Next Tuesday, November 6, 2018, Massachusetts voters will vote on ballot Question 1—an initiative that, if passed, has the potential to adversely affect health care and specifically, devastate the mental health system statewide. Driven by the Massachusetts Nursing Association, a union that represents about 25% of the nurses in Massachusetts, ballot Question 1 seeks to impose rigid nurse-to-patient staffing ratios that would be catastrophic to the already overburdened behavioral health system.
What Is Question 1?
The ballot initiative mandates arbitrary minimum nurse staffing levels in all units, in all hospitals, meaning:
- A set number of registered nurses
- At all times (including overnight shifts)
- In all hospitals
- With no flexibility, regardless of local circumstances, including emergency situations
- Requiring that services be closed or limited if sufficient nurses cannot be found and hired to meet the new mandate
Initiative Impact
Statewide Implications
If passed, the initiative will:
- Drastically increase hospital costs
- Impose mandated, at-all-times ratios between registered nurses and patients
- Require hospitals to comply with the ratios without reducing staffing levels of non-RNs
- Require implementation of a patient acuity system, used to increase staffing above the mandated ratios
- Impose a $25,000 per-violation, per-day fine on providers that do not comply
Financial Implications of Question 1 Within the Commonwealth
- The Health Policy Commission’s independent analysis concluded that passage of Question 1 would increase annual health care costs by over $900 million per year
Implications of Question 1 on Behavioral and Mental Health Care
- Projected closure of 1,000 out of 2,950 beds statewide
- Estimated annual implementation costs of $80 million/year for psychiatric units in acute care hospitals, $100 million/year for freestanding psych & substance use treatment hospitals, $46 million/year for Department of Mental Health hospitals, and a total cost of $226 million/year to the behavioral and mental health system
How Will McLean Be Affected?
- The cost to McLean, if Question 1 passes, will be greater than $10 million annually, assuming that nurses could be hired to meet the mandated ratio
- McLean’s projected nurse shortage would be more than 80 full-time equivalents
- McLean, as with all behavioral health facilities, would be mandated to have the same number of registered nurses for all three shifts, requiring a dramatic increase of nurses for the night shift, even though actual clinical needs are reduced because most patients are sleeping
What Others Are Saying About Question 1
Governor Charlie Baker
Gov. Baker says he is voting against Question 1, because “many community hospitals and some nursing homes, and even some rehab hospitals, would have their operational future put in jeopardy if that law were to pass.”
The Boston Globe
“Vote ‘no’ on Question 1. The nurse staffing ratio is wrong for Mass.”
The Wall Street Journal
“Higher medical bills would be one outcome, though another way to meet the ratios would be to limit patients. Boston Medical Center, the busiest provider of trauma and emergency services in New England, estimates Question 1 would force it to treat 100 fewer emergency-room patients every day and deliver 800 fewer babies each year.”
Who Else Opposes Question 1
- Every hospital in Massachusetts
- Half the nurses in the state
- More than half of likely voters in Massachusetts
- More than 20 leading health care and advocacy groups, including the Massachusetts Medical Society, American Nurses Association Massachusetts, Emergency Nurses Association, Massachusetts Taxpayers Foundation, Massachusetts Association of Behavioral Health Systems, and Greater Boston Chamber of Commerce
We urge you to vote “no” on Question 1, because, if passed, it would have a profoundly negative impact on the health of the people of Massachusetts.
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