Lizet Ocampo, Executive Director, Vot-ER
Daniel E. Dawes, Author, The Political Determinants of Health; Founding Dean, Meharry Medical College School of Global Health; Vot-ER Advisor
August marks Civic Health Month, a time to showcase the link between voting and health. It arrives this year against a difficult backdrop. The enhanced Affordable Care Act (ACA) subsidies that helped millions afford coverage expired at the end of 2025, and federal cuts to Medicaid are reshaping who can get care and how. The ACA was among the hardest-won health equity victories in a century, and its erosion is a reminder that policy gains are never permanent. They are defended, or lost, depending on who shows up to vote.
Health care points of care can meet this moment. They are among the few institutions that touch nearly everyone, across every demographic and every zip code, and health professionals remain among the most trusted messengers in American life. Vot-ER exists to turn that trusted relationship into nonpartisan civic power, connecting patients to nonpartisan tools that let them shape the policies driving their health. With the midterms months away, that work is now urgent.
The connection is not rhetorical. In 2022, the American Medical Association formally recognized voting as a social determinant of health. The evidence bears this out: states with more inclusive voting policies and higher civic participation see measurably better health outcomes, from lower infant mortality to lower rates of chronic disease. When people have a voice in the decisions that shape their neighborhoods and their care, health improves alongside representation.
Why the Midterms Are the Real Healthy Democracy Test
Presidential elections pull people to the polls. Midterms often see a stark dropoff. Turnout in midterm years runs well below presidential years, and the people most likely to sit them out are precisely those Vot-ER reaches: infrequent voters, first-time voters, and people in communities that have long been underrepresented at the ballot box—the same communities who experience health inequities. That makes 2026 the real proving ground for whether health care-based civic engagement can sustain participation when the national spotlight fades.
The early evidence is striking. While 2025 was not an electoral cycle with major statewide races across most states, there were pivotal gubernatorial and judicial races in New Jersey, Pennsylvania, and Virginia. In all three of these states, Vot-ER’s registered voters turned out at rates that exceeded their states’ general electorate by between 13.7-18.8 percent. These were low-visibility elections in a year most people ignored, and this population of voters who were contacted by health care professionals and centers still showed up. We anticipate 2026 will extend that pattern, showing that the model does not just capture enthusiasm in a presidential year but builds a durable habit of participation.
This builds on what we saw in 2024, when Vot-ER’s registered voters turned out at 79 percent, well above the national average of 59 percent. The throughline is consistent: when a trusted health care professional or institution invites someone into civic life, they stay engaged, even in the elections the rest of the country overlooks.
Meeting People Where They Already Are
When a patient is already in a clinic or receiving electronic communications from a clinic, already thinking about their health and the barriers they face, that is the moment to connect them to the tools that let them shape the policies driving those barriers. It is why Dr. Alister Martin, Vot-ER’s founder and now New York City’s Health Commissioner, first built Vot-ER’s nonpartisan voter registration model into emergency departments. Vot-ER’s model meets patients and health systems where they are. It places nonpartisan voter registration and turnout directly into health care settings, from simple QR codes a patient can use in a waiting room to integration within the electronic health record, so that offering registration tools and turnout communications becomes part of routine workflow rather than an added burden. It’s both relational and systemic. Research has long shown the appetite is there: when health professionals ask eligible voters who have not yet registered whether they would like to, 89 percent say yes (Martin et al. 2021).
This work has reached deep into the communities that have often been overlooked in the civic process and can now begin to see the benefits of their self-agency in civic life. Through patient-facing efforts in health care settings, Vot-ER is now connecting with more than 1.5 million patients in 2026 alone, using tools like text message outreach and patient portals to reach people where they already are. These are often patients in health centers that serve historically underrepresented communities and low propensity voters—the same communities that bear the heaviest burden when coverage disappears.
From the Ballot Box to the Census
Voting is not the only way communities make themselves count. Many civic engagement efforts are required to create better health outcomes. The decennial census determines how hundreds of billions of dollars in federal funding, including funding for health programs, are distributed across communities for a decade. An undercounted community is an underfunded community, in health care and nearly everything else. The populations most likely to be missed by the census overlap almost exactly with those most likely to be missed at the polls.
Health care settings can help close that gap, too. Vot-ER has begun exploring how health centers will play a role in census engagement, including focus groups with patients to understand what would help their communities be fully counted. This is both a near-term and a long-term strategy: the same trusted relationships and the same infrastructure that connect patients to voter engagement can help ensure their communities are counted, and therefore funded, for the decade that follows. It is a natural extension of Vot-ER’s work: the institutions people already trust with their health can also help them claim their full stake in the systems that shape it.
The Investment Opportunity
For health funders, the opportunity and the stakes are clear. What is happening to coverage and care has been exponentially heightened. Supporting nonpartisan civic health work is not a bet on a promising idea; it is an investment in a proven avenue for reaching the people most impacted by the political and social determinants of health.
The most durable investments will support the organizations and health settings already embedded in the communities most affected by health inequities, and will treat civic participation, at the ballot box and on the census form alike, as the upstream health intervention it truly is. When patients become voters and are counted where they live, the communities that have gone underrepresented for generations gain real power over the conditions that determine their health. The tools exist, the need is urgent, and the funders who move now will define what civic health looks like for the next decade.
References:
Martin, Alister, Raja, Ali & Meese, Halea. Health care-based voter registration: a new kind of healing. International Journal of Emergency Medicine 14, 26 (2021).