This week, SEIU Healthcare Pennsylvania -- the union that represents thousands of nurses, support staff and home-care workers across the state -- began airing radio ads urging hospital giant UPMC to come to the table with health insurer Highmark Inc. and asking lawmakers "to intervene and preserve access to UPMC care for Highmark's subscribers."
Last week, at a state Insurance Department hearing about Highmark's proposed acquisition of struggling West Penn Allegheny Health System, the SEIU was again in the insurer's corner: Members wore stickers that said, "Highmark & WPAHS, Stronger Together," and testified that the state should approve the purchase in order to preserve the health system and its 10,000 employees -- more than 2,000 of whom are members of SEIU Healthcare.
And last year, when he was still CEO of Highmark, Kenneth Melani urged labor leaders to get behind Highmark in its battle with UPMC over a new provider reimbursement contract to replace the one that is set to expire next summer. That contract -- which Highmark says it wants, and UPMC says it does not -- would allow Highmark members, including hundreds of thousands of local unionized workers, to maintain access to UPMC's hospitals and physicians while keeping their Highmark Blue Cross Blue Shield insurance.
So, why the chumminess between Highmark and the SEIU? Most obviously, it's born of immediate necessity -- Highmark wants to maintain its position as the dominant health insurer in the region and wants its acquisition of WPAHS to succeed. And the SEIU wants to maintain its 2,000 or so WPAHS union positions, which make up about 10 percent of SEIU Healthcare's total Pennsylvania membership of more than 20,000 employees.
"Our members are very committed to a health care system that works for our patents, and for our communities," said Neal Bisno, president of SEIU Healthcare Pennsylvania. "And that means having real choice in health care, [and] making sure that big systems like UPMC aren't becoming monopolies. ... We're not aligning with any entity. We're aligning with a set of principals."
But SEIU's support of Highmark also could be strategic from a long-term sense: Support of the insurer today could engender some good will tomorrow, especially if Highmark eventually wins its bid for WPAHS and arrives at a contract with UPMC. And being out in front on the fight also may win the hearts of nurses at other hospitals or care homes.
"They can placate the current members they have, and they can appeal to prospective members," said Doug Smith, a managing partner with the Pittsburgh office of Jackson Lewis LLP, a New York-based employment and labor law firm that specializes in "preventive practices" -- that is, winning or averting union elections -- among other practice areas.
"Any time you're dealing with SEIU Healthcare, you have to look at it from an organizing standpoint," he said.
Pennsylvania's largest health care union, which is one of seven Pennsylvania-based SEIU locals, has organized members in three of WPAHS's five hospitals. By contrast, the SEIU has organized staff in just a handful of UPMC's 20 hospitals.
"They want to make friends," said Gary N. Chaison, professor of industrial relations at the State University of New York at Buffalo. "You want to have as many friends as you can," especially in an uncertain economic time -- and health care, more so than most industries, is facing years of uncertainty and cost-cutting pressure.
But even given the uncertainty in health care brought about by spiraling costs and the pending Supreme Court challenge to the 2010 Affordable Care Act, investing in health care is still a good bet for labor.
The SEIU and other labor groups know that while union membership is sinking nationally -- it peaked at nearly 21 million members, or 24.1 percent of U.S. workers, in 1979, and was down to 11.8 percent in 2011, with private-sector penetration of just 6.9 percent -- health care has been one of the few labor growth markets.
In the U.S. Bureau of Labor and Statistics' annual report on union membership, about 14.7 percent of "health practitioner and technical operations" employees (or nearly 1.1 million of the 7.2 million such employees) were either in a union or represented by one in the collective bargaining process.
In the "health support services" employees category, membership and representation was about 9.3 percent, or 297,000 of the 3.2 million in that category. In the two categories combined, union representation works out to about 13 percent.
Those numbers are up from 2000, when about 693,000 workers were counted in the "health practitioner and technical operations" category.
"Health care is one of the last frontiers" for labor, Mr. Chaison said. "Unions are getting tired of being organized in declining industries and unorganized in growing industries."
Health care's position as a growth industry for labor is a product, partly, of a 1991 U.S. Supreme Court ruling that made it easier to organize hospital workers. Since then, the SEIU, AFSCME and others have been more active in health care.
It has paid off in a variety of ways, both for the organizers and, in the end, the patients who stand to benefit when nurses can organize, in the view of Amy Galuska, a registered nurse at Allegheny General Hospital. She noted her nursing union was the driving force behind a patient satisfaction campaign -- called "Hearts of Gold" -- that helped dramatically improve the patient experience in one of the hospital's cardiac units.
The campaign involved training nurses as well as other, nonunion support staff -- dietitians, housekeepers and anyone else who might encounters patients on a daily basis -- on bedside manner. The result was an 11 percent improvement in its Press Ganey survey scores. Press Ganey is a company that collects patient data and conducts exit surveys of patents after they are discharged.
The AGH chapter of SEIU Healthcare was able to win patient-to-nurse staffing ratio language in the nurses' most recent contract, which guarantees that nurses on Ms. Galuska's unit will be handling no more than five patients at a time at night and will start the day with three patients.
"Before that was part of our contract, we were going seven patients on night" shifts, Ms. Galuska said. "We just were not able to get everything completed." The mandated ratios "really changed the mood of the unit ... and you could [see] the turnaround with the patients.
"They actually know who their nurses are."
While union representation within the health care sector has been growing for the past two decades, notably, there was a slight reversal of that trend between 2009 and 2011. Both the total number of employees represented by unions and the proportion of health care workers represented by unions dropped.
That might be partly because of the recession, or partly because the "low-hanging fruit" had already been harvested -- meaning the easiest-to-organize hospitals and care homes already have been unionized.
It could also be because of the uncertain nature of today's health care market.
"Nonunion workers in the health care sector are insecure," Mr. Chaison said. "They don't want to antagonize their employers right now, especially nurses. They know there will be cost-cutting in health care, and they don't want that cost-cutting to come from them."
Mr. Smith, the Jackson Lewis attorney, suggested health care unions may have been biding their time until the National Labor Relations Board issued new rules on organizing, including a new regulation approved in 2011 that would speed up the time frame for unions to hold workplace elections and reduce legal challenges to those organizing campaigns.
As for the SEIU's latest effort, the radio ads will run this week, nudging lawmakers to act and coming down hard on UPMC for potentially subjecting patients to a "life-or-death challenge." In the radio spot, the narrator cautions that a local cancer patient may have to change her doctor midtreatment if Highmark and UPMC can't agree on a contract.
"Someone needs to force UPMC executives to act in the interest of health care need, not greed," said CeCe Peterson, a registered nurse at Allegheny General and an SEIU Healthcare Pennsylvania member, in a prepared statement.
"It's shameful and sad that a company that made more than $700 million in profits last year is putting Highmark consumers' care on the line to pad its bottom line."
Bill Toland: email@example.com or 412-263-2625. First Published April 26, 2012 12:00 AM