Ballot Question 1: Government Mandated Nurse Staffing at Hospitals All About Money, Jobs and Power


by Ted Tripp

Sr. Political Reporter

Some signs show “Nurses say Yes On 1.” Other signs show “Nurses say No On 1.” TV ads by Yes proponents say it’s all about patient safety and that 86% of nurses favor it. Proponents of No try to convince us that some small hospitals may close because of the added costs, and wait times to see an emergency room doctor will be longer.

Question 1 on the November 6th ballot would set government-mandated requirements for the maximum number of patients per nurse in various medical units of a hospital. Heavy fines, up to $25,000, would be imposed on hospitals for each violation of these mandates.

The Committee to Ensure Safe Patient Care is the ballot committee running the “Yes On 1” campaign. The latest Office of Campaign and Finance (OCPF) report shows it had raised $9.10 million as of October 1st. Of that amount, $8.97 million or 98.7% was donated by the Massachusetts Nurses Association.

And who are they? The Massachusetts Nurses Association is one of the 82 left-wing, social, labor and religious organizations that make up the coalition of Raise Up Massachusetts. You remember them. We wrote about Raise Up Massachusetts in the July issue of the Boston Broadside.

Raise Up Mass. was one of the leaders and leading fundraisers for the graduated income tax, $15/hour minimum wage and paid family leave ballot questions. The first was thrown out by the Massachusetts Supreme Judicial Court and the last two were withdrawn after Governor Charlie Baker negotiated a “grand bargain” which gave them almost everything they wanted. Also note that Raise Up Mass. was the key player in getting the Retailers Association of Massachusetts to withdraw its ballot question reducing the sales tax from 6.25% to 5%.

So Raise Up Massachusetts, of which the Massachusetts Nurses Association is a member, is all about redistribution of wealth – taking money from the more productive and giving it to the less productive.

Getting back to Question 1 itself, who also donated to the cause? The Health Professionals & Allied Employees Solidarity Fund kicked in $15 thousand, the Teamsters Local 25 Drive kicked in $10 thousand, the Unite Here Local 26 $10 thousand and the New York State Nurses Association kicked in $25 thousand.

So why would the Teamsters and Unite Here, a hotel and food service union, be interested in a ballot question on patient care? And why would a New York State Nurses Association send money to help Massachusetts patients?

The answer can be gleaned from the following list of organizations which support Question 1:


Health Care Organizations

Health Watch USA

Independence House, Inc.


Mass Health Professionals for Clean Energy (MHPCE)

Massachusetts Nurses Association

Massachusetts Student Nurses Association

Show Me Your Stethoscope Foundation

Tufts Progressive Alliance

United Nurses & Allied Professionals

Western Mass. Medicare for all

Women’s Health Institute

Nurses Nationwide and Globally

ANNF – Victoria Branch

California Nurses Association

Canadian Federation of Nurses Unions

Canadian Nursing Students’ Association

District of Columbia Nurses Association

Haitian Nurses Association

Illinois Nurses Association

Law Enforcement Officers Security Unions LEOSU, LEOSPBA

Manitoba Nurses’ Union

Michigan Nurses Association

Minnesota Nurses Association

National Nurses United

National Union of Healthcare Workers

Newfoundland and Labrador Association of Public and Private Employees (NAPE)

New Brunswick Nurses Union

New South Wales Nurses and Midwives Association Australia

New York Professional Nurses Union

New York State Nurses Association

Northeast Nurses Association

Nova Scotia Government and General Employees Union

Nova Scotia Nurses’ Union

Ohio Nurses Association

Pennsylvania Association of Staff Nurses & Allied Professionals

Philippine Nurses Association of New England

Prince Edward Island Union of Public Sector Employees’

Prince Edward Island Nurses’ Union

Queensland Nurses and Midwives’ Union

Registered Nurses’ Union Newfoundland and Labrador

Saskatchewan Union of Nurses

United Nurses of Alberta

Community Groups

Berkshire Democratic Brigades

Boston Musicians Association

Coalition for Social Justice

Education Enterprises

EPOCA (Ex-Prisoners and Prisoners Organizing for Community Advancement)

Foundation for a Green Future

Franklin County Continuing the Political Revolution

Greater Worcester Humanists

Jobs with Justice

Mass Interfaith Worker Justice

Mass Retirees

Mass Senior Action Council

Massachusetts Voter Table

Massachusetts Coalition for Occupational Safety & Health

Neighbor To Neighbor

New England Jewish Labor Committee

Our Revolution

Our Revolution Massachusetts

Pax Christi Boston

Progressive Democrats of America

Progressive Taunton

Public Higher Education Network of Massachusetts (PHENOM)

