Massachusetts Question 2, Medical Loss Ratios for Dental Insurance Plans Initiative (2022)

Massachusetts Question 2
Election date November 8, 2022
Topic Healthcare
Status a Approved
Type State statute	Origin Citizens

Massachusetts Question 2, the Medical Loss Ratios for Dental Insurance Plans Initiative, was on the ballot in Massachusetts as an indirect initiated state statute on November 8, 2022. The ballot measure was approved.

A "yes" vote supported this ballot initiative to: require dental insurance carriers to meet a medical loss ratio of 83% and require the insurer to refund the excess premium to its covered individuals and covered groups; require dental insurance carriers to submit an annual comprehensive financial statement to the Division of Insurance; and authorize the commissioner of the Division of Insurance to approve or disapprove of any insurance rates.

A "no" vote opposed establishing a medical loss ratio for dental insurance plans and enacting other regulations on dental insurance carriers.

Election results

Massachusetts Question 2
Result		Votes	Percentage
Yes		1,717,895	71.60%
No		681,238	28.40%

Results are officially certified.

Source

Overview

What did Question 2 change about dental insurance plans?

See also: Measure design

Question 2 required dental insurance carriers to submit to the insurance commissioner current and projected medical loss ratios for plans and specified financial information. It established the medical loss ratio for dental plans at 83% and required the insurer to refund the excess premium to its covered individuals and covered groups. The measure was designed to require carriers to submit information about the current and projected medical loss ratio, administrative expenses, and other financial information, as well as an annual comprehensive financial statement, to the Division of Insurance by April 1 each year.

The measure was designed to require carriers to file group insurance plans base rates and any changes to group rating factors that will take effect in the next calendar year in July of the preceding year. The commissioner became authorized to approve or disapprove of any product rates. The law applied to all dental insurance plans issued, effective, delivered, or renewed on or after January 1, 2024.

What is a medical loss ratio?

See also: Medical loss ratio

A medical loss ratio (MLR) is the portion of premium revenue a healthcare insurance company spends on claims, medical care, and healthcare quality for its customers in relation to administrative costs. Under Obamacare, health insurance companies were required to limit the portion of revenue that goes toward overhead and profit: individual and small group insurers were required to maintain a minimum medical loss ratio of 80%, while large group insurers were required to maintain a minimum MLR of 85%. Since 2015, Massachusetts law set the medical loss ratio for small or individual health insurance plans at 88%, and for large group plans the medical loss ratio aligns with the federal at 85%.

In 2019, the National Association of Dental Plans conducted a survey that found the average medical loss ratio for dental insurance plans in Massachusetts was 75.9%.

Who supported and opposed Question 2?

See also: Support and Opposition

There were three committees registered in support of the measure: Committee on Dental Insurance Quality, Fair Share for Dental Care, and Massachusetts Dental Care Providers for Better Dental Benefits. Together the committees reported $10.1 million in contributions. The Alliance of Independent Dentists Massachusetts, Association of Independent Dentists, Massachusetts Association of Orthodontists, Massachusetts Society of Oral and Maxillofacial Surgeons, and Massachusetts Dental Society endorsed Question 2. The top donor was the American Dental Association ($5.6 million).

Daisy Kumar, a registered nurse and founding member of the ballot question committee, said, "We do not expect dental insurance companies to waste our premiums by overpaying officers, having giant, wasteful commissions, sneaking payments to affiliates or gifts to parent companies that just add another layer of waste. Our insurance payments are not meant to be gifts to dental insurance companies. They are meant to help families like mine and yours."

There were two committees registered in opposition to the measure: Committee to Protect Access to Quality Dental Care and Committee for Competitive Dental Plans for Consumers. The committees reported $9.5 million in contributions. The top donors to the committees were Dental Service of Massachusetts ($5.0 million), Metropolitan Life Insurance ($1.3 million), and Principal Life Insurance ($963,637).

The Committee to Protect Access to Quality Dental Care said, "The proponents of this ballot question are not being straight with the voters. What they aren't telling you is that their anti-consumer proposal will increase costs for Massachusetts families and employers -- a nearly 40% premium increase in one recent study -- and can result in thousands of residents being denied access to much-needed dental care."

