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Public Policy

Ballot Initiative Brief: Policy Impacts of Question 1

On November 6th voters will be tasked with deciding the fate of a handful of ballot initiatives, including Question #1 which would mandate nurse staffing ratios in hospitals and other health care facilities across Massachusetts.

Mandated staffing ratios take decision-making authority away from doctors and nurses and apply a one-size-fits-all approach to staffing without taking into consideration the differences in hospital settings across the state. Health care professionals would be limited in their authority to determine staffing based on factors like the seriousness of patients’ conditions.

The proposed ratios would also be costly. According to an independent analysis by the Massachusetts Health Policy Commission (HPC), the ballot initiative conservatively is expected to add between $676 million and $949 million in increased annual costs once fully implemented. Community hospitals, many of which are already struggling financially, would need to add significant staff while employers and consumers will immediately be affected by the rising health care costs associated with implementing the proposal. These estimates do not include one-time costs and ongoing annual costs within emergency departments and outpatient departments.

And the impacts on employers would extend far beyond the price tag, including health care workforce shortages and implementation challenges. In some cases, it could result in reducing access to care. According to HPC’s analysis, Massachusetts health care providers would have to recruit between 2,286 and 3,101 additional registered nurses to comply with the mandated ratios.

This brief summarizes the proposed nurse staffing ratio requirements. Should the ballot initiative pass, the mandated ratios would go into effect on January 1, 2019, leaving Massachusetts health care providers less than two months to comply with the new law before it becomes effective.


Read the Chamber’s Ballot Initiative Brief: Mandated Staffing Ratios for Nurses