Voting is not only good for democracy, it is also good for your health, according to one of the nation's largest medical associations.

The American College of Physicians said voting empowers people to engage with their community, while ballot initiatives and elected officials determine just how well the health care system works.

Dr. Omar Atiq, president of the American College of Physicians, said voters ultimately determine peoples' access to health care services and physicians' ability to treat them.

"If there is more voter participation, there will be better health care policies and therefore, better health care," Atiq contended.

Atiq pointed out research shows states with fewer barriers to voting have better health outcomes than states with restrictive voting laws or gerrymandered maps. Missouri ranks 41st among states in terms of access to the ballot.

The American College of Physicians is encouraging all health care professionals and medical students to engage patients in nonpartisan, health care-related conversations about voting as a way to increase health equity. Atiq suggested posting voter registration information in patient waiting rooms is a good place to start.

"We are looking at talking to patients about the importance of their voice in making sure that the national resources are allocated to where we have optimal health for everyone," Atiq explained.

Atiq reported despite being one of the richest and most technically advanced nations in the world, the U.S. ranks lowest in life expectancy, for both men and women, among comparable countries. He added physicians have a responsibility to help their patients when they need it, and talking about voting on issues to improve health care is part of it.

Support for this reporting was provided by The Carnegie Corporation of New York.

By Vanessa Davidson / Broadcast version by Farah Siddiqi reporting for the Kent State NewsLab-Ohio News Connection Collaboration.

“As Ohio goes, so goes the nation” is a saying that rang true for many presidential election cycles. Ohio was a key swing state for decades, voting with the winner of U.S. presidential elections every year from 1960 until 2020. 

But since 2012, the margin of voters in favor of Republican presidential candidates has steadily increased. In 2012, around 47.7% of Ohio voters favored the Republican presidential candidate, followed by 51.7% in 2016 and 53.3% in 2020. 

In 2024, Donald Trump won 55.2% of Ohio votes. 

Experts cite a variety of reasons for that shift — including a decline in the power of labor unions, fewer college-educated voters than the national average and the effectiveness of the Republican Party’s campaign methods.

“Because we were a big manufacturing state, and because manufacturing jobs did usually require a college education, it wasn't necessary for a lot of Ohioans to get a college degree,” said former Ohio Governor Bob Taft, now a professor at The University of Dayton . 

“And you know, one of the key breaks now between Republican voters and Democrat voters is Republicans are doing a lot better with and particularly Trump is doing a lot better with voters without a college degree,” he said. “So I think that too is one of the factors that explains why Ohio has become so red as a state.”

Like many of the states that surround it, Ohio is what’s known as a Rust Belt state. With the flourishing of automotive and manufacturing industries, many blue-collar jobs emerged between the 19th century and the 20th century.

However, throughout the later half of the 20th century and early 21st century, factories gradually closed, taking manufacturing and supporting jobs with them. As a result, numbers in labor unions dwindled, causing a lack of resources and campaigning — a hit that impacted the strategy of the Democratic Party.

“Organized labor was a big part of the Democratic strength in Ohio when I first entered politics, because the labor unions had to have more members,” said Taft.

Taft was governor of Ohio from 1999 to 2007, representing the Republican Party. Ted Strickland, a Democrat, served one term after Taft. All Ohio’s governors since 2011 have been Republicans. 

Unions at that time, Taft said, “Had more resources. They actively engaged in political campaigns, generally on behalf of Democratic candidates. We still have labor unions which still have some members, but it's not on the scale that it used to be, say, 20 or 30 years ago.”

Ohio’s working class sought out support and representation after the 2007 recession, and still continue to by voting for candidates that prioritize their needs. The focus on blue-collar workers was key to former President Barack Obama’s consecutive wins in 2008 and 2012. 

“Obama did carry Ohio twice, but Obama was, I think, perceived as a change candidate, someone that would make things better,” Taft said. “And so, he was able to appeal to a broader group of voters than a Democrat might normally appeal to in Ohio.”