Measure design

See also: Text of measure

Question 2 required dental insurance carriers to submit to the insurance commissioner current and projected medical loss ratios for plans and specified financial information. It established the medical loss ratio for dental plans at 83% and required the insurer to refund the excess premium to its covered individuals and covered groups. The measure authorized the insurance commissioner to waive or adjust refunds if issuing refunds would result in financial impairment for dental insurance carriers.

The measure was designed to require carriers to submit information about current and projected medical loss ratio, administrative expenses, and other financial information, as well as an annual comprehensive financial statement, to the Division of Insurance by April 1 each year. The law also required the submitted data to be made public. The measure was designed to subject carriers to a public hearing if they report a risk-based capital ratio on a combined entity basis that exceeds 700% in its annual report. Carriers are required to submit testimony about the need for the surplus and its overall financial condition.

Carriers also are required to file group insurance plans base rates and any changes to group rating factors that will take effect in the next calendar year in July of the preceding year. The commissioner was authorized to approve or disapprove of any product rates. If a rate is disapproved, the proposed rate increase would be subject to a public hearing and a final written decision would need to be issued within 30 days after the hearing.

The proposed law does not apply to dental insurance plans issued to a self-insured group or where the carrier is a third-party administrator.

The law applied to all dental insurance plans issued, effective, delivered, or renewed on or after January 1, 2024.

At the time of the election, Massachusetts had established an 88% medical loss ratio for medical insurance plans, but there was no medical loss ratio for dental insurance plans.

Text of measure

Ballot question

The ballot question was as follows:

“

Do you approve of a law summarized below, on which no vote was taken by the Senate or the House of Representatives on or before May 3, 2022?

”

Ballot summary

The final ballot summary for Question 2 was as follows.

“

This proposed law would direct the Commissioner of the Massachusetts Division of Insurance to approve or disapprove the rates of dental benefit plans and would require that a dental insurance carrier meet an annual aggregate medical loss ratio for its covered dental benefit plans of 83 percent. The medical loss ratio would measure the amount of premium dollars a dental insurance carrier spends on its members’ dental expenses and quality improvements, as opposed to administrative expenses. If a carrier’s annual aggregate medical loss ratio is less than 83 percent, the carrier would be required to refund the excess premiums to its covered individuals and groups. The proposed law would allow the Commissioner to waive or adjust the refunds only if it is determined that issuing refunds would result in financial impairment for the carrier. The proposed law would apply to dental benefit plans regardless of whether they are issued directly by a carrier, through the connector, or through an intermediary. The proposed law would not apply to dental benefit plans issued, delivered, or renewed to a self-insured group or where the carrier is acting as a third-party administrator. The proposed law would require the carriers offering dental benefit plans to submit information about their current and projected medical loss ratio, administrative expenses, and other financial information to the Commissioner. Each carrier would be required to submit an annual comprehensive financial statement to the Division of Insurance, itemized by market group size and line of business. A carrier that also provides administrative services to one or more self-insured groups would also be required to file an appendix to their annual financial statement with information about its self-insured business. The proposed law would impose a late penalty on a carrier that does not file its annual report on or before April 1. The Division would be required to make the submitted data public, to issue an annual summary to certain legislative committees, and to exchange the data with the Health Policy Commission. The Commissioner would be required to adopt standards requiring the registration of persons or entities not otherwise licensed or registered by the Commissioner and criteria for the standardized reporting and uniform allocation methodologies among carriers. The proposed law would allow the Commissioner to approve dental benefit policies for the purpose of being offered to individuals or groups. The Commissioner would be required to adopt regulations to determine eligibility criteria. The proposed law would require carriers to file group product base rates and any changes to group rating factors that are to be effective on January 1 of each year on or before July 1 of the preceding year. The Commissioner would be required to disapprove any proposed changes to base rates that are excessive, inadequate, or unreasonable in relation to the benefits charged. The Commissioner would also be required to disapprove any change to group rating factors that is discriminatory or not actuarially sound. The proposed law sets forth criteria that, if met, would require the Commissioner to presumptively disapprove a carrier’s rate, including if the aggregate medical loss ratio for all dental benefit plans offered by a carrier is less than 83 percent. The proposed law would establish procedures to be followed if a proposed rate is presumptively disapproved or if the Commissioner disapproves a rate. The proposed law would require the Division to hold a hearing if a carrier reports a risk-based capital ratio on a combined entity basis that exceeds 700 percent in its annual report. The proposed law would require the Commissioner to promulgate regulations consistent with its provisions by October 1, 2023. The proposed law would apply to all dental benefit plans issued, made effective, delivered, or renewed on or after January 1, 2024.

