Sizing up Obamacare, unions urging unified push for single-payer system

Cite increasing burden at bargaining table

By David Sims
The Chief-Leader (New York), March 3, 2014

The Affordable Care Act’s changes to the nation’s health-care business mean good and bad things for organized labor, but a Feb. 27 LaborPress event on its impact focused more on pushing for a single-payer system in the state to relieve the increased pressure on unions.

The event, hosted by the District Council of Carpenters, featured union leaders and health-care administrators debating the new landscape as New York State begins selling health-care plans on the open marketplace as part of the exchanges offered under the ACA.

Buyers’ Remorse

Despite labor’s broad support as President Obama worked to pass the ACA in 2010, unions have grown increasingly wary of “Obamacare,” fearing that workers will be siphoned off from their plans to cheaper state-based exchanges, driving up premiums for those remaining in the union health-care system.

But the panelists at the LaborPress “Strategy Roundtable on Winning Better Healthcare,” moderated by Cornell Union Leadership Institute co-director Gene Carroll, said that unions should look beyond the ACA’s flaws and push for even more fundamental changes.

State Assemblyman Richard Gottfried, who chairs the Assembly’s Health Committee, noted unions’ evolved relationship with providing health care over the years, recalling that in 1967, the AFL-CIO opposed a statewide universal health plan pondered by then-Governor Nelson Rockefeller.

“There was a time when labor regarded the delivery of health benefits as one of the great things that it did,” he said. “I really think that at this point the labor movement does not regard its responsibility for delivering health benefits a big plus. Most strikes occur over health benefits. Most of the time, when labor is not able to deliver significant improvement in wages, it’s because every effort is devoted to health benefits.”

In the city and around the country, unions struggle with the unwieldy costs of health-care plans, with employers and governments always eager to cut back or pass more costs onto members. With ACA coming into effect, the system will get worse, not better, Mr. Gottfried said.

Making Workers Pay

“The availability of the exchanges is encouraging more and more employers to shift coverage to workers or drop it entirely,” he said. Noting that Governor Cuomo had proposed covering the health-care costs of those earning up to 200 percent above the poverty line, he said the continuing shift to more government-subsidized coverage “will add to the magnetic power of non-union coverage, of exchange coverage, to draw people out of existing coverage.”

Mr. Gottfried has written a bill proposing a single-payer health system for New York State that he said would bypass all of the problems of an insurance-based system. “It should be paid for publicly. The revenue should not come through regressive premiums, regressive co-pays and regressive deductibles,” he said.

“I would love to see that happen at the federal level. I think it’s pretty clear the environment in Washington has moved us further away,” he continued. “In New York, particularly as people have seen that with all the fixes to the system ACA has done it is still not a system that really can work for people ... there is renewed interest in the bill that I first introduced. We’re working to get it to the floor in the Assembly again.”

Communications Workers of America Local 1180 President Arthur Cheliotes said labor had to organize better and inform members as a collective about the realities of health care to better push for reforms like the ones Mr. Gottfried was suggesting.

‘System is Broken’

“The fact of the matter is that our political system is broken. It does not respond to the needs of the American people, it responds to those who contribute the most in the halls of Congress,” he said. “Unless we address that issue, we cannot begin to solve that problem. That takes some real internal effort on the part of the labor movement. We have not done a good job on educating our own members.”

Pushing back against the insurance industry, the pharmaceutical industry and the medical-device industry, which lobbied heavily in Congress to shape the ACA into the bill it became, will require a concerted campaign by labor unions, Mr. Cheliotes argued.

“If we’re going to address the issue of even having a labor movement in this country, we have to begin to organize our political power much better than we are,” he said. “We’re at that stage where we have such concentrated wealth in the hands of executives.”

Mitra Behroozi, the executive director of Service Employees International Union Local 1199’s health-care funds, said the ACA’s negative impact was somewhat exaggerated. “Before the ACA, unions were having a devil of a time maintaining affordable health care for workers,” she said. “ACA did not make that worse; the increasing cost of health care makes that worse.”

She also endorsed the idea of a single-payer system, citing Medicare as a health program with better cost controls, and said labor should try to bring as many people as possible under the same umbrella.

‘The More, the Less Costly’

“We should all be on the same side when it comes to ensuring that everybody has access to affordable-quality care,” she said. “Bringing more people into coverage is a way of keeping costs down.”

Oliver Fein, a practicing doctor who is chapter chair for the group Physicians for a National Health Program, said labor needed to support a single-payer plan to stop the disruption of “the patient-physician relationship” which will happen under ACA.

“The State of Vermont has declared through its legislature and governor that it is going to move to a single-payer approach,” although they can’t do it until 2017 under federal law, he added. “We’re going to see an example of how a single-payer might actually save money.”

The Chief-Leader is a New York City-based weekly civil service newspaper that focuses on municipal government and its labor unions while also covering issues affecting New York state and federal employees.