Donald Trump's victory in 2024 has also been partly attributed to his focus on promising change and speaking towards the working class. 

Social media has also played a role in Trump’s victories since he was able to reach broader audiences, said Dr. Lauren Copeland, the director of Community Research Institute at Baldwin Wallace University.

“Social media has played a large role in creating divisiveness in society, and at the same time, it's also provided candidates — such as former President Trump and now incoming President Trump — with platforms to directly reach out to their base without having to go through the media,” Copeland said. 

“I don't think that Trump would have succeeded as much as he did in 2016 had he not used Twitter effectively to reach his base.”

College degrees have also had a big impact on the way Ohioans vote. People with college degrees are more likely to vote Democrat than people without college degrees. 

Voters without degrees lean toward Republicans. According to the Pew Research Center, around 63% of Republican voters in 2022 did not have college degrees, compared to 49% of Democratic voters.

This divide in education represents a broader perspective. Often, people without college degrees prioritize issues like immigration and job security, which are topics that align with more conservative policies.

“People without a four-year college degree tend to be more conservative than people who have a four-year degree, or especially an advanced degree,” said Copeland.

According to 2023 census data, 32% of Ohioans have bachelor’s degrees, 4.2 percentage points below the national average of 36.2%. 

Racial demographics also play a part in how a community votes. Outside of major cities where the majority of people of color live — like Cleveland, Columbus, Cincinnati, Akron, Toledo and Dayton — all other counties in Ohio voted red in 2024.

“People who are nonwhite, such as African Americans, tend to be more liberal than their white counterparts,” said Copeland. 

In 2023, 76.7% of Ohioans were white, compared to 58.4% of Americans overall. 

“When you have a state like Ohio that has a lot less diversity than, say, other states like Illinois, New York, or even some of the states in the southwest, then you're going to have a climate in which Republicans are going to be more likely to win,” Copeland said.

With these many different factors influencing Ohio’s political landscape, Ohio’s future as a swing state is questionable. 

“Ohio will still be overall, in all probability, a Republican state, but… not as Republican as a state like Montana,” said Taft. “So I think a Democrat will win, potentially statewide, in Ohio. But it's a little uphill for the Democrat Party.”


This collaboration is produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.


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Lawmakers in Annapolis plan to introduce a bill to require a special election if a lawmaker is appointed to a seat in the first half of their term.

Maryland's constitution requires the political party committee in the district the former lawmaker represented to pick a replacement to fill the seat. The recommendation then is sent to the governor, who usually approves the person.

Del. Linda Foley, D-Montgomery County, the sponsor of the bill, said voters are sometimes represented by an appointed lawmaker for as long as four years.

"You end up with a rather large percentage of the General Assembly then being appointed and not elected and not facing the voters," Foley pointed out. "This has been an ongoing debate about whether this is a democratic way to replace people."

Nearly a quarter of state legislators in Maryland, including Foley, started in the legislature by political appointment, rather than an election.

The bill would not do away with the appointment process entirely. State legislators serve four-year terms, running in midterm elections. An appointment would be made, though any lawmaker appointed in the first half of the term would have to run in a special election held during the Presidential primary and general elections.

Foley emphasized the bill is not meant to fill every vacancy with a special election, a process she said would be costly.

"There is a cost factor to holding elections all the time and it's not insubstantial," Foley acknowledged. "Not to say that you can put a price on democracy, but you do have to consider what's the cost of doing this. Two years in office without having to face the voters isn't as problematic as four."


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By Marilyn Odendahl for The Indiana Citizen.
Broadcast version by Joe Ulery for Indiana News Service reporting for the Indiana Citizen-Free Press Indiana-Public News Service Collaboration.

For St. Joseph County Circuit Court Clerk Amy Rolfes, the statistics only confirmed what she had been seeing and hearing from voters in the days and weeks leading into the Nov. 5 election.

Nearly 59,000 registered voters in the Northern Indiana county cast a ballot either by mail or by going to the polls before Election Day, topping the number of voters who visited the polls on Nov. 5 by more than 5,000.