Resist the Pipeline

Stop the West Roxbury Lateral Pipeline (SWRL)

Socialist Alternative

The Labor Guild, Archdiocese of Boston

Women’s Institute for Leadership Development

Worcester Interfaith

Worcester Socialist Alternative

Democratic Town Committees

The Massachusetts Democratic Party

Agawam Democratic Town Committee

Amherst Democratic Town Committee

Barre Democratic Town Committee

Brewster Democrats

Braintree Democratic Town Committee

Bridgewater Democratic Town Committee

Chicopee Democratic City Committee

Colrain Democratic Town Committee

Dennis Democratic Town Committee

Easthampton Democratic Town Committee

East Longmeadow Democratic Town Committee

Hopkinton Democratic Town Committee

Huntington Democratic Party

Lunenburg Democratic Town Committee

Merrimack Valley Central Labor Council

North Adams Democratic City Committee

Northampton Democratic City Committee

North Reading Democratic Town Committee

Norwood Democratic Town Committee

Orleans Democratic Town Committee

Princeton Democratic Town Committee

Quincy Democratic City Committee

Randolph Democratic Town Committee

Reading Democratic Town Committee

Rehoboth Democratic Town Committee

Sunderland Town Democratic Committee

Shrewsbury Democratic Town Committee

South Hadley Democratic Town Committee

Sturbridge Democratic Town Committee

Truo Democratic Town Committee

West Boylston Democratic Town Committee

Westfield Democratic City Committee

Winchendon Democratic Town Committee

Labor and Working Families

Berkshire Central Labor Council

Greater Boston Labor Council

Greater Southeastern Labor Council

Hampshire Franklin Central Labor Council

Norfolk County Central Labor Council

North Shore Labor Council

Pioneer Valley AFL-CIO

Plymouth/Bristol Central Labor Council

Worcester Community Labor Coalition

AFSCME Local 944

AFSCME Local 1526

American Federation of Teachers Massachusetts (AFT Mass)

AFT Connecticut Executive Committee

Boston Metro Area Local 100, American Postal Workers Union, AFL-CIO

Boston Teachers Union

Bricklayers & Allied Craftsmen Union Local 3

HPAE, New Jersey

HPAE, Local 5118

IATSE Local 11

IBEW 103

IBEW 104

IBEW Local 2222

IBEW 2321

Insulators Local 6

International Association of Machinists and Aerospace Workers (IAMAW) Local 264

International Union of Operating Engineers Local 877

Ironworkers Local 7

Local 4 Operating Engineers

Massachusetts AFL-CIO

Massachusetts Democratic Party

Massachusetts State Council of Machinists

Massachusetts Teachers Association

Metro Boston Building Trades

National Union of Public and General Employees

New England Regional Council of Carpenters

Painters and Allied Trades DC 35

Pipefitters Local 537

Professional Firefighters of Massachusetts

Roofers & Waterproofers Union Local 33

SEIU Local 888


Teamsters Local 25

Teamsters Local 42

Teamsters Local 170

Teamsters Local 122

UAW Local 2322 & 2324

UAW Region 9 Massachusetts

UNITE HERE, New England Joint Board

UNITE HERE, Local 26

United Food & Commercial Workers Local 1445 & 1459

United Steel Workers Local 7912 & 9432

Utility Workers Union of America Local 369

There are some important points to note in this long list. First, under Nurses Nationwide many are from Canada where there is universal healthcare and where the wait times are long and the care is so good that Canadians come to the U.S. for health services when they can afford it. Other nurses associations are from out of state. Under Community Groups you see the words “social justice,” “socialist,” “progressive,” and “revolution.” Even the group “Resist the Pipeline.” Does anybody believe these are mainstream groups worried about safe patient care? You have got to be kidding.

Also note the long list of Democratic town committees. No Republican town committees? If Question 1 is such a good idea, you would think maybe one – one lonely Republican town committee – might support it? But no, there are none.

And the last list of Labor and Working Families is mostly a list of unions, teachers, carpenters, steelworkers, machinists, pipefitters, bricklayers and so forth. Are all these unions concerned about safe patient care?