”

Full text

The full text of the ballot initiative is below:

Readability score

See also: Ballot measure readability scores, 2022

Using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) formulas, Ballotpedia scored the readability of the ballot title and summary for this measure. Readability scores are designed to indicate the reading difficulty of text. The Flesch-Kincaid formulas account for the number of words, syllables, and sentences in a text; they do not account for the difficulty of the ideas in the text. The secretary of state wrote the ballot language for this measure.

The FKGL for the ballot title is grade level 11, and the FRE is 60. The word count for the ballot title is 26.

The FKGL for the ballot summary is grade level 17, and the FRE is 23. The word count for the ballot summary is 613.

Support

Committee on Dental Insurance Quality led the Vote Yes on 2 campaign in support of the initiative.

Supporters

The committee posted a list of endorsements on its website that can be found here.

Unions

• Alliance of Independent Dentists Massachusetts
• Association of Independent Dentists
• Massachusetts Association of Orthodontists
• Massachusetts Society of Oral and Maxillofacial Surgeons
• Medicaid Orthodontists of Massachusetts Association

Organizations

• American Dental Association
• Massachusetts Dental Society

Arguments

• Daisy Kumar, a registered nurse and founding member of the ballot question committee: "We do not expect dental insurance companies to waste our premiums by overpaying officers, having giant, wasteful commissions, sneaking payments to affiliates or gifts to parent companies that just add another layer of waste. Our insurance payments are not meant to be gifts to dental insurance companies. They are meant to help families like mine and yours."
• Dianne Morad, a lobbyist working with the ballot question committee: "A yes vote would help fix a broken system in which insurance companies benefit from denying claims and limiting coverage."
• Cesar R. Sabates, D.D.S., president of the American Dental Association: "We see approval of the ballot measure as a watershed moment in how dental insurance is provided for patients. Dental plans should serve patients first and foremost, and the companies that offer them should welcome transparency and accountability, rather than hide from it."

Official arguments

The following is the argument in support of Question 2 found in the Official Voter Information Guide:

Official Voter Information Guide: A YES vote expands consumer protection laws that already exist for medical insurance companies to dental insurance companies. A YES vote ensures better coverage and value for patients, instead of unreasonable corporate waste. For example, according to its own 2019 Form 990, Delta Dental (in Massachusetts alone) paid executive bonuses, commissions, and payments to affiliates of $382 million, while only paying $177 million for patient care. A YES vote would eliminate this inequity. Similar to medical insurance, this law would require dental insurance companies to allocate at least 83% of paid premiums to patient care, or refund premiums to patients to meet this standard. Insurance companies will try to confuse voters by saying that dental insurance premiums will increase. This is false, because Section 2(d) of the law specifically disallows increases above the consumer price index without state approval. Stop the corporate waste. Vote YES for fair dental insurance. ---Dr. Patricia Brown, DMD, MPH, The Committee on Dental Insurance Quality

Opposition

Committee to Protect Access to Quality Dental Care led the campaign in opposition to the initiative.

Opponents

Corporations

• Dental Service of Massachusetts
• Metropolitan Life Insurance
• Principal Life Insurance
• Sun Life Financial
• United Concordia Companies

Arguments

• Committee to Protect Access to Quality Dental Care, the committee opposed to the measure: "The proponents of this ballot question are not being straight with the voters. What they aren't telling you is that their anti-consumer proposal will increase costs for Massachusetts families and employers -- a nearly 40% premium increase in one recent study -- and can result in thousands of residents being denied access to much-needed dental care."

Official arguments

The following is the argument in opposition to Question 2 found in the Official Voter Information Guide:

Official Voter Information Guide: This question will increase costs for Massachusetts families and employers — a 38%-premium-increase in one recent independent study — and could result in thousands of people losing access to dental care. With consumer prices soaring, we don’t need a new regulation that will increase costs and decrease choice. There is no law like this ballot question anywhere in the nation. The Massachusetts Legislature actually repealed a similar law in 2011 because it proved overly burdensome and provided no real benefits for consumers. Federal lawmakers excluded it from Obamacare, and a special commission in Massachusetts reviewed and rejected a similar provision. Further, the state already requires reporting from dental plans.---Louis Rizoli, Committee To Protect Public Access To Quality Dental Care

Campaign finance

The campaign finance information on this page reflects the most recent scheduled reports that Ballotpedia has processed, which covered through January 20, 2023.

