Unions in Healthcare

State of Unions in Healthcare

Although healthcare is not a typical model one thinks of when studying union organization, there has been a slight increase in both participation in private hospital unions and larger national unions since 2004 (Daly, 2016). The number of healthcare and social assistance union members increased by 22,000 in 2015 to reach 1,242,000, which was enough to maintain the 7.3% share of workers in 2015. This proportion has seen small rises and drops since, but as the healthcare workforce gears up for potential repeal and replacement of the ACA, many could start to rely on unions in an attempt to keep their job and negotiate new pay if this results in a drop in demand.

The main organizations on the national stage are SIEU United Healthcare, National Nurses United, the American Federation of Labor, and The United Food and Commercial Workers International Union. The job of most of these organizations is to provide resources and support for local unions and encourage unionization. Even though two of these examples integrate outside of healthcare, they sometimes represent the many healthcare workers that are not providers of care. National Nurses United has become a much more significant advocate in recent years, campaigning aggressively to represent a number of workers in healthcare previously represented by the SIEU (Maher, 2013). In the state of Texas, we are most likely to deal with National Nurses United if our employees want to unionize.


Recent Union Operations

Given the gradual increase of unionization activity in healthcare, a number of unions have been very active for employees. A majority of larger union activities include the activation of union groups at certain hospitals as well as negotiation processes in the ratification of labor deals. Below are a number of hospitals where unions have organized to meet different goals for the employees (Gooch, 2017):

Providence based Rhode Island Hospital- Rally over changes in lifespan sick policy

Windham Community Memorial- Ratification of 3 year labor deals

Partners Healthcare Hospital- allowing union of about 500 service workers

Providence Tarzana Medical Center- contractors demonstrated over housekeeping jobs lost to internal services department

Pocono Medical Center- Organized Protests against layoffs and staffing changes

U.S. Appeals Court- Backing Massachusetts hospital system’s ability to incentivize hiring non-union employees

Impact of Law and Policy in Texas & Nationwide

At the state level, there are a number of legislative acts that limit and regulate unions. Texas is a right to work state, where one cannot be forced to join a union in order to be hired. Furthermore, and “open shop” policy prevents, “strike or picket to force an employer to recognize the union or to force other employees to accept the union as a bargaining agent if the union does not actually represent a majority of the employees working when the strike began” (TSHA, 2010).

There are a number of national laws that Unions and employers must meet. The two most important are the Taft-Hartley act and the Landrum-Griffen act. The Taft Hartley Act prevents jurisdictional strikes, political strikes, secondary boycotts, mass picketing, and donation to political campaign. The Landrum-Griffen Act created bodies in trusteeship, union officers as fiduciaries in asset control, and annual financial report submissions among others.

Both the ACA and other legislation have had an impact on many unions, including those in healthcare. Healthcare benefits are an important part of union advocacy, and depending on the state, the ACA has reduced access to the most plentiful benefits due to mandates and lack of tax subsidies now available to them (UPMC, 2014). Perhaps even more importantly, they were unable to prevent the passing of the “Cadillac tax”, which is a 40% excise tax on high cost employer health benefit plans (Lemieux, 2016). This plan will go into effect in 2018 unless the ACA is repealed before this happens. Given the uncertainty that will come with an ACA repeal, it will be interesting to see how unions and workforces react to the potential drop in demand that could come if insurance coverage drops significantly.

Individual Hospital Policy

It is important for any healthcare providers to have both preventative and reactionary policies in place for the unionization of their workers. While the existence of unions is not inherently detrimental, their existence at an organization does show a lack of trust or communication between management and employees. Because of this, it is important for human resources to be involved in strategic workforce planning. They and upper management must ensure that employees trust them, lines of communication are in place for issues, and that they recognize legitimate employee concerns. On the reactive side, management must be willing to recognize if mistakes are made, or if employees are not receiving proper pay or benefits. They must be willing to approach any negotiations seriously, and remain respectful of their employees.



          Daly, R. (2016, January 29). Unionization Surges in Healthcare. Retrieved February 10, 2017, from https://www.hfma.org/Content.aspx?id=46176

          Gooch, K. (2017, February 6). Hospitals and Unions: 8 recent conflicts, agreements. Retrieved February 10, 2017, from http://www.beckershospitalreview.com/human-capital-and-risk/hospitals-and-unions-8-recent-conflicts-agreementsfeb-6.html

          Gooch, K. (2017, January 20). Hospitals and Unions: 13 recent conflicts, agreements. Retrieved February 10, 2017, from http://www.beckershospitalreview.com/human-capital-and-risk/hospitals-and-unions-13-recent-conflicts-agreementsjan-20.html

          Lemieux, J., & Moutray, C. (2016, April 25). About the Cadillac Tax. Retrieved February 10, 2017, from http://healthaffairs.org/blog/2016/04/25/about-that-cadillac-tax/

         Maher, K. (2013, January 3). Healthcare Unions Will Join Forces. Retrieved February 10, 2017, from https://www.wsj.com/articles/SB10001424127887323689604578220072127879906

         Texas State Historical Association. (2010, June 15). Union Regulation. Retrieved February 10, 2017, from https://tshaonline.org/handbook/online/articles/oju01

       UMPC. (2014, September 17). Obamacare and Unions. Retrieved February 10, 2017, from http://www.yourhealthcaresimplified.org/news/obamacare-and-unions/


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