Beyond the exam room: How physicians can seamlessly share information about registering to vote with patients

A few years into practicing at Lynn Community Health Center (LCHC) in Lynn, Massachusetts, I started noticing a pattern I couldn’t screen my way out of. I’d ask a patient about their diabetes control, walk through their food access, ask whether they had reliable transportation to pick up insulin—all the standard social-determinants-of-health questions we’re trained to ask.

But underneath nearly every one of those answers was a policy decision someone else had made: about SNAP eligibility, about MassHealth transportation benefits and about pharmacy reimbursement. My patients were living downstream of decisions they’d had almost no hand in shaping.

That’s the structural determinant of health that clinical medicine tends to leave alone. As Daniel Dawes, author of “The Political Determinants of Health” has put it, voting is arguably the most consequential of the political determinants of health—the mechanism by which the “causes of the causes” of poor health actually get decided. And the data backs up the intuition: Research at the global, national and state level shows a consistent association between voter participation and health outcomes.

The scale of the gap is hard to ignore once you see it. There are an estimated 72 million unregistered eligible voters in the United States—roughly the entire population of France. When you overlay who those unregistered voters tend to be (young, lower-income and disproportionately people of color) against who tends to be most marginalized by our health system, the circles overlap almost completely. These are our patients.

Can we make civic engagement easier for our patients?

Healthcare workers are among the most trusted professionals in the country—more trusted than teachers, clergy, accountants or the police—and 85.2% of American adults saw a health professional at least once in 2024. That combination of trust and reach means primary care touches more unregistered voters than almost any other institution in a community like Lynn, where a large share of our patient panel is low-income, immigrant and non-English-speaking.

Because of this, we at LCHC partnered with Vot-ER, a non-partisan nonprofit that builds healthcare-based civic engagement tools, because they’ve already solved the problem of how to do this without turning clinical staff into political organizers. Their model is deliberately narrow: provide information, never advocacy; make registration frictionless; and keep it nonpartisan by design.

Using existing channels for outreach

We didn’t create a new program so much as thread civic engagement through four channels we already had:

• People power: During the normal flow of a clinic day, medical assistants, nurses, PCPs and pharmacy staff could offer voter registration information to patients—the same way they might mention a flu shot. No new appointment type, no separate workflow.
• Epic power: We built Vot-ER’s QR codes directly into the after-visit summary, auto-populated in the patient’s preferred language. A patient leaving with their AVS in Spanish got a registration link in that same language, without staff having to remember to hand out a separate flyer.
• CareMessage power: We used our existing patient texting platform to send registration reminders and links, reaching patients who might never see a QR code on paper.
• An onsite drive: On National Voter Registration Day, we staffed an in-person table—the highest-touch, lowest-tech version of the same offer.

Our results

In our first year, 2024, we saw 1,559 scans of our voter resource landing page and 1,000 clicks on “Check Your Registration.” A local newspaper covered the effort after our National Voter Registration Day onsite drive. These can seem like small numbers in the context of 45,000 patients, however, considering this was optional information offered in the margins of routine visits and a single onsite drive, we are very pleased with these results.

Addressing concerns

The first and loudest concern, predictably, was political neutrality. In a climate where voting itself has become polarized, some staff and patients worried that offering registration information—even while nonpartisan—signaled a political stance from the health center.

We addressed this with clear communication to our staff and ensuring that all communications and handouts were absolutely nonpartisan. Interestingly, many of our staff were new to voting and learned a lot about the connections between healthcare and voting throughout this involvement.

The second was workload. Medical assistants and nurses are already stretched across rooming, vitals, screening, documentation, etc. Adding “offer voter registration” to that list risked being one more mandate that either gets skipped under time pressure or resented. We did not require all staff to participate and we did not expect every patient to get connected to voter registration.

We built up our Vot-ER team organically, one person at a time. If there was some time in between a vaccine and the PCP visit, then the medical assistant would speak with the patient about voter registration. 

Our tips for practices who want to try this

If you’re a primary care leader considering something similar, a few lessons transferred cleanly from our experience:

1. Ride existing infrastructure rather than building new. The Epic AVS integration and CareMessage outreach worked because they piggybacked on tools staff already used every day. Anything that required a new step in the workflow saw far lower uptake than anything embedded in an existing one.
2. Nonpartisanship has to be structural, not just stated. It’s not enough to tell staff “this is nonpartisan”—the tools themselves (Vot-ER’s materials, in our case) need to make partisanship structurally impossible, so staff never have to exercise judgment about who gets offered the information.
3. Start with the highest-trust touchpoints. The after-visit summary and in-person conversations outperformed anything more passive, which tracks with the broader finding that healthcare workers’ trust advantage is the actual asset being spent here.
4. Measure what you can, and be honest about what the numbers do and don’t show. We can report registration clicks; we can’t yet report downstream voting behavior or health outcomes, and I’d caution other practices against overclaiming impact before that data exists.

Voting is a health behavior

Addressing the structural determinants of health doesn’t require primary care to become political. It requires primary care to recognize that civic participation is itself a health behavior—one we’re uniquely positioned to support without ever telling a patient how (or whether) to vote.

For a federally qualified health center like ours, whose entire mission is rooted in the idea that access and equity are inseparable, this felt less like a new initiative than an overdue extension of the one we already had.

Related reading:

Why ensuring continued access to vaccines is essential to the health of America

Swimming through a sea of white coats: Finding my voice in advocacy