Have you figured it out yet? Question 1 is not about safe patient health. It’s all about jobs, jobs and more jobs. That’s why labor unions and the Democratic Party are behind this ballot measure.

But all these nurses that will have to be hired to increase staffing levels will be costly. In April the Massachusetts Health and Hospital Association, opponents to Question 1, commissioned an independent study on the cost, and  the report ( concluded that approval of this initiative could cost the healthcare system $1.31 billion the first year and $900 million/year thereafter.

On October 3rd, the Massachusetts Health Policy Commission (MHPC) released its own report ( on Question 1 and concluded that if passed the provisions would cost $676 to $949 million/year. MHPC also looked at California’s government-mandated patient to nurse ratio law which was passed in 1999, and concluded that although California had to significantly increase nurse staffing, there was “no systemic improvement in patient outcomes.”

Proponents of Question 1, of course, had their own study ( done by a professor at the Boston College School of Nursing and she came up with a figure of $47 million for implementation.

Whatever the numbers are, and it looks like they will be closer to the $900 million mark than the $47 million, someone will have to pay for it if Question 1 passes. And first in line is the hospital that has to hire the extra nurses. That cost will then be passed on to the patients, insurance companies and government agencies like MassHealth, Medicare and so forth. If any of these resist the higher costs, that will put pressure on the hospitals and medical centers to change behavior such as cutting back on services or eliminating entire departments. Some already on the edge of breaking even may even be forced to shut down. This is not a threat but a reality.

Back to California for a minute. California was the first and is the only state to pass comprehensive government-mandated patient-to-nurse staffing limits. It is also used as a benchmark by proponents for the Massachusetts ballot initiative. Here is a comparison of the two plans:

From Ballotpedia

It’s a little hard to sort out and compare Question 1 to California, but if you look closely you will see that the Massachusetts’ initiative is even more stringent than the California law and would require even more nurses. For example, labor and delivery is two patients per nurse in California but is only one patient per nurse in Massachusetts.

Think jobs and money.

So how did this whole Question 1 thing get started?

Late in the fall of 2017 the Committee to Ensure Safe Patient Care submitted the Question 1 language along with 75,542 certified signatures to Secretary of State Bill Galvin’s office.

You remember seeing hundreds of nurses gathering signatures out in front of supermarkets and post offices, don’t you? You don’t? Well, maybe that’s because the nurses weren’t out collecting signatures. The Committee to Ensure Safe Patient Care contracted with JEF Associates to collect the signatures and paid them handsomely – $570,518. That’s $7.55 per signature of Nurses Association money.

In contrast, Question 2 on the ballot, about a commission to recommend overturning a Supreme Court decision, paid only $2.03 per signature.

When you have lots of money, money is no object to getting what you want.

So, what is the opposition to Question 1?

The Coalition to Protect Patient Safety was formed to oppose the patient-to-nurse government mandate. It has raised $13.35 million as of October 1st, $12.68 million provided by the Massachusetts Health & Hospital Association, or 94.97%. The remaining donors were mostly Massachusetts hospitals and medical centers, but the Organization of Nurse Leaders donated $44,059 to the effort. The donor hospitals ranged from the well-known Boston medical institutions to the small, rural medical centers, and even the religious hospitals. In-kind expenditures, mostly from hospitals, have added another million dollars to the effort to defeat Question 1.

So, who else opposes Question 1? Here is a list of groups and organizations supporting the opposition:

Coalition Supporters


Academy of Medical-Surgical Nurses – Greater Boston Chapter

American Nurses Association-Massachusetts

Emergency Nurses Association – Massachusetts State Council

Infusion Nurses Society

Massachusetts Association of Colleges of Nursing (MACN)