See also: Campaign finance requirements for Massachusetts ballot measures

There are three committees registered in support of the measure: Committee on Dental Insurance Quality, Fair Share for Dental Care, and Massachusetts Dental Care Providers for Better Dental Benefits. Together the committees reported $10.1 million in contributions. There are two committees registered in opposition to the measure: Committee to Protect Access to Quality Dental Care and Committee For Competitive Dental Plans for Consumers. The committees reported $9.5 million in contributions. Massachusetts also requires other organizations that spend money to support or oppose ballot measures to report amounts to the Massachusetts Office of Campaign and Political Finance. Massachusetts Fiscal Alliance reported spending $12,858.92 in opposition to Question 2.

	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Support	$9,735,717.36	$385,629.40	$10,121,346.76	$9,644,968.24	$10,030,597.64
Oppose	$9,262,235.00	$263,118.61	$9,525,353.61	$8,910,891.11	$9,174,009.72
Total	$18,997,952.36	$648,748.01	$19,646,700.37	$18,555,859.35	$19,204,607.36

Support

The following table includes contribution and expenditure totals for the committees in support of the ballot measure.

Committees in support of Question 2
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Massachusetts Dental Care Providers for Better Dental Benefits	$7,036,722.10	$90,629.40	$7,127,351.50	$6,991,982.20	$7,082,611.60
Committee on Dental Insurance Quality	$2,598,995.26	$295,000.00	$2,893,995.26	$2,552,986.04	$2,847,986.04
Fair Share for Dental Care	$100,000.00	$0.00	$100,000.00	$100,000.00	$100,000.00
Total	$9,735,717.36	$385,629.40	$10,121,346.76	$9,644,968.24	$10,030,597.64

Donors

The following table shows the top donors to the committees registered in support of the ballot measure.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
American Dental Association	$5,575,000.00	$12,265.00	$5,587,265.00
Mouhab Rizkallah	$2,481,460.22	$295,000.00	$2,776,460.22
Massachusetts Dental Society	$110,500.00	$18,000.00	$128,500.00
Gary Oyster	$125,000.00	$0.00	$125,000.00
California Dental Association	$75,000.00	$0.00	$75,000.00

Opposition

The following table includes contribution and expenditure totals for the committees in opposition to the ballot measure.

Committees in opposition to Question 2
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Committee to Protect Access to Quality Dental Care	$7,582,185.00	$67,381.60	$7,649,566.60	$7,230,645.97	$7,298,027.57
Committee For Competitive Dental Plans for Consumers	$1,680,050.00	$195,737.01	$1,875,787.01	$1,680,245.14	$1,875,982.15
Total	$9,262,235.00	$263,118.61	$9,525,353.61	$8,910,891.11	$9,174,009.72

Donors

The following table shows the top donors to the committees registered in opposition to the ballot measure.

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
Dental Service of Massachusetts	$5,000,000.00	$19,182.04	$5,019,182.04
Metropolitan Life Insurance	$1,320,000.00	$17,588.00	$1,337,588.00
Principal Life Insurance	$950,000.00	$13,669.00	$963,669.00
Delta Dental Plan Association	$795,000.00	$0.00	$795,000.00
Guardian Life Insurance Company of America	$500,000.00	$2,857.00	$502,857.00

Methodology

To read Ballotpedia's methodology for covering ballot measure campaign finance information, click here.

Media editorials

See also: 2022 ballot measure media endorsements

Ballotpedia identified the following media editorial boards as taking positions on the measure.

Ballotpedia lists the positions of media editorial boards that support or oppose ballot measures. This does not include opinion pieces from individuals or groups that do not represent the official position of a newspaper or media outlet. Ballotpedia includes editorials from newspapers and outlets based on circulation and readership, political coverage within a state, and length of publication. You can share media editorial board endorsements with us at editor@ballotpedia.org.

