Pressure to cut costs of health care bears down on union members who provide it
By Stephen T. Watson, The Buffalo News, N.Y. | |
McClatchy-Tribune Information Services |
In
And workers at long-term care facilities have faced layoffs, or uncertain futures, as nursing homes across the region have closed or switched from not-for-profit to private ownership.
"I think our members are feeling a greater amount of pressure on the job. The work is getting more difficult, and the fight to improve wages and benefits is more challenging year in and year out," said
The health care workforce long has been a bright spot in the region's lackluster jobs market, and it is a rare source of good news for private-sector unions whose memberships have shrunk recently.
But many workers feel under siege today, because the state and federal governments are prodding the industry to provide better care at lower costs.
Services that traditionally were provided in a hospital or nursing home setting increasingly are being delivered in an outpatient clinic or in the home, where unions are less common and competition is fierce. Health care reform is accelerating this reshaping of the industry and its financial model.
With employee salaries and benefits making up the largest part of their budgets, health care providers are looking to rein in labor costs.
At some facilities, workers face contentious contract negotiations, job cuts and growing demands on those left on the payroll -- the nurses and aides who take care of our sick and our elderly. Other institutions try to work with their union employees.
"Costs are so out of control, and there are so many opportunities for bringing efficiency in the delivery of health care," said
'A real problem'
Health care costs have exploded over the last decade, and providers are feeling the squeeze to lower their costs and to deliver care more efficiently.
Spending on health care in this country hit
For all of that spending, however,
"So we have a real problem on our hands," said
In a first step to rein in those costs, federal and state governments are reducing how much they reimburse hospitals and long-term care centers to treat
And provisions in the Affordable Care Act emphasize preventive care, seeking fewer hospital readmissions and more treatment provided at a lower cost in outpatient or home settings.
Health care is labor-intensive, and employee salaries, health insurance and retirement benefits make up a large part of providers' budgets. For example, employee costs made up 57 percent of
"Where the rubber hits the road is, labor is a significant cost, whether it's unionized or not, and so if your revenue streams are under stress, and you can't grow it fast enough to overcome COLA, then you've got to cut. It's just simple math," said
25,000 local members
Health care is a key piece of the economy, however, and the trillions of dollars spent on health care nationally support 18 million jobs in that sector.
And in Buffalo Niagara, health care has seen steady growth even as overall employment has stagnated.
Between
And the health care sector has provided a boost to area unions, which otherwise have seen their membership decline. Union members made up 17.9 percent of the area's private-sector workforce in 2003, but just 14.9 percent in 2013, according to data compiled by researchers
This area's three main health care unions -- 1199SEIU,
The jobs aren't easy. Those workers care for the ill, the dying, the aged and the infirm. They draw blood and empty bedpans and deliver meals and keep rooms clean.
But the jobs have been attractive because they offered the prospect of steady employment, decent pay and good benefits to workers with a wide range of educational backgrounds.
"I love my job. I always wanted to be a nurse since I was 5 years old," said
Major battleground
Any efforts to rein in health care spending put those jobs at risk, and that's why the health care sector is shaping up as a major battleground for private-sector unions.
"I think they're trying to come into the area and make a statement to the unions," said
The
"We've been very clear, I think, throughout negotiations that these negotiations are about local issues, the local realities of the hospital," said
At
Small, community hospitals aren't alone in facing financial woes or the threat of closing. Five not-for-profit nursing homes in the Buffalo area have closed over the last five years.
Outside
"When these nursing homes are sold, we are going in to organize these people, because these employers that are coming in are horrible. I mean, they want to pay minimum wage, they want to pay very little in benefit structure," said
Officials from the
Seeking cooperation
A few health care providers and their unions are trying to work together to confront the industry's stark financial and regulatory realities.
At
"That speaks volumes in terms of his philosophy and the philosophy of the organization," said
Management and union leaders at BlueCross BlueShield of
That job shift was a key component of the contract negotiated earlier this year between BlueCross BlueShield and Local 153,
"We bargained really hard and let them know from the beginning, look if you need to get the things you need, we need to get some of these jobs back in Buffalo. And we ended up making the deal," said
The original 40 jobs will end up closer to 50 by the time the workers start early this month.
"I would say that any good negotiation is a little bit difficult, because if it's going to be balanced, there needs to be a good level of discussion and consideration from both sides. And I think that's what we have," said
Auto industry analogy
Demand for health care only will grow as the baby boom generation ages, but experts say the industry's unions have to adapt to remain strong.
"If the health care unions don't get smart about where the industry is going, and try to become a partner in that process, those jobs are not going to be union," Lazes said.
Union members agree, and they say they believe they're well-positioned to weather this period of industry change.
"Health care has been community-based," said
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