Consensus Question 2

Question 2 in the Massachusetts League's study of the Ballot Question Process deals with the short fiscal impact statements that appear in the red "Information for Voters" booklet. It asks "Do the statements of fiscal consequences in the "Information for Voters" red booklets from 2016 and 2018 provide voters with the information they need to make an informed decision on the potential fiscal impact of passing the ballot question(s)? Should voter information beyond the 100-word statement of fiscal consequences found in the “Information for Voters” red booklet be available, such as through public meetings, webinars, telephone call-ins, websites, etc.?"

These fiscal impact statements, first added in 2016, are prepared by the Executive Office of Administration and Finance. In 2018, only Ballot Question 1 on mandated nurse staffing levels had more than an "indiscernible" fiscal impact on state and local government finances. The numbers in "Information for Voters" were developed by the Health Policy Commission, an independent state agency charged with monitoring health care spending and providing policy recommendations. They estimated only the costs related to the handful of state-owned hospitals, and noted some other possible increases in direct state expenditures. These costs were presented as absolute numbers ($67,800,000 up to a high of $74,800,000 annually), with no background or context. How many state-owned hospitals are there? What are their current operating costs?

Meanwhile, proponents and opponents published cost estimates that differed by a factor of 20. The diverging reports used by the proponents and opponents can be found, with difficulty, on line. A report by Boston University professor Judith Shindul-Rothschild, used by the proponents of the ballot measure, comes up with an upper-limit figure of about $45M in additional annual costs. The report by the Health Policy Commission comes up with about $950M. That was the number cited by the opponents of the measure, but for comparability to the Shindul-Rothschild study, which included only acute care hospitals, the comparable figure from the HPC study would be $680M. Of course these are not the direct fiscal impacts to state and local governments, which is all that the Red Book is obligated to provide.

Using the national average cost of a hospital bed ($2200 per day) and an estimate of the number of acute care hospital beds in Massachusetts (15,000), the higher figure from the opponents (about $680M per year) suggests an increase in hospital costs of about 5.6%, while the Shindul-Rothchild upper-limit estimate comes in at under 0.4%. Would such percentage representations be easier for voters to understand?

In Colorado, a short fiscal impact summary is included in the "Blue Book" (their equivalent of our "Red Book"), but the information that it summarizes is also available on line in a companion volume Blue Book Fiscal Impact, prepared by Legislative Council Staff. Compare the information available starting on p. 14 on Amendment 73 (a complex amendment that would have increased school funding that failed), with what voters had for our Ballot Question 1.

Information on Consensus Question 2 is found on pp. 3-4 of the Study Guide.

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