Support

• The Boston Globe Editorial Board: "Dental insurers, who have been exempt from certain Affordable Care Act regulations, ought to be held to a higher standard. Passing this ballot measure will finally get the ball rolling on Beacon Hill — and make visiting the dentist a little less daunting."
• The Boston Globe Editorial Board: "Dental insurers, who have been exempt from certain Affordable Care Act regulations, ought to be held to a higher standard. Passing this ballot measure will finally get the ball rolling on Beacon Hill — and make visiting the dentist a little less daunting."
• The Berkshire Eagle Editorial Board: "Insurance reimbursement rates are often cited as a pressure against opening up shop in lower-population areas and accepting insurance often held by low-income folks. This measure could alleviate this dental pain somewhat, either by driving up reimbursements or preventing excessive premium increases — or by at least getting our arms more firmly around the problem with the data that could be mined from the Question 2’s reporting requirements. ... The Eagle endorses both a yes vote on Question 2 and a call for the Legislature to do its job instead of leaving it to the ballot box."
• The Harvard Crimson Editorial Board: "Currently, Massachusetts has no regulations on the dental insurance MLR. Given the lack of publicly available data on the dental insurance MLR in Massachusetts, it is unclear how much of dental insurance companies’ revenue actually goes toward dental care, as opposed to administrative costs and profits. Passing Ballot Question Two will resolve this issue — not only by mandating a minimum MLR but also by making the data on this key measurement available to the public. ... Vote Yes on Ballot Question Two."

Opposition

You can share campaign information or arguments, along with source links for this information, at editor@ballotpedia.org.

Polls

See also: Ballotpedia's approach to covering polls and 2022 ballot measure polls

Are you aware of a poll on this ballot measure that should be included below? You can share ballot measure polls, along with source links, with us at editor@ballotpedia.org.

Massachusetts Question 2, Medical Loss Ratios for Dental Insurance Plans Initiative (2022)
Poll	Dates	Sample size	Margin of error	Support	Oppose	Undecided

UMass Amherst/WCVB	10/20/22 - 10/26/22	700 RV	± 4.3%	68%	20%	12%
	Question: "Question 2 - Would regulate dental insurance rates, including by requiring companies to spend at least 83% of premiums on member dental expenses and quality improvements instead of administrative expenses, and by making other changes to dental insurance regulations."

Note: LV is likely voters, RV is registered voters, and EV is eligible voters.

Background

Dental insurance in Massachusetts

The following table details the financials of dental insurance companies operating in the state in 2019. Small and large insurer designations are based on revenue. The data was collected by the National Association of Dental Plans in a survey conducted in April 2021.

Medical loss ratio

A medical loss ratio (MLR) is the portion of premium revenue a healthcare insurance company spends on claims, medical care, and healthcare quality for its customers in relation to administrative costs. The Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA) or Obamacare, was passed in March 2010. It placed new regulations on insurers' medical loss ratios by limiting the portion of revenue that goes toward overhead and profit: individual and small group insurers were required to maintain a minimum medical loss ratio of 80%, while large group insurers were required to maintain a minimum MLR of 85%. This means at least 80 or 85% of premium revenue is required to be used to pay customer claims and support improvements in health and healthcare quality, such as wellness promotion programs. This requirement does not include dental insurance companies.

Each year, insurers were required to publicly report their medical loss ratio and other financial information for each state and market segment. If their MLR falls below 80% or 85%, they would be required to notify their customers and provide a rebate the following year. The law exempted insurers serving fewer than 1,000 individuals in a state.

Medical loss ratio for health insurance in Massachusetts

Since 2015, Massachusetts law set the medical loss ratio for small or individual health insurance plans at 88%, and for large group plans the medical loss ratio aligns with the federal at 85%.

Laws related to dental loss ratios in other states

Ballotpedia identified the following laws related to dental medical loss ratios in other states.

California: In 2018, the California State Legislature adopted Senate Bill 1008, which required insurers to report dental loss ratios to the state's Department of Managed Health Care or the Department of Insurance. In 2014, the state passed Assembly Bill 1962, which required dental carriers to publicly report annual loss ratio data in a format that matched the Affordable Care Act medical loss ratio calculation.

