By Jane Birnbaum

As health insurance premiums explode, employers are trying to shift costs to workers, who increasingly face the choice of maintaining health coverage at the cost of wage increases. At the same time, many low-paid workers, such as those at Wal-Mart, must pass up the pricey plans they’re offered, while others are offered no coverage.

Add the 41.2 million Americans who now lack coverage—80 percent in working families, according to the Henry J. Kaiser Family Foundation—and a recent Mercer Human Resource Consulting survey in which employers say they expect a 14.6 percent health care cost hike this year after a 14.7 percent increase in 2002, and there’s no question that American health care system is broken.

But change could be coming at the state level, where activists are focusing their political strength on this grassroots issue. “We established a special health care committee and came to the conclusion pretty quickly that just tinkering with the system won’t solve the problem,” says Wisconsin State AFL-CIO President David Newby. “We need to break the logjam.”

Says Madison, Wis., electrician and Electrical Workers Local 159 activist Jim Maloney, “Four out of 18 of the union electricians on the last job I worked told me they had no health coverage for them and their families because they couldn’t afford it. I am ready to turn out for rallies, to write letters, whatever it takes to get workers affordable coverage.”

	Wired for action: IBEW Local 159 member Jim Maloney says he's ready to do "whatever it takes" to ensure workers receive health coverage.

The current Republican-dominated Congress is unlikely to approve Democrats’ proposals for expanded job-based and publicly financed health care programs for the poor and working poor. And some employers dream of handing workers a defined-contribution lump sum for coverage that could leave them fending for themselves in the solo health insurance market.

Taking the lead at the state and local levels to create equitable solutions are state federations, central labor councils and local unions. In nearly a dozen states, activists are fighting for passage of legislation providing health care for all or other coverage increases.

“This kind of experimentation is essential for the victories to come, because this is how health care gets done,” says Bernie Horn, policy director for the nonprofit Center for Policy Alternatives. “Ultimately, one of these programs will be adopted. You have to talk about health care, create plans and have a bunch of plans shot down. Eventually you find the one that is politically and financially feasible, and that state will prove that it works.”

To preserve job-based health coverage, activists are focusing on plans that ensure all employers contribute to workers’ health care costs—the same way all employers must pay into state workers’ compensation and unemployment insurance funds. “Forging coalitions with union employers, religious groups and others, unions are taking the lead in making sure that all employers pay their fair part of the health care bill,” says Machinists Director of Strategic Resources Steve Sleigh. “Right now, employers who don’t provide affordable health coverage have an unfair competitive advantages over those who do. They’re free riding.”

Corporations riding the system

For example, 95 percent of United Food and Commercial Workers grocery employees nationwide have health insurance (most of the other 5 percent are new hires waiting to get on the company plans). But at nonunion retailer Wal-Mart, now rolling out its so-called superstores that include full-sized groceries—40 in California alone over the next few years—the nation’s largest private employer’s “always low prices” slogan does not extend to employee health coverage. Only about 30 percent of low-paid Wal-Mart workers buy its expensive plan, according to the UFCW.

Some Wal-Mart workers have coverage through their spouses, who may well be union members. (Because of higher wages and greater affordability of coverage, 75 percent of union workers participate in their employers’ medical plans, compared with 49 percent of all nonunion workers, according to the Bureau of Labor Statistics’ 2000 National Compensation Survey.) But many without any insurance get little care until they’re so ill they land in hospital emergency rooms. The hospitals then pass on a large portion of those huge unpaid costs to insured patients, who wind up paying higher premiums.

Taking Action on Health Care at the State Level State federations, central labor councils and local unions in a range of states are working for passage of legislation that would provide health care for all or other increases in health coverage.

State Initiative Proposal/Action California Health care for all State federation introduced bill in February Illinois Health care for all Health care for all under employer-based approach Maine Health care for all Gov. John Baldacci signed order starting process toward providing universal coverage early January 2003. Plans to fund initiative through grants Maryland Health care for all Public–private partnership for universal health care coverage Massachusetts Employer mandate Health Care for All coalition succeeded in getting bill on 2003–2004 legislative session New Hampshire Covering the uninsured Expand the Health Kids program, which currently covers 17,000 children New Mexico Health care for all All state residents will have guaranteed coverage. Long-term care and mental health parity part of plan Oregon Health care for all All employers would pay family health care assessment and get credit for expenses already incurred to insure workers and their families. Health plan would cover those without job-based coverage Health care for kids Expand coverage through Oregon Health Plan, which provides comprehensive benefits with no deductibles and nominal co-pays Washington Health care for all UFCW considering approach that would mandate contributions from employers of particular size Winsconsin Health care for all through employer-based system Public and private employers would pay per employee through employer-assessment regardless of size

Fixing the system

Legislation now being crafted by the California Labor Federation and the Wisconsin State AFL-CIO would stop such passing of the health care buck by compelling all employers to pay their fair share of health care. The Wisconsin proposal creates a health insurance pool administered by the state that includes all private and public employers.

“By creating a statewide purchasing pool for the health care of all Wisconsin workers and their families, we will cut the cost of insurance for employers who currently offer decent coverage and extend that coverage to most of those currently uninsured or inadequately insured,” says Newby.

Says IAM District 10 Director Thomas Lesch, who originated the Wisconsin plan: “The larger your group, the more risk you can absorb.”

The California concept also mandates health contributions from employers. Both proposals would allow unions to bargain for additional coverage—dental and vision care, for example. And both include provisions for access by independent contractors, part-time workers and the self-employed.

“Costs are shooting up so dramatically, they’re putting union health funds and workers’ health at risk,” says California Labor Federation Executive Secretary-Treasurer Art Pulaski, “Without union contracts, coverage for workers would be going down a lot faster.”

Sacramento, Calif.-area janitor Rosalina Garcia, an SEIU Local 1877 member with job-based insurance that covers her but not her two children, plans to help mobilize support for the federation’s initiative. “I believe that all workers and their family members should have the basic right to health insurance through their jobs,” she says.

		From America@work, March 2003.

Employer contributions a ‘no brainer’

Activists in both states are gaining support from union employers who provide workers’ health coverage. Richard Marsek owns Milwaukee-based Maintenance Service Corp., which currently employs about 60 IAM Local 1668 members who rebuild and repair machine tools for the aerospace and automotive industries. He’s been explaining the state federation’s plan to fellow business owners at trade conferences.

“I pay 100 percent of my plan’s premium, which has been going up about 20 percent to 30 percent annually for the past three or four years,” says Marsek. “I hire very skilled workers, many in their early 50s, whose age greatly increases the premium. By doing the right thing, I’m being crucified. I’m a right-wing Republican, but also an independent businessman and certified public accountant, and I think mandating employer contributions, bringing all employed people into one group, is a good way to go. It’s a no brainer.”

Robert Kraig, SEIU Wisconsin State Council political director, is looking forward to using his union’s new automated telephone dialing system to enable activists to ask state legislators for support. “The whole national AFL-CIO political program is about taking the political capacity developed in elections and using it during nonelection years to develop grassroots lobbying capacity,” he explains.

In California, Pulaski also foresees a massive mobilization campaign. “Health care reform is giving us an opportunity for the good guys to be counted and the bad guys to be noticed and to help union members understand the difference,” he says.