State and local residents will decide on various healthcare ballot issues when they head to the polls in November.
Here are five measures to know:
1. Mandated nurse-to-patient staffing ratios in Massachusetts hospitals. Question 1, proposed by the Massachusetts Nurses Association, calls for mandated nurse staffing ratios that would vary by unit, floor or department. Supporters argue mandated nurse staffing ratios will improve patient care, and opponents say the ratios will worsen nurse care delivery, lead to longer emergency room wait times, and hurt community hospitals and mental health facilities.
2. Hospital charge initiative in Palo Alto, Calif. The measure, initially filed in May, would place a 15 percent cap on the amount Palo Alto-based hospitals can charge in excess of direct patient care costs. Hospitals, medical clinics and other providers in Palo Alto would have to refund payers for charges exceeding the 15 percent cap within 180 days of each fiscal year.
3. California dialysis initiative. Proposition 8, known as the Fair Pricing for Dialysis Act, would limit the amount insurance companies are required to reimburse dialysis clinics for treatment to 115 percent of allowable costs. Under the initiative, dialysis clinic revenue above that threshold would be rebated largely to insurers. Rebates would not go to government programs that provide lower reimbursement, such as Medicare.
4. Montana initiative to fund Medicaid with tobacco tax hike. The Montana initiative calls for a $2 tax increase on a pack of cigarettes to pay the state's share of Medicaid expansion costs. It would take effect Jan. 1. The initiative would also increase the tax on snuff and tax vaping products.
5. Idaho Medicaid expansion initiative. Idaho voters will decide on whether the state should expand Medicaid. If approved, the measure would expand coverage to residents under 65, who earn 133 percent of the federal poverty level or below and who do not qualify for other state insurance coverage.