However, Rolfes already knew early voting was popular by the public's reaction to St. Joseph County's third early-voting site that was opened this year for the first time. The new polling place was opened two weeks before the general election in Center Township's public library, located in the southern portion of the county.

The site was busy every single day it was operating, Rolfes said, and voters were thanking the staff giving them a convenient place to vote.

"Clearly the voters have spoken," Rolfes said. "They enjoy early voting."

The final vote tallies from the November election show the popularity of early voting was similar across the state to what Rolfes saw in St. Joseph County. According to data from the Indiana Secretary of State, 1.6 million eligible Hoosier voters - 54% of all who cast a ballot in the 2024 general election - voted either absentee or in person prior to Election Day. Comparatively, 1.87 million registered Indiana voters - 61% of those who voted - went to the polls early in the 2020 general election.

Despite the early voting numbers, Indiana's overall voter participation slipped this year. The secretary of state reported that 4.84 million Hoosiers were registered to vote in November, which is 86,085 more than were registered in November 2020. However 2.97 million, or 61%, voted in the 2024 general election, which is 94,349 fewer than the 3.07 million, or 65%, who voted four years ago.

Julia Vaughn, executive director of Common Cause Indiana, said she is disappointed that lawmakers are not doing more to improve the state's voter turnout numbers. Changes that would enable more Hoosiers to vote include same day voter registration, extending voting hours, and prohibiting candidates and their supporters from being any closer than, at least, 100 feet from the entrance of a polling site on Election Day.

"That's frustrating when clearly we have a big problem with turnout and zero problems in term of (election) security, yet our policymakers continue to make voting more restrictive in the name of making it more secure," Vaughn said. "We should be opening it up in the name of getting more people involved."

Demand continues for early voting

Like St. Joseph County, Clark County in Southern Indiana opened another early voting site for the November election.

Clark County Circuit Court Clerk Ryan Lynch said the second polling place, at the R.E.M.C. building along U.S. 60, was a more convenient option for voters in the middle and northern parts of the county. They did not have to travel to the courthouse in downtown Jeffersonville to vote.

Lynch said he believes the additional polling location motivated more people to vote early. Although the 22,522 voters in Clark County who voted either by mail or in-person before Election Day was down from the 28,666 who cast an early ballot in 2020, he does not expect interest in early voting to wither.

"I think we should definitely plan for big turnouts for early voting and put more resources into that to be prepared," Lynch said.

After the Marion County Election Board voted against extending early voting by two hours in the morning, Marion County Circuit Court Clerk Kate Sweeney Bell kept the polling site in the City County Building open until 10 p.m. the Saturday and Sunday before the Nov. 5 election. She said she added hours in the evening to make voting more convenient and had noticed that individuals who voted in the evening were wearing uniforms, indicating they were shift workers in hospitals, law enforcement agencies and private companies.

"It worked," Sweeney Bell said, but she did not commit to extending the hours in future elections.

In Marion County, 165,186, or 46% of registered voters, cast an absentee or early ballot in 2024. That was down from the 215,931, or 55% of registered voters, who voted before Election Day in 2020.

Not only were Hoosiers voting early this year, but they were, apparently, seeking answers to their voting questions sooner.

Ami Gandhi, director of strategic initiatives and the Midwest Voting Rights Program at the Chicago Lawyers' Committee for Civil Rights, said during the early-voting period, more Indiana voters were calling the 866-OUR-VOTE election protection hotline the CLCCR established. Also, they were calling before the voter registration deadline passed and before absentee voting began.

"Across the board, we heard from voters in many different parts of the state who have an interest in expanded access to early voting, including voters who wanted more locations in their county (and) voters who were seeking expanded hours and who were shocked, and at times upset, by the relative early end time to early voting on any given day," Gandhi said.

A 'chilling impact,' low turnout

Wells and Whitely counties recorded the highest turnout rates in Indiana at 73% each in November. Marion and St. Joseph counties tallied the lowest turnout rates in the state at 55% each.

