Your ballot initiative breakdown, from patient limits, to campaign finance, to transgender rights

On Election Day (Nov 6), Massachusetts voters will vote “yes” or “no” on three questions. The first is about establishing safe patient limits in hospitals, the second regards money in politics, and the third relates to transgender protections in public accommodations. With a flurry of messages floating from every direction like hail in a New England snowstorm, it can be difficult to understand the history behind these questions and the implications of the laws they can trigger. With help from experts and advocates from all corners, we compiled this guide to decipher the arguments.

Q1

This question, which has spurred a yard-sign war on lawns across the Commonwealth, asks voters to approve a law that would limit the number of patients assigned to nurses working at hospitals and other health facilities. While currently there is no standard for patient-to-nurse limits in Mass, if passed, those exceeding the maximum allowed number of patients would theoretically be fined.

According to Kate Norton, spokesperson for the Safe Patient Limits campaign (aka the “Yes” side), the Massachusetts Nurses Association (MNA) and nurse advocates have been pushing for safe patient limits for 20 years. “Putting this on the ballot was really the only option left on the part of nurses to try and secure safe patient limits and make sure that patients are getting the same care equity across every hospital in the Commonwealth,” Norton said.

The lack of standards is concerning, Norton added, saying there are grave consequences for patients when nurses have too many patients to simultaneously care for. “Put yourself in their [patients’] shoes,” she said. “Do you want to be one of four patients that a nurse is taking care of at the same time, or one of eight patients? Nurses do excellent work, but it’s just not safe. … You see things like increased rates of readmission. You see greater rates of infections.”

Conor Yunits, spokesperson for Coalition to Protect Patient Safety, characterized the proposed law as rigid. “Question 1 imposes rigid, government mandated nurse staffing ratios on a health care system that has the best patient outcomes in the world,” Yunits said, adding that critical programs and community hospitals could be forced to close. “These astronomical costs will force hospitals to limit services and close entire units, or close completely if they cannot afford the costs needed to comply. This will result in bed closures and cuts to community health programs, such as cancer screenings, opioid treatments, mental health services, domestic violence programs and pre- or post-natal care at hospitals across the state. It will cause some hospitals to close.”

Norton said the argument that programs will be closed because of this law is unfounded. “Programs and services don’t get cut because of nurses,” she said. “Programs and services get cut because they don’t make enough profit to the satisfaction of their executives.” The Yes on 1 spokesperson also suggests that voters “follow the money.”

“The opposition side here has been funded by the Massachusetts Hospital Association and hospitals across Massachusetts which function as corporate entities,” Norton said. “You’ve got hospital executives making well into the seven figures; last year the hospital industry generated $28 billion in revenue. There is no question the hospitals can support this, but they’re using scare tactics. They’re using threats and intimidation to try and confuse the voters.”

Q2

This less-discussed referendum will ask voters to approve a law that would create a Citizens Commission to investigate campaign finance and make amendments to the United States Constitution to limit how much money corporations, unions, and other artificial entities can spend on elections. The initiative behind Question 2 was sparked by Citizens United v. FEC Supreme Court (2010), which yielded the decision that “Political spending is a form of protected speech under the First Amendment, and the government may not keep corporations or unions from spending money to support or denounce individual candidates in elections.”

Voting “yes” on this question would mean supporting a 28th Amendment to overturn Citizens United and related cases. Ben Gubits, the spokesperson for People Govern, Not Money, which is leading the “Yes on 2” effort, said that since Citizens United, elections have become increasingly expensive.

“It had a profound impact on our democracy where those that can afford to make large campaign contributions have more voice in our democracy than average citizens do,” Gubits said. “The commission will take testimony, hold hearings, issue reports on campaign finance and the impact of money in politics in Massachusetts and what’s happening in campaign finance. … They’ll make recommendations on language for the 28th Amendment. They will also be kind of the people’s watchdog to hold our elected officials and members of Congress accountable.”

The Massachusetts Fiscal Alliance is leading the “No on 2” campaign against such reforms. Paul Craney, spokesperson for the group, said that a “yes” vote on Question 2 means voting to “have your First Amendment rights restricted more.” When asked what he means by having freedom of speech restricted by voting to limit big money’s influence in elections, Craney said the proponents of Question 2 are asking, “Can we put into the US Constitution discrimination? So you pick out winners and losers in campaign finance law. The constitution is very clear that everyone should be treated the same.”

Craney pointed to the proposed millionaires’ tax ballot question that sought to create an additional 4 percent state tax on those earning more than $1 million annually, with the revenue going to education and transportation. That referendum didn’t make it to the ballot but, according to Craney, made “a similar argument where [proponents] wanted to put into the state constitution discrimination meaning that if you earn a certain amount, you’re treated differently than others. That was blatantly unconstitutional. … The Supreme Court has already ruled that Citizens United, the court case that’s starting this question, is constitutional and it’s everyone’s right.”

In response to those claims, those who are behind Question 2 say the imbalance between those who are able to make massive campaign contributions and average citizens is itself discriminatory.

“We are trying to take power away from the billionaires and special interests that dominate our elections and deliver it back to average citizens,” Gubits said. “The people should have power in our government, not just the special donors and the people that can afford to make large campaign contributions.”

Q3

Question 3 asks voters if they want to keep a law that prohibits discrimination against transgender people in any place of public accommodation. Freedom for All Massachusetts is leading the campaign to vote “yes” while Keep MA Safe is running the “no” side.

This particular fight for transgender rights in Mass can be traced at least as far back as 2011, when the Transgender Equal Rights Coalition pushed for legislation that protects transgender people from discrimination in employment, credit, housing, and education. Five years later, Freedom for All Massachusetts pushed through the unfinished work and passed the law to protect people from discrimination in public places. But now, this component of transgender rights is under threat.

“Voters will vote yes to uphold the law or no, which would repeal the law,” said Matthew Wilder, spokesperson for Freedom for All Massachusetts. “The bar was really low for the no side to place this on the ballot. They only needed 32,000 signatures.” Wilder added: “At its core it’s about dignity and respect for transgender people and [to] ensure they are free from discrimination and harassment in all public places. … We want to make sure this law is upheld, that those protections remain.”

Yvette Ollada, spokesperson for Keep MA Safe, said that the organization is leading the No on 3 campaign because the “current bathroom law allows for predators and convicted sex offenders to enter women’s locker rooms, bathrooms and fitting rooms. … We need to repeal the law because we need to protect women. … We are concerned about convicted sex offenders abusing the law to prey on women.”

Asked about why her group wants to repeal a provision that protects transgender people from discrimination, Ollada said, “The definition of gender identity is too broad.”

Countering that argument, Wilder noted there has not been any uptick in criminal activity since the law went into effect two years ago. Indeed, a 2018 study published in Sexuality Research and Social Policy shows that there is no link between transgender rights law and bathroom crimes.

“All this law does is protect transgender people from harassment and discrimination in public places,” Wilder said. “Look at the facts.”

“A friend of mine found ‘No on 3’ flyers at the train station,” said Kaleigh O’Keefe, an activist working with LGBTQ+ organization Pride at Work to rally yes votes. “Their ads are coming out full swing right now. People like to think they live in a progressive place and like to think of themselves as progressive. But for somebody who maybe doesn’t know a lot about these issues, if you’re presented with an ad like this, you’re going to be afraid.

“Transgender rights are not safe anywhere, we need to fight for them.”