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Hospital administrators found a natural ally in their efforts to thwart mandatory nurse staffing ratios: other executives.

Question 1 looms large, with the statewide vote less than three weeks away. So prominent business groups are making their final push against the ballot question that would set standards for the maximum number of hospital patients that can be assigned to a nurse at any given time.

The state’s largest employer group, Associated Industries of Massachusetts, e-mailed members on Wednesday, urging them to reject the union-backed Question 1. The AIM note highlights the state Health Policy Commission estimate that the question would drive up costs by $676 million to $949 million a year, and decries the way it takes decisions away from care providers. AIM chief executive Rick Lord says the e-mail, which also called for members to support Question 3 involving transgender rights, arrived in at least 15,000 inboxes.


The Greater Boston Chamber of Commerce e-mailed its own policy brief opposing Question 1 earlier this month, and expects to issue another one within the next week. The Retailers Association of Massachusetts and the Massachusetts Business Roundtable sent out their own missives. And executives at AIM and the Massachusetts Taxpayers Foundation have criticized the mandated ratios in recent public appearances.

One thing they’re not doing: chipping in money. As of Oct. 1, the campaign against Question 1 spent nearly $12 million. Almost every dime came from the Massachusetts Health & Hospital Association.

The pro-side, which spent about $8 million by that filing deadline, also has one primary source of money: the Massachusetts Nurses Association. A number of registered nurses also contributed, though those individual donations represent a small fraction of the total.

A spokeswoman for the “Yes on 1” campaign says it’s not surprising that business leaders focused on money: It’s a familiar language for them. She says her group is more focused on patient care. Make no mistake, she says, hospitals can afford to take this on.


But at what cost? That’s what has various business groups anxious. The ballot question includes language to prevent layoffs in other departments to offset the hiring of more nurses. Health insurance in Massachusetts, the critics say, is expensive enough.

The business groups play this aspect down, but it’s worth noting: Hospital executives often hold spots on these groups’ boards and are chummy with their leaders. Also, the anti campaign has endorsements from a long list of smaller chambers, in parts of the state where hospitals are among the few large private-sector employers.

Then there’s the principle of the matter. Business groups often gripe about “governing by ballot initiative” — a sloppy part of democracy, they say, for complex issues such as this one. And many are already frustrated by overly controlling government mandates.

It’s hard to know whether their opposition will make a difference come Nov. 6. But the polls indicate this will be a close vote, even among nurses. The business groups’ extensive networks could be a crucial factor.

Jon Chesto can be reached at jon.chesto@globe.com. Follow him on Twitter @jonchesto.