Question Five ... You Decide

When Election Day arrives November 7th, you'll have to make some decisions on questions on the ballot.

Eight groups submitted the forms and signatures required to have their ballot questions voted on this year (at least 28,550 or 38,067 signatures are needed, depending on the type of ballot question it is).

Question Five is the ballot question concerning the state's healthcare and health insurance system. Its proponents say that it will improve access to healthcare. Opponents say that if it passes it will ruin our existing healthcare system and force employers and consumers to pay billions more annually for a reduced quality of care-all while creating more government bureaucracy and red tape (you've probably seen the commercials with the physician trying to help a patient but can't with all the "red tape" falling from above.)

And, there's an important twist that doesn't show up on the summary you'll see at the polls: a new Patient's Rights and Healthcare Reform Law was passed unanimously by the legislature this year and was signed by the Governor in July. The new law is slated to take effect in January, seven weeks after we vote on the ballot questions.

Many of the original supporters of Question Five, including the health care advocacy group Health Care for All (HCFA), withdrew their support for the ballot question once the new healthcare law passed. HCFA's statement on Question Five said, "We should recognize Chapter 141 (the new law) as the great collective victory it is. Let's work for enforcement and move on to propose the next steps toward universal health care."

Many people concerned about healthcare in Massachusetts (not just patient groups and not just insurance companies) think that the Patient's Rights and Healthcare Reform Law is better written and better suited to actually improving healthcare and increasing patients' rights than the language in the ballot question.

But, the final petitions for Question Five were submitted days before the new law passed. So, legally the language from Question Five has to be on the statewide ballot this fall, even if no one supports it.

Now, there are still people supporting Question Five, but not nearly as many as there were before the new law passed-most of the original supporters now want to see the new law go into effect in January, as scheduled, and think that it will move us in the right direction. And, they also fear that passing Question Five would not only undermine the effectiveness of the new Patient's Rights and Healthcare Reform Law, but also create a dangerous chaos in the state's healthcare system.

In other words, lots of people familiar with the healthcare system say we just can't have both Question Five and the new law-it wouldn't work, we need to let the new law go into effect on its own.

Are you with me?

What will happen if Question Five passes since the new law is supposed to go into effect, too? We don't know for sure. Maybe the new law will be overturned, or maybe we'll have two "systems" in place. I've asked around, the one thing that's certain is that we'll probably see some legal action on either side.

So, what would Question Five really do?

What is the Patient's Rights and Healthcare Reform Law scheduled to do?

Both Question Five and the new law include provisions for commissions to make recommendations to the legislature-slightly different types of commissions, but they each require a commission. If it passes, we may end up with two commissions charged with doing similar things, and, frankly, that would create chaos.

Question Five authorizes a broad variety of people (well beyond just medical doctors) to order tests and treatments for patients. Opponents of Question Five say that this type of system is unsound (health plans say they'd be unable to review the credentials or monitor the quality of care of health care professionals-some of whom may not be all that "professional") and would drive medical costs through the roof. Once in effect, the new law gives physicians and patients greater control over their treatment. And, it allows patients to appeal HMO (Health Maintenance Organization) decisions to an independent review panel.

Question Five supporters say that passage will "control" HMOs, reduce paperwork and control costs. Opponents say that passage would dismantle the managed care system in Massachusetts, increase costs and force our HMOs out of business here. If this happens, it would mean that current HMO subscribers would either have to pay for indemnity insurance (costing ten to forty percent more than HMO coverage) or, go uninsured. Additionally, employers who pay for part of their employees' health care costs would either have to pay a higher amount per employee (and probably have to cut back somewhere else), scale back the amount/type of health care coverage they could offer to employees, or, if the costs get too high, eliminate the coverage they offer altogether.

So, it's confusing. And, there are many pieces to the puzzle of improving quality and access in healthcare.

For more information on Question Five and the other ballot questions take a look at one of Secretary Galvin's voter guides, or visit this website:

To read the Patient's Rights and Healthcare Reform Law visit:

It's up to you.

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