In 2003, Mass-Care started a campaign to make health care a constitutional right in Massachusetts through amending the constitution.

The proposed amendment stated:

Section 1: The People of the Commonwealth of Massachusetts hereby declare it necessary and expedient to alter the Constitution by the adoption of the following Article of Amendment:

Upon ratification of this amendment and thereafter, it shall be the obligation and duty of the Legislature and executive officials, on behalf of the Commonwealth, to enact and implement such laws, subject to approval by the voters at a statewide election, as will ensure that no Massachusetts resident lacks comprehensive, affordable and equitably financed health insurance coverage for all medically necessary preventive, acute and chronic health care and mental health care services, prescription drugs and devices.

Mass-Care, along with the nurses union and a big coalition of healthcare advocates successfully collected the almost 90,000 needed signatures in 8 weeks, representing every legislative district in the Commonwealth. Under state law, if the initiative receives the vote of least one-fourth of the members for 2 consecutive years at the State Convention, then the initiative will appear on the ballot for a vote of the people. The first year the initiative passed overwhelmingly: 153-41. However, the second year, leadership refused to allow it to come out of committee, ensuring that it wouldn’t be submitted to voters in 2008.

Mass-Care sued the legislature for violating the rights of the people. The case was finally ruled by the Massachusetts Supreme Judicial Court, which agreed with Mass-Care that the Legislature had a constitutional duty to give all pending constitutional amendments and up or down vote (as had been ruled just a week prior concerning an initiative marriage equality amendment); however, due to separation of powers, the Court could not force the legislature to do so. It was a great blow to health care advocates, who felt that they had finally evinced overwhelming support for the movement, but also for everyone living in the Commonwealth who values the integrity of our democratic processes.

This was largely enabled by the fact that legislators can vote in secrecy leaving their constituents, the vast majority of support M4A having no idea how their representatives voted.