The pro and con campaigns around Ballot Question 1 have been ramping up, with competing TV ads promising better patient care or warning of dire consequences if Question 1 passes. WGBH's Morning Edition Host Joe Mathieu spoke with Reporter Gabrielle Emanuel to fact-check those TV ads and discuss Ballot Question 1. The transcript below has been edited for clarity.

Joe Mathieu: First of all, tell us what Ballot Question 1 is all about.

Gabrielle Emanuel: So, the proposed law sets legal limits on how many patients can be assigned to a nurse. And that's across all hospitals in Massachusetts. And these limits — ratios of nurse-to-patient — vary based on the hospital unit. So in an E.R., it's different than a psych ward, and they also vary based on the patient condition. So if a patient's really sick, there's a different requirement. They don't take into account things like how experienced the nurse is, or what time of day it is, so hospitals are busier during the day, but the ratios are the same day or night. Now, the 'Yes campaign' says this is really important, because they've been overburdened for a long time. And this would improve patient safety. That's their argument. The 'No campaign' says this would cost a fortune, and it would put patients at risk, and especially the most vulnerable patients. So they're painting two very different pictures here.

Mathieu: And that's why we're here right now. We're going to fact-check the ads that we've been bombarded with, starting with the 'Yes on 1 Campaign.'

Clip of a 'Yes On 1' Campaign Ad: "86 percent. 86 percent. 86 percent of nurses are voting yes on Question 1."

Emanuel: So, 86 percent. We have to be careful with that number. That originally comes from a survey that was done six months ago, and it was commissioned by the Massachusetts Nurses Association. That is the union that brought this ballot initiative and has been pushing for staffing limits for years. The union represents 20 percent of nurses across the state, but in this survey, just under 50 percent of the respondents were in the union. So the union is highly over-represented in this sample. And then it's also worth noting that there's been a recent survey not by the union, and that found that nurses were divided about 50/50.

Mathieu: So here's some of another ad the 'Yes Campaign' has put out.

Clip of a 'Yes On 1' Campaign Ad: "Independent scientific studies found that patient care suffers when nurses have too many patients. That's why nurses put this on the ballot."

Mathieu: So you hear something like that it's pretty hard to argue with.

Emanuel: Yes. And it's accurate, but it's not the whole story. So, there is a whole body of research that says, the fewer patients a nurse has, the better quality of care they get. And, you think about it like a classroom. The fewer kids to a teacher, things are better. It kind of seems obvious. But the research does not back up that ratios are the way to get there. So that's kind of the question, and when we look to California, which is the only state that's implemented these ratios, their patient care got better on some measures, got worse on others, and experts end up saying it's kind of a wash.

Mathieu: Okay, let's listen to an ad from the 'No on 1 Campaign.'

Clip of a 'No On 1' Campaign Ad: "$900 million a year. That's the official state cost estimate for question 1. Nine hundred million. That will cost 'your premiums to rise with no improvement in patient outcomes.' Vote no on one."

Mathieu: He even says it in that menacing tone. So how accurate is this?

Emanuel: Yeah, so that $900 million a year comes from the Health Policy Commission, which is an independent state agency that decided to do their own analysis of this law. And, I have to say, their figures really did line up much more closely with the 'No Campaign' than the 'Yes Campaign.' That said, they're skewing it a bit. The Health Policy Commission offered a cost estimate that was a range. It went from $676 million a year to $949 million. And they said that could be an underestimate. But, obviously, the ad just picked out that $900 million a year number, on the higher end of the range. In terms of higher premiums, the report says it's possible that it will increase premiums. And the 'Yes Campaign,' the other side, is suggesting a much lower cost for a year, and they say that money should come out of CEO salaries, not influence higher premiums.

Mathieu: So we're taking possibilities and theories and putting them into campaign ads. Okay, we're going to hear one more one last TV ad from the 'No Campaign.'

Clip of a 'No On 1' Campaign Ad: "We won't be able to serve the needs of our patients. In fact, emergency rooms will have to limit capacity. Some by more than 100 patients a day. And that patient could be you."

Mathieu: What do you think?

Emanuel: So, this one I had to reach out to the 'No Campaign' and ask, 'Where did that number come from?' And it turns out, it came from an analysis, an internal analysis, done by the Boston Medical Center (BMC). And they said, if this law is enacted right now, and we have to meet these ratios with our current staffing, would we be able to see all the patients in the E.R.? And they said, they wouldn't, by 100 patients a day. But, that's kind of a weird way to look at this, because if the law passes, they'll be hiring more nurses, like most other hospitals in the state, and then you have questions. Are there enough nurses? Are the nurses experienced enough? Are they drawing them away from nursing homes? But trying to kind of implement this law without changing the number of nurses just doesn't totally make sense. It's not the most useful number to think about.

Mathieu: It sounds like none of these are terribly useful. It's really hard to clear through the clutter here when you have vested interests trying to sell you on an idea.

Emanuel: It is, yeah, and both sides are are really selling it, and, kind of, picking out the numbers that are best for their argument.

Mathieu: So again, enter WGBH's Gabrielle Emanuel. This is really important reporting that you've done. And it's not just this conversation if people want to go to the website. You've put together essentially one sheets for people to look at each ballot question pros and cons and understand what they have to think about.

Emanuel: Exactly. So what we did is we tried to write the ballot question in plain English, just one, two sentences, explaining what's at stake here, and then we laid out kind of the best arguments on each side and other facts to know. What have other states done? What's the cost of this ballot initiative? So everything's on one page for each ballot question.

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