Maine: In 2022, the Maine State Legislature adopted LD 1266, which required dental insurance companies to report their medical loss ratios annually to the Maine Bureau of Insurance beginning on July 31, 2023. The law required the superintendent of the bureau to identify insurers that fall outside two standard deviations from the average dental loss ratio and require additional financial information. The superintendent may also request a remediation plan for such insurers that could include rate and benefit modifications.

Massachusetts Division of Insurance

The Massachusetts Division of Insurance is one of five regulatory agencies overseen by the Office of Consumer Affairs and Business Regulation. The division "monitors financial solvency, licenses insurance companies and producers, reviews and approves rates and forms, and coordinates the takeover and liquidation of insolvent insurance companies and the rehabilitation of financially troubled companies," as well as, "investigates and enforces state laws and regulations pertaining to insurance and respond to consumer inquiries and complaints." The Massachusetts Commissioner of Insurance oversees the division and is appointed by the governor.

Path to the ballot

See also: Laws governing the initiative process in Massachusetts

The state process

In Massachusetts, the number of signatures required to qualify an indirect initiated state statute for the ballot is equal to 3.5 percent of the votes cast for governor in the most recent gubernatorial election. No more than one-quarter of the verified signatures on any petition can come from a single county. The process for initiated state statutes in Massachusetts is indirect, which means the legislature has a chance to approve initiatives with successful petitions directly without the measure going to the voters. A first round of signatures equal to 3 percent of the votes cast for governor is required to put an initiative before the legislature. A second round of signatures equal to 0.5 percent of the votes cast for governor in the last election is required to put the measure on the ballot if the legislature rejects or declines to act on a proposed initiated statute. Signatures for initiated statutes in Massachusetts are collected in two circulation periods. The first period runs from the third Wednesday in September to two weeks prior to the first Wednesday in December, a period of nine weeks. If the proposed law is not adopted by the first Wednesday of May, petitioners then have until the first Wednesday of July (eight weeks) to request additional petition forms and submit the second round of signatures.

The requirements to get an initiated state statute certified for the 2022 ballot:

• Signatures required (first round): 80,239 signatures
• Signatures required (second round): 13,374 signatures
• Deadline (first round): The deadline to submit the first round of signatures to the secretary of state was December 1, 2021. Signatures needed to be submitted to local registrars by November 17, 2021.
• Deadline (second round): The deadline to submit the second round of signatures was July 6, 2022.

If enough signatures are submitted in the first round, the legislature must act on a successful petition by the first Wednesday of May. The measure only goes on the ballot if the legislature does not pass it and if the second round of signatures is successfully collected.

Details about this initiative

• Question 2 was filed by Dr. Mouhab Rizkallah on August 3, 2021.
• On September 1, 2021, the attorney general cleared the initiative for signature gathering.
• The campaign announced that they submitted over 104,000 validated signatures to the secretary of state's office on December 1, 2021.
• At the end of December, the secretary of state certified the petition to the legislature.
• The state legislature did not pass the initiative before the May deadline. The campaign was cleared to gather a second round of signatures.
• On July 7, the state elections office reported that the initiative had filed a second round of signatures.
• On July 14, the secretary of state informed the campaign they had qualified for the ballot.

Cost per required signature

Sponsors of the measure hired Ballot Access Management to collect signatures for the petition to qualify this measure for the ballot. A total of $625,000.00 was spent to collect the 93,613 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $6.68.

Lawsuit

  

Lawsuit overview
Issue: Whether the ballot initiative's subjects are related and "mutually dependent" as required by the state constitution
Court: Massachusetts Supreme Judicial Court
Ruling: Ruled in favor of defendants; the ballot initiative's subjects are related
Plaintiff(s): Lory-San Clark and Wendy Sutter	Defendant(s): Attorney General Maura Healey (D), et. al
Plaintiff argument: The initiative violates the constitutional requirement because it relates to two separate subjects.	Defendant argument: The two subjects of the initiative are closely related.

  Source: Gloucester Daily Times

In February 2022, Lory-San Clark and Wendy Sutter filed a lawsuit against Attorney General Maura Healey (D) and the initiative campaign arguing that it violated the state constitution's requirement that the subjects of an initiative are "related" and "mutually dependent." The plaintiffs argued that the initiative concerns two unrelated subjects—setting a minimum medical loss ratio for dental insurance plans and requiring dental insurers to provide annual financial reports of all lines of business including non-dental insurance products. The Supreme Judicial Court heard arguments for the case on May 2, 2022.

