How Hospitals Can Help Get Out The Vote

Crossposted at HealthAffairs blog.

As I write this, the Supreme Court has yet to reveal its decision about the Affordable Care Act. Regardless of what they decide, we can be certain of one thing. This November, the ability of Americans to get the facts they need to make informed choices about the future of US health policy will be as important as their ability to exercise their right to vote.

But a recent spate of restrictions on voting rights in many states may make it harder for millions of eligible Americans, including people of color and lower-income voters, to cast their ballot. Without their voice, local and national debates about health policy will be less informed and less representative. And since these groups are disproportionately sicker and underserved, it is reasonable to predict that costly and preventable health disparities will persist or worsen if the voices and concerns of our most vulnerable neighbors are muted in the electoral process.

America’s hospitals, which alone provide around 110 million outpatient visits each year, are well-positioned to help address these related challenges to civic participation and health policy.

For public health advocates, voter engagement in these settings represents an important yet often overlooked opportunity to mobilize voters to support community prevention-oriented policies. For civic groups and local election officials, seizing the opportunity to partner with health care professionals and mobilize voters in hospital settings can help uphold the right to vote for millions of Americans. In 2008, a pilot effort by our nonpartisan coalition registered nearly 26,000 voters in health care settings and hinted at the potential of health professionals and students within hospitals and clinics to help mobilize voters. That work also laid the foundation for a simple premise: for eligible Americans, it should be as easy to register to vote at a doctors’ office as it is at the Department of Motor Vehicles.

An Epidemic Of Voter Restrictions

For months, voting rights experts have been raising concerns about the state-by-state spread of voting restrictions. According to the Brennan Center, at least 180 bills introduced since the beginning of 2011 in 41 states could make it harder for nearly 5 million Americans to vote this November – a number larger than the margin of victory in two of the last three presidential elections.

These voting restrictions will likely increase long-standing gaps in civic participation rates. People of color, people with disabilities, low-income voters and other traditionally marginalized groups have faced major challenges to electoral participation in the past. Now these citizens, in addition to seniors and students, face new risks due to recent laws including photo ID and proof of citizenship requirements which many experts consider overly burdensome and restrictive. In many states, it will now be harder for a citizen, particularly one from a historically underserved community, to prove her eligibility to vote.

Once eligible, Americans will have a harder time registering to vote in at least sixteen states where new restrictions have been introduced, including those that end same-day, Election-Day voter registration, and voter registration mobilization efforts.

Health Depends On A Vibrant Democracy: Why Voting Rights Matter

For a growing number of doctors, nurses, and health professionals, upholding the right to vote and speaking out against overly burdensome restrictions on voting is not just a civic duty. It’s also a way to help break the vicious cycle that links civic and health disparities.

A growing international consensus built on years of research shows that the root and distribution of many diseases start with a lack of equitable, prevention-oriented policies, health-promoting environments, and adequate healthcare. Historically marginalized communities, especially low-income residents, people of color, and people with disabilities, have borne the brunt of these downstream diseases. Childhood asthma, which is linked to pollution and a lack of healthy housing, is a classic reminder of this link between upstream policymaking and downstream health disparities. Spurred by this more nuanced understanding of disease, some healthcare providers are now learning how to reshape clinical care and improve the social factors that make people sick.

These upstream ingredients for healthy living — community-level prevention, healthy environments, and high-quality health care — all depend on the participation of an engaged electorate to shape policies and decisions about how resources are allocated. Ultimately, health is shaped not just by the advocacy of professional interest groups or policymakers but also by the depth and quality of grassroots-level civic participation. And civic participation itself is shaped by our health, or the lack thereof.

According to the US Census Bureau, for instance, nearly 1 in 7 registered voters who did not vote in 2008 cited illness or disability as the main barrier to voting. (Among lower-income nonvoters, illness was a barrier for nearly 1 in 5 people – a rate about three times higher than higher-income nonvoters). Our health depends on and is a resource for a vibrant democracy. Breaking the vicious cycle of civic and health disparities, therefore, requires innovative, linked approaches to promote health and democracy.

Hospital-Based Voter Registration: A Prescription For America’s Civic Health

According to the Centers for Disease Control and Prevention, Americans visit hospital outpatient clinics nearly 110 million times a year. That’s roughly 37 visits for every 100 Americans and does not include visits to the emergency room, hospital stays, or even visits to non-hospital, office-based physicians. The sheer number of hospital outpatient visits rivals the number of Americans served by the Department of Motor Vehicles, where voter registration is an integrated and commonplace option. By following the example of community health centers, hospitals can seize a major opportunity to expand nonpartisan voter engagement and mobilize millions of Americans to get involved in health policy and democratic decision-making.

Web Videos To Help Health Professionals Engage Voters

To turn this vision of nonpartisan hospital-based voter engagement into a reality, RxDemocracy, a coalition of doctors and medical students sponsored by the National Physicians Alliance, recently teamed up with the Brennan Center, a nonpartisan public policy and law institute, to produce a three-part online video series for health professionals. As a scalable application of “flip-teaching,” these videos aim to spur discussion and action among current and future health professionals with instructive web clips that they can watch on their own or share with hospital-based colleagues. As discussed in these videos, hospitals can take relatively simple steps to help Americans register and vote.

Under the 1993 National Voter Registration Act, hospitals can provide voter registration forms, permit nonpartisan voter registration drives on-site, and even request to be state-designated voter registration agencies. Some hospital associations in Texas and Mississippi have been helping staff register to vote. Recently, the American Hospital Association launched its own voter engagement campaign. Not surprisingly, these efforts are typically components of larger advocacy campaigns that help promote hospital interests. Understanding and navigating these interests will be important for health professionals and advocates who seek to educate voters about community prevention and population health-oriented approaches to improving our nation’s healthcare system.

An opportunity for helping millions of Americans exercise their rights, improve public health, and help strengthen the electoral process is well within reach. It starts with visiting the hospital.

Copyright ©2010 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.