THE NOVEMBER BALLOT QUESTION that would mandate minimum nurse staffing levels at Massachusetts hospitals is a complicated issue.
Health care experts offered views that were sharply at odds with each other at a hearing this week of the state Health Policy Commission, with some saying the measure would unquestionably lead to better patient outcomes, while others said there’s no evidence for that and raised concerns about the question’s effect on costs and possible unintended consequences, including nurse shortages or the shutdown of services at financially stressed facilities.
Even members of the commission seemed flummoxed by the debate. “I can understand why voters right now are very confused in Massachusetts,” said commission member Tim Foley, vice president of 1199SEIU, during Wednesday’s hearing. Stuart Altman, the commission chairman, said he’s encountered lots of people who want to “do the right thing” on the ballot question, but can’t figure out what that is.
No such uncertainty, however, seems to have plagued many of the state’s most prominent Democratic officials, who are all lining up on the “yes” side.
Both of the state’s US senators have come out in favor of Question 1. Boston Mayor Marty Walsh is on board. And so are several member of the state’s congressional delegation: Joe Kennedy, Jim McGovern, Steve Lynch, and Michael Capuano as well Democratic congressional nominees Ayanna Pressley and Lori Trahan.
While health policy experts and voters wrestle with the complexity of the measure, for many Democrats it seems to be a straightforward issue of lining up with an important constituency.
The Massachusetts Nurses Association is responsible for getting the measure on the ballot, and the state’s largest nurses’ union seems to be winning the day with most Democratic pols who have weighed in.
“It’s a historic practice that Democrats are pro labor and pro nurses, and so it is a continuation of a longstanding trend,” said John McDonough, a professor at the Harvard T.H. Chan School of Public Health and a former Democratic state representative from Boston.
“This is one way in which folks in the Democratic Party can reaffirm their commitment to labor and working-class voters,” said Peter Ubertaccio, a political science professor at Stonehill College.
While Gov. Charlie Baker has come out against the question, the list of Democratic officeholders publicly opposed to the measure consists of a handful of mayors, one Cambridge city councilor, and one state rep, Chris Markey of Dartmouth, who also crossed party lines this week to endorse Baker’s reelection.
Dan Cence, a spokesman for the Coalition to Protect Patient Safety, the group opposed to the ballot question, which is heavily bankrolled by the state’s hospitals, said most Democratic officials have had longstanding relationships with the nurses’ union.
“I believe their support is reflective of their relationship with the union. I don’t think it has much do with the policy of it,” Cence said of the ballot question. “Marty Walsh is a card-carrying member of the Laborers Union. It’s hardly a shock that he or Stephen Lynch [another former union official] would be supporting their brothers and sisters in labor.”
Kate Norton, a spokeswoman for the Committee to Ensure Safe Patient Care, which is backing the question, said it was “insulting” to think elected officials were getting behind the ballot measure simply because of union loyalty.
“This isn’t about party politics, this is not about labor,” said Norton. “This is about patient safety, period. These are folks who have been advocates for working families. They are putting their name behind the yes on 1 vote for nurses, for patients, and for safe patient limits.”
The closest any prominent Democratic officials have come to opposing the question is staking out ground of studious neutrality. That was the position House Speaker Robert DeLeo took earlier this week – despite having voted in previous years to advance measures on Beacon Hill to impose nurse staffing minimums.
DeLeo claimed he has been too preoccupied with helping Democratic candidates and backing the transgender rights ballot question to give much consideration to the nurse-to-patient staffing ratios measure, remarks that seemed curious coming right outside the room where he had just addressed the Health Policy Commission’s annual hearing on health care cost trends.
DeLeo left open the possibility that he’ll weigh in on the ballot question before the election, but offered no assurance that he would.
Senate President Karen Spilka said she, too, has yet to make up her mind on the issue.
“I appreciate the work that the Health Policy Commission has undertaken to understand this issue, and quite frankly I am still digesting a lot of the new information contained within their report,” she said in a statement. “I am also continuing to listen to stakeholders on all sides. I am aware that there is much to consider on this issue, and I need more time to think carefully about it before reaching a final decision.”
While the ballot question has gained lots of backing from other prominent Democratic leaders, that’s not translating to runaway numbers in recent polls.
Two recent polls show different sides ahead. A Suffolk University poll released in September showed voters leaning toward yes, 52-33. A University of Massachusetts Lowell poll released earlier this month had the measure losing, with 51 percent of likely voters supporting the no side and 43 percent saying they’ll vote yes.
Meanwhile, a September WBUR poll had the question deadlocked 44-44. A WBUR poll this month looked at how nurses viewed the ballot question and found they were similarly divided, with 48 percent planning to vote yes and 45 percent saying they’ll vote no. The subgroup of nurses who belong to a union were more favorable toward the measure, but there was still sizeable opposition, with 60 percent in favor and 33 percent opposed.
“It’s more complicated than it would appear to a lot of people and it’s played out differently than many folks would have anticipated,” said McDonough, the Harvard health policy professor. “A lot of people expected it would pass overwhelmingly.”
That passage of the question now looks like no sure thing should not be surprising, however. Proponents of ballot questions often carry an added burden of making the case for change, while opponents often only need to cast doubt on some elements of a proposal to convince voters to cast a no ballot and hold pat with the status quo.
Ubertaccio, the Stonehill College political scientist, said that’s exactly what seems to be happening with questions about the possible impact of the ballot question on struggling community hospitals serving lots of low-income patients or on overall health care costs.
“I think the opponents have been pretty skillful in their approach,” he said. “I think they’ve raised a sufficient amount of doubt.”