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Here’s a perplexing question about Ballot Question 1: Just when, if approved, would the new law go into effect?

Question 1, backed by the Massachusetts Nurses Association, would set strict limits on the number of patients assigned to nurses working in hospitals.

The last line of the question says: “This act shall take effect on Jan. 1, 2019.” That’s just eight weeks after Election Day.

Hospitals, which strongly oppose the law, have warned that it’s essentially impossible for them to hire and train thousands of new nurses in that amount of time.

In addition, it seems unlikely that state officials would be ready to fully enforce the law on Jan. 1.

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The ballot question requires the state Health Policy Commission to write regulations for implementing the law. The commission, along with the attorney general’s office, would be charged with ensuring that hospitals comply with those rules. If the commission finds a violation at a hospital, it would report that violation to the attorney general’s office. Then the attorney general’s office could file a court action to demand penalties of up to $25,000 per violation, per day.

Speaking with reporters last week, Attorney General Maura Healey said this all will take time to implement.

“There would be time needed . . . for HPC to do the work that it needs to do in terms of regulations, and then for our office to come up with a framework,” she said.

Officials at the Health Policy Commission, without getting specific, also indicated the process would take time.

“The law’s effective date is Jan. 1, 2019. There are no prescribed timelines in the law for regulatory action. It is premature to commit to a timeline at this point,” the commission’s executive director, David Seltz, said in a statement. “This is a hugely important issue that will impact the delivery of care for every resident of the Commonwealth going forward. If passed, the HPC will act as deliberatively and expeditiously as possible.”

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Another wrinkle: the Health Policy Commission released a report this month that said Question 1 could cost the Massachusetts health care system more than $900 million a year. That report drew the ire of the nurses union.

Union officials, when asked about the timeline of the law, acknowledge that full enforcement is likely to take a while — even though the ballot question they wrote says Jan. 1.

“The question of implementation timeline is solely with the Health Policy Commission, and with their reluctance to address the issue and their overall complete lack of transparency, it seems unrealistic that they would have regulations completed by Jan. 1, 2019,” Kate Norton, a spokeswoman for the nurses union, said in an e-mail.

But some hospitals are saying that they will move to close beds right away if Question 1 passes, because the costs of hiring additional nurses would be too high.

“We take this piece of legislation very seriously,” said Dan Cence, a spokesman for the hospital coalition fighting Question 1. “With the way it’s written, we have to take them on their word and be ready to implement it.”

Call it another point of disagreement on an issue where there is already plenty.


Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.