On June 15, 2022, the supreme court ruled unanimously in favor of the defendants. The court wrote that the ballot question would create “an integrated regulatory scheme that would comprehensively address dental insurance rates that are excessive, inadequate, or unreasonable.”

How to cast a vote

See also: Voting in Massachusetts

See below to learn more about current voter registration rules, identification requirements, and poll times in Massachusetts.

How to vote in Massachusetts

Poll times

In Massachusetts, most polling places are open from 7:00 a.m. to 8:00 p.m. However, municipalities may open their polls as early as 5:45 a.m. An individual who is in line at the time polls close must be allowed to vote.

Registration

Check your voter registration status here.

To vote in Massachusetts, one must be a United States citizen, a resident of Massachusetts, and at least 18 years old on or before Election Day.

The deadline for registration is 10 days prior to the election. A voter can register online, by mail, or in person at any registration office or the Registry of Motor Vehicles. A form of identification is required to register. The following are acceptable forms of identification:

• Valid driver's license
• State-issued identification card
• Current utility bill
• Bank statement
• Paystub
• Government-issued check
• Any other government document displaying the voter's name and address

Automatic registration

Massachusetts automatically registers eligible individuals to vote through the Department of Motor Vehicles, division of medical assistance, health insurance connector authority, and other agencies that collect what state law defines as reliable citizenship information.

Online registration

See also: Online voter registration

Massachusetts has implemented an online voter registration system. Residents can register to vote by visiting this website.

Same-day registration

Massachusetts does not allow same-day voter registration.

Residency requirements

To register to vote in Massachusetts, you must be a resident of the state. State law does not specify a length of time for which you must have been a resident to be eligible.

Verification of citizenship

See also: Laws permitting noncitizens to vote in the United States

Massachusetts does not require proof of citizenship for voter registration. An individual must attest that they are a U.S. citizen when registering to vote. According to the state's voter registration application, the penalty for an illegal registration is a "fine of not more than $10,000 or imprisonment for not more than five years or both."

All 49 states with voter registration systems require applicants to declare that they are U.S. citizens in order to register to vote in state and federal elections, under penalty of perjury or other punishment. Seven states — Alabama, Arizona, Georgia, Kansas, Louisiana, New Hampshire, and Wyoming — have laws requiring verification of citizenship at the time of voter registration, whether in effect or not. In three states — California, Maryland, and Vermont — at least one local jurisdiction allows noncitizens to vote in some local elections. Noncitizens registering to vote in those elections must complete a voter registration application provided by the local jurisdiction and are not eligible to register as state or federal voters.

Verifying your registration

The Elections and Voting page, run by the Massachusetts Secretary of the Commonwealth office, allows residents to check their voter registration status online.

Voter ID requirements

Massachusetts does not require voters to present identification (ID) while voting, in most cases.

However, voters will be asked to show ID in the following circumstances:

“

You are voting for the first time in Massachusetts in a federal election; You are an inactive voter; You are casting a provisional or challenged ballot; The poll worker has a reasonable suspicion that leads them to request identification.

”

The following list of accepted ID was current as of August 2024:

• A driver's license
• A state ID card
• A recent utility bill
• A rent receipt or lease.
• A copy of a voter registration affidavit
• A letter from a school dormitory or housing office
• Any other printed identification which contains your name and address

Click here for the Secretary of the Commonwealth of Massachusetts' page on accepted ID to ensure you have the most current information.

“

Acceptable identification must include your name and the address at which you are registered to vote. Examples of acceptable identification include: a driver's license, state-issued ID card, recent utility bill, rent receipt, lease, a copy of a voter registration affidavit, or any other printed identification which contains the voter's name and address.

”

See also

2022 measures

• 2022 ballot measures
• Healthcare on the ballot
• 2022 petition deadlines

Massachusetts

• Massachusetts ballot measures
• Massachusetts initiative laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls
• Ballot measure signature costs

External links

• Full text

Support

• Yes on Question 2 campaign website
• Yes on Question 2 Facebook page
• Yes on Question 2 Twitter page

Opposition

Submit links to editor@ballotpedia.org.