Unions Fight For That: Adequate Healthcare Benefits For All Workers
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Labor unions have led the fight for many of the benefits workers receive on the job today, such as minimum wage, paid sick leave, overtime pay, and retirement. Of all of the benefits, though, the most important may be access to health insurance and other healthcare benefits.
Although there were some successful efforts as early as the late 1800s to get employers to provide health benefits to workers, the greatest gains were made after World War II. At that time, unions “pushed companies to fund health care benefits as a way to provide improvements in lieu of wage increases,” according to AEPC, a labor management purchasing coalition.
As a result of those efforts and many others since then, almost 55 percent of Americans have employer-sponsored health insurance, according to 2022 data from Statista.
Here’s a look at the role labor unions have played and continue to play in protecting access to this basic benefit for all workers.
Unions Help Secure Adequate Healthcare Benefits Access for All Workers
Medical costs are a financial burden to too many people. According to a 2019 study, nearly 67 percent of all personal bankruptcies are tied to medical debt. The key “culprit” for that debt is “inadequate healthcare insurance,” says Dr. David Himmelstein, study co-author and a distinguished professor in the School of Urban Public Health at Hunter College.
Unions have worked to change this. One of their top areas of concern is the well-being of workers, which is why unions strive to combat inequality in the healthcare system. Their involvement has been a critical element in the expansion of access to healthcare benefits in the United States. This is because union members and nonunion workers alike benefit from union successes in advocacy, lobbying, and negotiation efforts.
“Unions set a standard for working conditions in industries in which they are prevalent,” the Joint Economic Committee Democrats (JEC) states in a brief. “If employers have to compete for workers who have a good chance of getting a union job, nonunion employers have to pay higher wages and offer better benefits to attract and retain workers.”
Those standards are constantly changing alongside the evolving needs and expectations of union members who make their demands for contract negotiations. With each new contract comes stronger protections for union members and, subsequently, the greater workforce.
“Health care benefits negotiated through the collective bargaining process are generally known to be more comprehensive and affordable,” says Glenn Di Biasi, fund administrator for the United Food and Commercial Workers (UFCW) National Health and Welfare Fund. The stronger union standards compel nonunion employers to stay competitive in their offerings which means better benefits for workers.
The challenge for unions is understanding what their members need in terms of healthcare protections in negotiated contracts.
Unions Are at the Forefront of Healthcare Changes
Rising costs and changing needs are ever-present challenges for unions as they look for solutions to the problems of access to adequate and affordable healthcare benefits for members.
Rising Healthcare Costs
It’s no secret that healthcare costs in the U.S. continue to rise to unaffordable levels for many Americans, even those with health insurance. Subsequently, the cost of healthcare insurance coverage is rising and employers are passing some of the increase to their employees.
“The bulk of the research literature indicates that, one way or another, most of the burden of ever-increasing health care costs falls on the shoulders of workers,” write Laurel Lucia and Ken Jacobs at the UC Berkeley Labor Center. “That burden may come in the form of lower wages, higher premium contributions, or higher out-of-pocket costs.”
Unions try to mitigate the rise in costs to the workers. They bargain for contracts that protect healthcare benefits and require employers to share that burden. They also put pressure on healthcare providers to lower the costs of healthcare services.
For example, Service Employees International Union (SEIU) Local 32BJ in New York City joined a coalition of unions and patients’ rights groups to form the Coalition for Affordable Hospitals to “push for legislative change, build grassroots pressure and leverage the collective buying power of thousands of union members to take on hospital pricing directly,” shares Aidan McNally, chief steward at CUPE3906. In one successful effort, the coalition was able to stop the adoption of a premium-sharing plan the New York Presbyterian Hospital tried to introduce in 2022.
Changing Healthcare Needs
The healthcare needs of workers are always evolving. In today’s post-pandemic environment, workers want their healthcare benefits to include aspects such as mental health services, help managing health outcomes, and more telehealth services. To meet these expectations, unions are innovating the way they negotiate healthcare benefits.
Unite Here Health, for example, focuses on health outcomes by training union members to lead workshops that teach coworkers how to manage chronic conditions. UHH is a member of America’s Agenda, a coalition of organizations, including unions, that work together to devise ways to control healthcare costs and spending.
Healthcare delivery is “an engineering issue,” says Mark Blum, executive director of America’s Agenda and president and cofounder of Solidaritus. “We need to redesign care delivery to address the cost drivers and promote smarter delivery design.”
For some unions, that means endorsing direct primary care healthcare models. In such a model, union members pay a monthly subscription fee for access to a direct care provider; there are no copays or deductibles. The unions hire clinicians in these clinics to provide same-day service for workers, often with extended hours and longer visits to ensure optimum care. Two examples of such clinics include:
- The Brooklyn Health Center and five other area clinics, run by the New York Hotel and Motel Trades Council and the Hotel Association of New York City Employee Benefit Funds.
- Solidaritus Health, a partnership between the UFCW and UAW.
Using these clinics is not mandatory for members, but “plan leaders have learned it is important to give members options,” write Martha Hostetter and Sarah Klein, at The Commonwealth Fund.
These avenues for addressing the issue of healthcare offerings directly impact the immediate needs of their members; additionally, unions get involved in lobbying for changes to the overall healthcare system that would help the general population, including their members.
Unions Lobby for U.S. Healthcare System Changes
While unions are helping drive changes through collective bargaining, they are also advocating for systemic changes to the overall healthcare system. Labor leaders have lobbied for the expansion of Medicaid and Medicare programs and some have even supported the creation of a single-payer system instead of the current employer-based system.
Expanding Medicaid and Medicare
Medicaid and Medicare provide healthcare coverage for aging and low-income people who don’t have access through an employer. Unions generally support these programs as a means for addressing inequality in the healthcare system. Too many people work full-time jobs and still can’t afford basic medical care.
When Congress was trying to pass the American Families Plan bill in 2021 that included provisions to expand the Medicare program, 17 unions joined together to write a letter in support of the bill’s passage.
The letter states: “The American labor movement has fought for more than a century to make quality health care a basic right in the United States. On behalf of our collective membership, we urge you to take action in the American Families Plan package to improve health care for millions of Americans by improving and expanding the Medicare program.”
When it comes to expanding Medicaid, unions have lobbied in support of the expansion at the state level. “Our rural communities are losing necessary health care facilities,” wrote the South Dakota Farmers Union after Medicaid expansion passed in the state in 2022. “Medicaid expansion will help keep rural healthcare facilities open.”
Single-Payer Healthcare System
Some (but certainly not all) unions, like the United Electrical, Radio & Machine Workers of America (UE), support the creation of a single-payer healthcare system.
“Our health care system fails to provide quality care to every U.S. resident and wastes hundreds of billions of dollars a year in unnecessary administrative costs,” the UE asserts. “A Medicare for All single-payer system — supported by UE since 1943 — would expand and improve the cost-effective and administratively efficient Medicare program to finance comprehensive, high-quality health care for everybody in the U.S.”
If and until that happens, workers rely on unions to safeguard the healthcare benefits they do have while winning greater protections that set new industry standards and combat rising costs. Unions can use a tool like UnionTrack® ENGAGE® to poll their members on healthcare issues important to them as they enter into contract negotiations and encourage members to support legislation that improves the overall healthcare system.
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