Election Day: The Votes of Hospitalized Patients Matter

Supporting the right to vote for hospitalized patients

Election day—it’s coming up. For many Americans, this is an opportunity to shape the future of our country, state, and local communities. Getting admitted to the hospital unexpectedly early this November—that’s coming up too (for many voting Americans). So, what are those individuals to do if they want to vote?

The ability to vote is paramount and is now recognized as a social determinant of health. In 2022, the American Medical Association issued a resolution acknowledging the ability to vote as a social determinant of health and supported efforts that facilitate “safe and equitable access to voting.”¹ The Health Resource & Services Administration released guidance for health systems to support non-partisan registration efforts for federally funded health centers, and many organizations, including the American College of Physicians, have called on healthcare practitioners to consider promoting voting access as a fundamental healthcare duty.^2,3

Calls for hospitalists to participate in the electoral process and promote access to voting have been increasing.^4-6 Facilitating voting access for the tens of thousands of Americans on our inpatient teams in the immediate days leading up to November 5—now that sounds like something hospitalists might be masters at!

Emergency absentee voting—what is It?

Regular absentee ballots are available for those who know they won’t be able to be present at the polls on Election Day. A majority of states, however, have absentee ballot deadlines which, in some cases, can be several days or even up to two weeks before Election Day. This allows for a period of vulnerability for individuals intending to vote in person who become hospitalized or otherwise experience a health barrier to making it to a voting location on November 5.

Enter the emergency absentee voting process. For those with unforeseen health circumstances who did not arrange in advance to vote by regular absentee ballot, many states’ voting regulations include the provision of emergency absentee ballots. These regulations allow individuals hospitalized or in post-acute care facilities leading up to the election to vote without needing to be physically present at a voting location on Election Day.

In a 2021 study assessing state voting laws, 39 states had emergency absentee voting processes allowing registered voters who couldn’t make it to the polls for health-related reasons the chance to cast their ballots. The study revealed substantial differences in emergency absentee voting procedures among states, including variations in who could act as an “authorized agent” to assist with the ballot, whether a physician’s signature or affidavit was necessary, and whether a notary or witness was required.⁷ So how does a patient go about voting from the hospital?

Emergency absentee voting process

The general process for hospitalized patients to vote is the following: the patient (who must be a registered voter) completes the emergency ballot application which is then submitted to their Board of Elections (or other voting regulatory body). The Board of Elections then sends the ballot to the patient who fills it out, and it is then returned to the Board of Elections. Depending on the state in which the patient lives, the application and ballot can be sent electronically, by mail, in person, or through an authorized agent (Figure 1).

For example, the state of New Mexico requires a written request for an absentee ballot signed by the patient and the healthcare practitioner. The request and ballot itself can be delivered by a patient-designated authorized agent. However, the state of Kansas requires the patient to request the ballot from the County Election Office and an authorized agent cannot be used. For examples of a few additional states and elements of their processes, please see Table 1. For a list of other states’ requirements, visit PatientVoting.com or your state’s Board of Elections website.

Most states allow for an authorized messenger to take in-person trips to and from the election office to deliver the application, pick up the ballot, and deliver the ballot. Some states have restrictions on who can help with which steps. However, it is encouraged to use case management team members and/or hospital-based volunteers to help patients with this process and ensure that they understand their voting options. Deadlines for when patients can request and submit ballots vary significantly by state. Additionally, some states send bipartisan, in-person teams to patients in their hospital rooms to complete their ballots.

With the high variability in processes and how difficult it can be to find appropriate steps on some state-specific websites, Patient Voting, a non-partisan organization that seeks to increase voter turnout among registered hospitalized voters, contains a state-by-state summary of policies. Its site includes links to state commissioner websites detailing more specific language as well as emergency ballot applications for printing in the hospital in many cases.

What can hospitalists do to support patients who want to vote?

As hospitalists, there are a handful of ways we can facilitate voting for the patients who are under our care leading up to the election. At a minimum, we should become familiar with our state and county regulations on emergency absentee voting and be able to counsel our patients on the appropriate first steps for a patient to take. In the coming weeks, every hospitalist should take a look at PatientVoting.com to learn about their local processes.