Organization of Nurse Leaders

Western Massachusetts Nursing Collaborative


American Academy of Pediatrics – Massachusetts Chapter

American College of Cardiology – Massachusetts Chapter

Atrius Health

American College of Physicians – Massachusetts Chapter

American College of Surgeons – Massachusetts Chapter

Baycare Health Partners

Baystate Health Practices

Brain Injury Association of Massachusetts

Beth Israel Deaconess Care Organization

Beth Israel Deaconess HealthCare

Beverly Radiology Associates

Brigham and Women’s Physicians Organization

Conference of Boston Teaching Hospitals

Cooley Dickinson Physician Hospital Organization

Emerson Physician Hospital Organization

Harvard Medical Faculty Physicians

Heywood Physician Hospital Organization

Highland Healthcare Associates IPA

Home Care Alliance of Massachusetts

Home Care Foundation

Hospice & Palliative Care Federation of Massachusetts

Lahey Clinical Performance Accountable Care Organization

LeadingAge Massachusetts

Lowell General Physician Hospital Organization

Mass Home Care

Massachusetts Academy of Dermatology

Massachusetts Ambulance Association

Massachusetts Assisted Living Association

Massachusetts Association for Mental Health

Massachusetts Association of Behavioral Health Systems

Massachusetts Association of Physician Assistants

Massachusetts Association for Medical Staff Services

Massachusetts Association of Practicing Urologists

Massachusetts College of Emergency Physicians

Massachusetts Council of Community Hospitals

Massachusetts Foot and Ankle Society

Massachusetts Health & Hospital Association

Massachusetts Health Data Consortium

Massachusetts Independent Pharmacists Association

Massachusetts League of Community Health Centers

Massachusetts Medical Society

Massachusetts Orthopaedic Association

Massachusetts Pharmacists Association

Massachusetts Psychiatric Society

Massachusetts Radiological Society

Massachusetts Section – American Congress of Obstetricians & Gynecologists

Massachusetts Senior Care Association

Massachusetts Society of Anesthesiologists

Massachusetts Society of Clinical Oncologists

Massachusetts Society of Eye Physicians and Surgeons

Massachusetts Society of Health-System Pharmacists

Massachusetts Society of Neurosurgeons

Massachusetts Society of Otolaryngology/Head & Neck Surgery

Massachusetts Society of Pathologists

Massachusetts Society for Respiratory Care

Merrimack Health Network

MetroWest Healthcare Alliance

Mount Auburn Cambridge Independent Practice Association

New England Quality Care Alliance

North Shore Medical System

North Shore Physicians Group

Northeast Physician Hospital Organization

Partners Community Physicians Organization

Partnership for Health in the Berkshires

Physicians’ Organization at Boston Children’s

The Pointe Group

Providers’ Council

Reliant Medical Group

Signature Medical Group

South Shore Health System

South Shore Physician Hospital Organization

Southcoast Physicians Group

Southcoast Health Network

Tufts Medical Center Community Care

Tufts Medical Center Physicians Organization

Tufts Medical Center Community Care

UMass Memorial Medical Group

UMass Memorial Accountable Care Organization

VNA Care

Winchester Physician Hospital Organization


AdCare Hospital

Anna Jaques Hospital

Athol Hospital

Baystate Franklin Medical Center

Baystate Medical Center

Baystate Noble Hospital

Baystate Wing Hospital

Berkshire Medical Center

Beth Israel Deaconess Hospital-Milton

Beth Israel Deaconess Hospital-Needham

Beth Israel Deaconess Hospital-Plymouth

Beth Israel Deaconess Medical Center

Beverly Hospital

Boston Children’s Hospital

Boston Medical Center

Brigham and Women’s Faulkner Hospital

Brigham and Women’s Hospital

Cambridge Health Alliance

Cambridge Public Health Commission

Cape Cod Healthcare Inc.

Cape Cod Hospital

CareGroup, Inc.

Carney Hospital

Circle Health, Inc.

