voting, distributed forms and collected completed ones. Nurses did not verify voting eligibility. Patients did not participate for the following reasons: not registered, registered in another county, non-citizens, too ill, not interested, did not like candidates/issues, or declined without explanation. A hospital representative delivered 27 completed forms to the voting center. Election officials verified 11 (41%) applications and rejected 16 (59%) because applicants were not registered or registered in another county. Among the 11 absentee ballots, 8 (73%) were delivered; 3 patients were already discharged. All 8 ballots were completed and submitted to a polling location for counting during the election.


We describe a successful hospitalist-led patient advocacy initiative to help voters submit a ballot despite acute illness requiring hospitalization. US voter participation is notably low and recent elections have been decided by small margins. This program serves as a roadmap for hospitalists and other healthcare leaders to facilitate hospitalized voter participation in elections. On-going effort to advertise broadly and scale these programs to regional or national level is needed to ensure hospitalized eligible voters can participate in future elections.