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    As a result of the COVID-19 crisis, inequities within our healthcare system are on full display, and it further exposes how our most vulnerable are treated when seeking care. The disparities around who gets tested, access to testing, and whether they can even be seen by a health care provider are even more apparent during this crisis. Politicians, celebrities, and athletes are reporting access to testing while this is not the lived experienced of everyday Americans.

    Even with the advancement of technology and an encouraged reliance on telehealth, these inequities in our health care system are the reflection of a country with barriers to civic engagement for its most vulnerable. We live in a country where 51 million potential voting-age adults are not registered to vote.

    Disproportionately, those who are not registered to vote fall into one of three categories – the young, the poor, and those of color. For example, 36 percent of eligible African Americans and 48 percent of Hispanics were not registered to vote in the 2014 presidential election. And rates among young citizens are not much better; just 50% of millennials voted in the 2016 election, compared to 69% of Baby Boomers and 63% of Generation X.

    It turns out that the same demographic groups that are not registered to vote also disproportionately utilize ERs at higher rates across the country for non-emergency care because they lack access to primary care. In other words, patients who are young, people of color, and have low income are frequently coming to the emergency room for non-life threatening conditions. 

    Consider, the annual visit rate was 45.1 ED visits per 100 persons for the average patient in America. But when stratified among patients of color the visit rate was almost two times higher at 85 visits per 100. I’m an ER doctor and I see this phenomenon nearly every shift, but how do we empower our most vulnerable in order to create change?

    Why not use the opportunity to register them to vote in the ER and in other health care settings where marginalized communities get their health care?

    VotER Gets Patients Registered to Vote While They Wait

    VotER is a new civic engagement organization that registers patients to vote in health care settings as described here in the Boston Globe. VotER was launched through a collaboration between Massachusetts General Hospital, TurboVote, and ideas42 and we build platforms that offer non-emergency patients a chance to register to vote in 90 seconds or less using a combination of iPad kiosks and behaviorally informed posters, stickers, and discharge paperwork while non-emergency patients wait in ERs and community health centers.

    Our early pilots have resulted in significant demand from over 50 hospitals across the country in two months – and we are confident this model will lead to large increases in voter registration rates when paired with effective integration with engaged and social justice oriented staff like social workers in chosen health care settings. 

    How We Work

    iPad Based

    VotER uses ipads contained in freestanding kiosks in areas where low acuity patients wait in the ED. The ipads are programmed to only allow voter registration. Above the ipads are large signs that invite voter registration. 

    Patient Phone Based

    We deploy posters in the ED that have a text to register feature which allows patients to text a ‘short code’ to a specific number which lets them register using their phone or use a QR code to initiate the same process.

    Second, we have developed patient handouts that have embedded QR codes and URL links that connect patients to the same Turbovote voter registration platform. 

    Social workers as innovators in civic engagement

    Studies demonstrate that social workers participate in political activities more than other professions and vote at higher rates than the general population. Indeed the institution of The Human Service Employees Voter Registration and Education Campaign (Human SERVE) and the successful National Social Work Voter Mobilization Campaign (Voting is Social Work) demonstrate that the social work profession has always known that voter registration and voting support a robust democracy, a just society, and an equitable health care system.

    Moreover, social workers have a long track record of success doing voter registration at rates higher than other traditional voter registration groups. During the 1984 election, for example, just 1% of those working with Human SERVE voter registration campaign registered 275,000 people nationally

    At VotER, we know that for decades social work has been out in front doing the hard work of voter registration in health care settings — and the tide is now turning. Hospitals are now becoming engaged participants, and VotER is letting them do this in a way they’ve never been able to before.

    We value the legacy of activism and empowerment among the field of social work and know that VotER needs input from social workers to blend our novel approach with on the ground tactics and real-world applications inspired by you. We also know that while VotER’s early pilots have resulted in demand and excitement from hospitals across the country, we need the input and insight of the field of social work to truly scale this effectively. 

    We know that without participation from those most hurt by the healthcare system, politicians will continue to turn a blind eye to the needs of disenfranchised patients. Do you have ideas on how to partner effectively? Do you have suggestions on how social workers can use part, or all, of the VotER platform in the 2020 election and beyond? We’d love to hear your thoughts and suggestions here.

    Call to Action and How You Can Help

    We need your help and ingenuity to address this challenge — specifically, to explore how healthcare workers and spaces can support patients with voter registration via VotER. If you are interested in partnering with us, fill out this form to connect with us

    Behavioral Econ nerd, ER doc, sometimes writer, current Faculty in the Center for Social Justice

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