Massachusetts, the first state to enact a universal health insurance coverage law, may also be among the first to experience the political upheaval that could come with healthcare reform driven changes.

The state’s nursing union, frustrated over job loses, cost cutting and the recent abrupt closure of North Adams Regional Hospital, is seeking to put two bills on the ballot that would force greater public disclosure of hospital finances and also tighten standards for nurse to patient ratios. The Hospital Profit Transparency & Fairness Act is House Bill (HB) 3844. The Patient Safety Act is HB 3843.

This past week, the Massachusetts Nurses Association/National Nurses United also launched a radio ad campaign that highlights what they say is hospital CEOs' “excessive” pay and money held in Cayman Islands accounts.

Meanwhile, several of the state’s, physician groups, hospitals and healthcare systems have become concerned about the state’s recent deal with Partners HealthCare to drop barriers to its acquisition of Hallmark Health System in Melrose, Massachusetts, and South Shore Hospital in South Weymouth, Massachusetts, in exchange for provisions that would hold down prices for several years.

A coalition that includes Boston's Beth Israel Deaconess Medical Center and Tufts Medical Center, Cambridge Health Alliance, Lahey Health, and Atrius Health, as well as several community hospitals and physician medical groups, wrote to state Attorney General Martha Coakley and Deputy Attorney General Christopher Barry-Smith to express their worry about not having had a say in state’s deal with Partners.