Question 1 Briefing

On November 6th, voters in Massachusetts will be asked to vote on a series of ballot questions, including Question 1 – a proposal to mandate nurse staffing levels in hospitals in the state.  Your support is desperately needed in helping voters understand the negative impact Question 1 will have on patient care, our communities and North Central Massachusetts.

Please consider sharing the following message and join the statewide effort to raise awareness and provide education regarding Question 1.

  • Staffing decisions should be left to the judgement of qualified healthcare professionals in our hospitals, not imposed via the ballot box. These new government mandated nurse staffing ratios would be enforced at all hospitals, on all units, at all times with no flexibility.  A rigid, one-size-fits-all approach threatens the quality of care for patients and would have a detrimental impact on the state’s healthcare system.
  • Virtually every major health care group, including the Massachusetts Medical Society, American Nurses Association, Emergency Nurses Association, Massachusetts League of Community Health Centers, American Academy of Pediatrics, Academy of Medical-Surgical Nurses and Massachusetts Senior Care Association, opposes Question 1 and feels that it would have devastating consequences for patients. Consider what would happen under the new law if an emergency department were to reach its full legal allowance of patients under the new mandates.  The hospital would not be able to admit any more patients, forcing patients and ambulances to waste valuable time in life and death situations searching for an alternative hospital.
  • Every hospital in the state, including our three community hospitals located here in North Central Massachusetts – UMass Memorial HealthAlliance Clinton Hospital, Heywood Hospital and Nashoba Valley Medical Center – also oppose Question 1.  Question 1 would raise costs substantially for these hospitals and negatively impact their ability to provide care.  To implement this costly unfunded mandate, they will be forced to make deep cuts to critical programs, such as opioid treatment and mental health services.  Statewide, Question 1 is projected to lead to the reduction of 1,000 behavioral health beds (38% of the total supply).[i]  In addition, many smaller community hospitals are already struggling financially and will not be able to absorb the added cost and will be forced to close.
  • The independent, non-partisan Massachusetts Health Policy Commission has estimated that passage of Question 1 would cost the Commonwealth up to $949 million annually.[ii] Patients, employers and taxpayers will end up footing the bill for these new government mandates through increased taxes and higher premiums.
  • There is no evidence that Question 1 will improve the quality of care. Out of all 50 states only one other state (California) has mandated nurse staffing ratios and there is no evidence that it has led to improved care.  United Health Foundation ranks California seventeenth nationally in terms of statewide health.  Massachusetts ranks first.[iii]  In addition, a study conducted in 2018 of hospital patient safety ranks Massachusetts fourth in the nation for percentage of hospitals with top patient safety rating, while California ranks twenty-fifth.[iv]

We would encourage you to vote against this measure.  Patient safety should always be the primary concern of the Commonwealth’s healthcare system.  While proponents of this question may be well intentioned, its severe cost and detrimental impact on the state’s healthcare system cannot be ignored.

For more information, please contact Christopher McDermott, Public Affairs Manager at 978.353.7600 ext. 224 or email

Click here to view the Chamber’s positions on the Ballot Questions.

Click here to view our Op-Ed on Question 1

[i] (Coalition to Protect Patient Safety)

[ii] (Massachusetts Health Policy Commission, 2018)

[iii] (Attorney General of Massachusetts)

[iv] (The Leapfrog Group, 2018)