Sweeney Bell was disappointed by her county's low turnout. She said the first hour the polls were open on Election Day, about 40,000 people voted in Marion County; however, the rush of voters that usually comes between 4 and 6 p.m. never materialized.

"I'm baffled when people have such power and choose not the exercise it," Sweeney Bell said, adding that voting is essentially asking people who they want making the decisions that will affect every part of their lives. She said she is disappointed and not sure why people chose to stay home, rather than go vote.

"If I knew why, I could do something about it," Sweeney Bell said.

Rolfes tried to encourage voting in St. Joseph County by producing a couple of educational videos. She was allowed to use the local public television station's studio for an hour and half and she made four "super nerdy" videos, providing instruction on such things as voting by mail and using the voting machine to cast a ballot.

"Voting information is key to increasing voter turnout," Rolfes said.

Vaughn, of Common Cause Indiana, said she believes some new voters and naturalized citizens did not go to the polls this year because of the claim by Indiana Attorney General Todd Rokita and Indiana Secretary of State Diego Morales about noncitizens voting in state elections. The two elected officials announced a few weeks before the Nov. 5 election, that they had asked the federal government to verify the citizenship status of 585,774 individuals on Indiana's voting rolls.

Calling the move by Rokita and Morales a "political stunt," Vaughn alleged the whole point of creating the list and the making announcement was to have a "chilling impact" to discourage people from voting. She said the election protection hotline did not get any calls from individuals who had their citizenship status challenged when they tried to vote, but some new voters did call the CLCCR hotline with concerns about causing trouble if they cast a ballot.

"How widespread that (was), I can't really say, but we, at least, heard from a few people and I've done this long enough to know when you get a few calls, there are many more people who didn't call," Vaughn said. "They just stayed home."

Intimidation incidents rising on Election Day

Along with Indiana voters asking for the location of their polling place and what they should do if the poll book does not have them listed as a registered voter, Gandhi said the election protection hotline also received calls about voter intimidation and aggressive electioneering at some polling places.

Reports of intimidation included Hamilton County, where a group of individuals were standing outside a polling place waving Make America Great Again flags and harassing voters, according to CLCCR and Vaughn.

Sweeney Bell said in Marion County, poll worker training was updated to include de-escalation techniques. The additional instruction was in response to the false rhetoric about insufficient election security and ineligible voting, she said.

"I have no worries about the security of the ballot," Sweeney Bell said. "I worry about the security of the poll workers."

That training appears to have helped defuse an incident at a Marion County polling place that is still being investigated and could result in criminal charges. According to Sweeney Bell and Vaughn, a man became belligerent and shouted profanities, after he was told he had to remove his Make America Great Again hat and turn his T-shirt, which identified a specific candidate, inside out. The man took off his shirt, revealing he was carrying two guns and a knife. The police were called and the poll workers were able to get the man through the voting process as quickly as possible so he left with harming anyone.

Sweeney Bell said a report detailing what happened is still being compiled. The Marion County Election Board is scheduled to meet Dec. 12, she said, and the members will talk about the incident.

"I don't think it's over," Sweeney Bell said.

In Clark County, Lynch said poll workers at one voting site were also able to defuse a situation on Election Day. Someone came to the polling place and wanted to sit and watch the machine that tabulates all the ballots. The workers at the site enlisted help from the clerk's office and the staff was able to mitigate the situation so the individual left and police did not have to be called, he said.

Vaughn said the misinformation and intimidation has gotten "exponentially worse" since 2016. Indiana's laws do not provide much protection or prevention of escalating situations, she said, noting the state allows people to electioneer within 50 feet of the polling place, one of the shortest distances in the country, and while the state permits voting sites to restrict weapons and post signs, the statute has no teeth, so officials can do little if anyone violates the restrictions.

"People (are) being very hostile to voters who they perceive to be making different choices from them," Vaughn said. "Hoosiers need to practice a lot more tolerance during election season than we have been. It just seems to be getting worse each presidential election year. We desperately need somebody to bring the temperature down."


Marilyn Odendahl wrote this article for The Indiana Citizen.


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