Many states require a statement from a physician or healthcare practitioner verifying that a health-related condition exists which precludes a patient from making it to a voting location. As such, hospitalists should make themselves available for our patients in this regard if needed. Hospitalists can create templated language or dot phrases within our electronic medical records and share them with our colleagues. An example of some templated language is provided in Figure 2.

Hospitalists can also incorporate asking admitted patients in the emergency department or on the floor if they would like to know more about voting while hospitalized and provide the information on requesting and submitting absentee ballots. This aligns with our role in addressing social determinants of health and caring for patients in a holistic manner.^8,9

At the health system level, hospitalists can also take lead roles at our institutions to improve voting awareness and engagement. Examples of such engagement have been reported with hospitalists taking roles in designing voting registration assessments as routine, healthcare-team member workflows, coordinating voter registration drives, and advocating for their hospitals to partner with nonpartisan civic engagement organizations.⁴ Within the realm of emergency absentee voting, we can organize other hospitalists in our groups by sharing information on local voting policies and brainstorming ways to integrate facilitation of ballot requests within our workflows.

Final thoughts

Life itself can be unpredictable and undergoing a hospitalization is perhaps one of the most vulnerable and disrupting challenges one can experience. However, it should not stop those who desire to perform their civic duty from casting their ballots. As hospitalists, we have a unique vantage point and access to tens of thousands of voting Americans who, because of illness, find themselves in our wards and units leading up to the election. We can play a pivotal role in helping make our patients’ voices heard. 

Dr. Thomas

Dr.Pizanis

Dr. Thomas is a resident physician in internal medicine at the University of New Mexico in Albuquerque, N.M., where she is a member of the hospitalist training track. She plans to practice as a hospitalist in the state of New Mexico. Dr. Pizanis is an associate professor and co-director of the University of New Mexico’s hospitalist training track, division of hospital medicine, department of internal medicine, at the University of New Mexico School of Medicine in Albuquerque, N.M.

References

1. American Medical Association. Support for Safe and Equitable Access to Voting H-440.805. AMA website. https://policysearch.ama-assn.org/policyfinder/detail/voting?uri= %2FAMADoc %2FHOD.xml-h-440.805.xml. Published 2022. Accessed August 30, 2024.
2. U.S. Department of Health and Human Services Health Resource and Services Administration. Voter Registration and Health Centers. HRSA website. https://bphc.hrsa.gov/compliance/scope-project/voter-requirements. Updated March 2022. Accessed August 30, 2024.
3. Cline K, Hilden D, et al. Ensuring equitable access to participation in the electoral process: a policy brief from the American College of Physicians. Ann Int Med 2023;177(1):68-69.
4. Rubiano C, Schoenberger A. Hospitalists, the catalyst for voter engagement in healthcare. The Hospitalist website. https://www.the-hospitalist.org/hospitalist/article/37528/career/hospitalists-the-catalyst-for-voter-engagement-in-healthcare. Published August 1, 2024. Accessed August 30, 2024.
5. SHM Policy Committee. Hospital medicine, it’s time to vote. The Hospitalist website. https://www.the-hospitalist.org/hospitalist/article/229706/mixed-topics/hospital-medicine-its-time-vote Published October 8, 2020. Accessed August 30, 2024.
6. Skandhan A. Why hospitalists should vote and help patients with civic engagement. The Hospitalist website. https://www.the-hospitalist.org/hospitalist/article/33136/advocacy/civic-engagement/. Published September 1, 2022. Accessed August 30, 2024.
7. Tang OY, Wong KE, et al. Emergency absentee voting for hospitalized patients and voting during COVID-19: a 50-state study. West J Emerg Med. 2021;22(4):1000-9. doi: 10.5811/2Fwestjem.2021.4.50884
8. Equitable allocation of resources. J Hosp Med. 2017;12(S1):S62. doi: 10.12788/jhm.3016
9. Palliative care. J Hosp Med. 2017;12(S1):S71-72. doi: 10.12788/jhm.3008