Decisions at the ballot box

James Mandell, MD, CEO

James Mandell, MD, is chief executive officer at Children’s Hospital Boston. In the following post he weighs in on some issues facing Massachusetts voters on Tuesday.

The weather is getting cooler and the leaves are blowing about—a sure sign that fall has arrived in New England. Another staple of the season are the seemingly incessant TV advertisements and phone calls reminding us of an upcoming election. While campaigns can be tiresome, it helps to remember how fortunate we are to live in a democracy that guarantees every American a voice in the direction of our country.

This year, we in Massachusetts have a great deal at stake. While voting is a very private matter, as a hospital leader, I must offer my perspective on the statewide ballot questions. Passage of these questions would have a devastating effect on this hospital and the children and families we serve. Right now, Massachusetts has the lowest uninsured rate, the highest childhood immunization rate and some of the best school performance in the country. These services would be in jeopardy if these questions pass.

Question 1 would eliminate the sales tax on alcohol products and, if passed, would reduce state revenues by $110 million annually. Alcohol is not a necessity and doesn’t deserve a special tax exemption. The only goods in Massachusetts exempt from the sales tax are necessities like food, clothing and prescriptions. Revenues from the alcohol tax fund prevention and treatment services to help youth and adults beat addictions and get their lives back on track. Numerous studies have shown that the alcohol tax is among the most effective ways to deter underage drinking. Only five states in the country do not have a sales tax on alcohol.

Question 3 would reduce the sales tax from 6.25 percent to 3 percent, and would result in the state losing approximately $1 billion in sales tax revenues in fiscal 2011 and $2.5 billion in 2012. The Massachusetts Taxpayers Foundation estimates that if Question 3 is approved by the voters, the state would face a $4.5 billion budget gap for fiscal 2012—a $2 billion structural deficit plus $2.5 billion in lost sales tax revenues.

About one third of all state budget expenditures are for health care programs, including MassHealth, CHIP and the health safety net. At Children’s, around 30 percent of our patients rely on these programs for their health care coverage. Passage of this ballot question would require dramatic cuts in coverage, services and provider rates. Many of our most vulnerable patients also depend upon a wide range of human services programs—from WIC to the Early Intervention program to mental health services. No matter where you line up politically on the question of taxes or the role of government, a $4.5 billion gap in the Massachusetts state budget would be devastating to hospitals and to the programs that our families rely on. If this question passed, it would mean such a big cut–about 8 percent of the whole state budget–that all heath, human service, local aid and education funds would be at great risk.

The economic challenges for the past few years have forced all Massachusetts families, institutions and local governments across the state to rise to the occasion.  We have found ways to reduce costs and operate more efficiently, and move forward with great promise and potential. But reducing the state revenues by billions of dollars would stymie the ability of all health and human service providers to continue to provide essential services to the most vulnerable citizens in our state. I urge you to vote “No” on both Ballot Questions 1 and 3. Regardless of your decision, please know that this is a very important election and your vote counts on November 2.