Cooley Dickinson Health

Curahealth Hospital Stoughton

Dana-Farber Cancer Institute

Emerson Hospital

Fairlawn Rehabilitation Hospital

Fairview Hospital

Falmouth Hospital

Franciscan Children’s

Good Samaritan Medical Center

Harrington Hospital

HealthSouth Braintree Rehabilitation Hospital

HealthSouth New England Rehabilitation Hospital

HealthSouth Rehabilitation Hospital of Western MA

Hebrew Rehabilitation Center

Hebrew SeniorLife

Heywood Healthcare

Heywood Hospital

Holy Family Hospital – Haverhill

Holy Family Hospital – Methuen

Holyoke Medical Center

Lahey Hospital & Medical Center

Lawrence General Hospital

Leonard Morse Hospital

Lowell General Hospital

Martha’s Vineyard Hospital

Massachusetts Eye and Ear Infirmary

Massachusetts General Hospital

McLean Hospital

Melrose-Wakefield Hospital

Mercy Medical Center

MetroWest Medical Center

Milford Regional Medical Center

Morton Hospital

Mount Auburn Hospital

Nantucket Cottage Hospital

Nashoba Valley Medical Center

New England Baptist Hospital

New England Sinai Hospital

Newton-Wellesley Hospital

North Shore Medical Center

Norwood Hospital

Partners Continuing Care

Providence Behavioral Health Hospital

Quincy Community Care Network

Saint Anne’s Hospital

Saint Vincent Hospital

Shriners Hospital for Children

Shriners Hospital for Children-Boston

Signature Healthcare

Signature Healthcare Brockton Hospital

South Shore Hospital

Spaulding Hospital for Continuing Medical Care Cambridge

Spaulding Rehabilitation Hospital

Spaulding Rehabilitation Hospital Cape Cod

St. Elizabeth’s Medical Center

St. Luke’s Hospital

Sturdy Memorial Hospital

The Mercy Hospital

Tobey Hospital

Trinity Health Of New England

Tufts Medical Center

UMass Memorial HealthAlliance-Clinton Hospital

UMass Memorial Marlborough Hospital

UMass Memorial Medical Center

Vibra Hospital of Southeastern Massachusetts

Vibra Hospital of Western Massachusetts

Winchester Hospital


Associated Industries of Massachusetts

Auburn Chamber of Commerce

Blackstone Valley Chamber of Commerce

Bristol County Chamber of Commerce

Burlington Area Chamber of Commerce

Cambridge Chamber of Commerce

Cape Ann Chamber of Commerce

Cape Cod Canal Chamber of Commerce

Cape Cod Chamber of Commerce

Chamber of Central Mass South

Chelsea Chamber of Commerce

Concord Chamber of Commerce

Corridor Nine Area Chamber of Commerce

Cranberry Country Chamber of Commerce

Economic Development Council of Western MA

East of the River 5 Town Chamber of Commerce

Greater Boston Chamber of Commerce

Greater Chicopee Chamber of Commerce

Greater Gardner Chamber of Commerce

Greater Springfield Regional Chamber of Commerce

Greater Westfield Chamber of Commerce

Massachusetts Business Roundtable

Massachusetts Taxpayers Foundation

Marlborough Regional Chamber of Commerce

Medford Chamber of Commerce

MetroWest Chamber of Commerce

Milford Area Chamber of Commerce

NAIOP Massachusetts

Nantucket Island Chamber of Commerce

Nashoba Valley Chamber of Commerce

Newburyport Chamber of Commerce

Newton-Needham Regional Chamber of Commerce

North Central Massachusetts Chamber of Commerce

North Quabbin Chamber of Commerce

North Shore Chamber of Commerce

Plymouth Area Chamber of Commerce

Retailers Association of Massachusetts

Salem Chamber of Commerce

Sandwich Chamber of Commerce

Shrewsbury Street Area Merchants Association

Somerville Chamber of Commerce

South Shore Chamber of Commerce

SouthCoast Chamber of Commerce

Stoughton Chamber of Commerce

Taunton Area Chamber of Commerce

Tri-Town Chamber of Commerce

United Regional Chamber of Commerce

Wakefield Lynnfield Chamber of Commerce

Waltham Chamber of Commerce

Wellesley Chamber of Commerce

Woburn Business Association

Worcester Regional Chamber of Commerce

Note the types of organizations listed. We have physicians, nurses, surgeons, pharmacists, teaching hospitals, senior care, home care, and many chambers of commerce. The Massachusetts Medical Society and the Harvard Medical Faculty Physicians oppose Question 1.

Every Massachusetts hospital – that is EVERY Massachusetts hospital opposes Question 1. You might think that if Question 1 was so good for patient care, maybe one – just one – hospital in the state might back it? But no, proponents couldn’t get one hospital on board.

And look at the quality and professionalism of the organizations. There are no long lists of political town committees. There are no social justice groups or activists looking for power and glory. Nobody trying to stop a pipeline in this group.

Let’s wrap this whole discussion up with a question. Compare all the supporters in favor of Question 1 to all the supporters opposed to Question 1.

Which group do you think better represents what’s in our best interest for the Massachusetts healthcare system? Then you will know how to vote on November 6th.

For more information on the Yes On 1 ballot committee, see For the No On 1 ballot committee, see    ♦


2 Replies to “Ballot Question 1: Government Mandated Nurse Staffing at Hospitals All About Money, Jobs and Power

  1. Thank God this mandate did not pass or Massachusetts would be one step closer to Socialism with Government controlled Nurses. Immediately the State would have hired more cronies to regulate, causing more government jobs for favors or friends. Bigger government just what we don’t need.

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