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Healthcare Labor Unions Flex Their Muscles

Analysis  |  By MedPage Today  
   April 24, 2019

Recent events spotlight concerns about caring for underserved, VA staffing

This article was first published on Tuesday, April 24, 2019 in MedPage Today.

By Joyce Frieden, News Editor, MedPage Today   

Labor unions for healthcare workers are ramping up their activity in 2019, pushing for increased charitable activity from non-profit health plans and full staffing of healthcare jobs at the Department of Veterans Affairs.

A group of union workers at Kaiser Permanente—the $80 billion integrated health plan with more than 12 million members and facilities in eight states plus the District of Columbia—has been trying to draw attention to what it says is a failure by the plan's leadership to provide care for the underserved.

In early April, a group of members of the Coalition of Kaiser Permanente Unions—a federation representing more than 80,000 KP employees—protested outside a Washington hotel while the health system's CEO, Bernard Tyson, was inside receiving an award.

The protest was held to raise awareness "that Kaiser is under-serving Medicaid patients," according to a coalition press release.

"Kaiser serves a very low percentage of Medicaid patients, suggesting its profits are boosted by excluding the nation's poorest people. For instance, while Medicaid funds healthcare for 21% of Americans, Kaiser's Medicaid patient volume is only 9.6%." In addition, the workers "are also concerned that Kaiser is operating as a nonprofit in name only," the release said.

"Kaiser made $4 billion in profits last year, is sitting on $31.5 billion in reserves, and pays 30 executives more than $1 million annually, and yet operates as a 'non-profit' organization."

In response, John Nelson, KP's vice president of communications, said in a statement that KP is "disappointed that some union leaders are choosing to make false allegations and pursue an adversarial, destructive approach as part of their bargaining strategy.

"Here are the facts," Nelson said. "Since 2013, our Medicaid enrollment has more than doubled, from 455,000 to over 918,000 this year. That's a 102% increase since 2013. In context, our overall enrollment over the same period rose by 30%. We view Medicaid as critical to achieving our mission of providing care to the communities we serve."

"Kaiser Permanente is an integrated system of healthcare and coverage, and we go well beyond providing charity care in our emergency departments and inpatient areas," Nelson said. "We work to provide the uninsured and underinsured with a medical 'home' where they can get continuity of care and comprehensive treatments."

The protest came about a week before the COKPU was due to begin negotiations with the health plan on a national contract agreement for its workers. The last national contract expired on Sept. 30, 2018, although local union contracts were not set to expire until "mid-to-late 2019 or later," according to a coalition press release. The coalition began bargaining on April 18 and will have another one in mid-May, a spokesman said.

COKPU is smaller today than it was last year. In late March 2018, 22 local unions representing 45,000 KP employees announced that they were splitting apart from COKPU following mounting disagreements between the smaller unions and the coalition's largest union, SEIU United Healthcare West, according to an article posted on the website of the Northwest Labor Press, a union-supported newspaper for union members in Oregon and southwest Washington state.

"SEIU-UHW wanted to have more say over Coalition decision-making, and on its own began to pursue a more confrontational strategy," the article said, adding that the departing unions had a good relationship with KP, which they wanted to maintain.

The new group named itself the Alliance of Healthcare Unions and began its own negotiations, which culminated on Nov. 1, 2018 with a ratified national contract that included wage increases and better benefits, the group said in a press release.

Another KP union that was never a part of COKPU—the California Nurses Association, now a part of National Nurses United—reached its own agreement with KP last March on a 5-year contract that features 12% raises for its members, which include 19,000 RNs and nurse practitioners (NPs), according to the Northwest Labor Press article.

The NNU is also involved with another large healthcare employer: the VA. Last Wednesday, the NNU held an event in the Bronx featuring Rep. Alexandria Ocasio-Cortez (D-N.Y.) to draw attention to the Trump administration's plans for increasing privatization of care for veterans.

"For years, we've had the CHOICE program where vets can go outside the VA to get the care they need; the point was for them to access care when they can't get to the VA," Better Omeh, an NP and an NNU delegate to her local chapter, in the Bronx, said in a phone interview.

"But now they want to expand the CHOICE program where even patients [close by] are told they can go outside the VA to get care," Omeh said. "The concern is that they won't get the kind of care they get at the VA because [the VA staff has] been uniquely trained to be able to deliver care to the veterans," she said.

If the issue is that there is a long wait time at the VA, "why not hire more doctors and nurses so patients can get the care they need there?" Healthcare staffing at the VA is already an issue, she said. "Right now over 43,000 vacancies need to be filled; that's not a priority of this administration but it needs to be done."

The VA did not respond to requests for comment on this story.

Photo credit: Marie Kanger Born / Shutterstock


Union workers at Kaiser Permanente have been trying to draw attention to what they say is a failure by the KP's leadership to provide care for the underserved.

Healthcare labor unions are also raising concerns about the VA's CHOICE program, and how it could potentially harm veterans needing unique care services.

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