Late last year, when most Americans were celebrating the holidays, the nation’s leading health care unions were busy working on strategies to help President Joe Biden and the Democrats triumph in the 2024 elections.
Every minute counts, says Susan Naranjo, executive director of the Committee of Interns and Residents, a national union that represents physician trainees as part of the Service Employees International Union (SEIU).
“Our 30,000 members cannot sit on the sidelines, because health care is an issue that transcends the red-blue divide. Voters in red states are as concerned as those in blue states about the cost of medications and the availability of hip replacement surgery,” she says.
“Many of our patients are poor, so it is crucial to re-elect President Biden and candidates to Congress, as well as state legislatures, who will speak up for them when safety net policies are decided.”
David Sachs/SEIU (CC BY-NC-SA 2.0)
SEIU nurses rally in front of Republican National Committee headquarters in Washington, D.C., 2011.
Jean Ross, a co-president of the 225,000-member National Nurses United (NNU), which played an important role in the victories of independent Vermont Senator Bernie Sanders in several 2016 Democratic presidential primaries, agrees.
“If Joe Biden doesn’t win a second term, the country will be dead in the water,” she says. “In addition to threatening to reopen the contentious fight to repeal the Affordable Care Act that dominated his first term, Donald Trump has vowed to roll back Medicaid, food stamps, and other programs that have enabled millions to survive.”
President Biden needs all the support he can get. A December Monmouth University poll found that only 34 percent of Americans approved of his job as President, his lowest rating since he took office. From July to December of last year, his approval among Democrats dropped from 88 percent to 74 percent. It was worse among independents, falling from 38 percent to 24 percent.
And this year’s presidential election is shaping up to be the most expensive in U.S. history, expected to surpass the $14 billion spent on the 2020 presidential race and the $16 billion spent on midterm elections two years later.
To overcome these hurdles, Biden is looking to unions for support. During his first campaign rally of the 2024 election cycle, in June 2023, he told a crowd of about 2,000 union members in Philadelphia, Pennsylvania, that he is “the most pro-union president in American history.” He added: “What I’m really proud about is being re-elected the most pro-union president in history.”
That same month, the AFL-CIO, which includes sixty unions with 12.5 million workers, responded by giving Biden the earliest endorsement in its history.
“From bringing manufacturing jobs home to America to protecting our pensions and making historic investments in infrastructure, clean energy, and education, we’ve never seen a President work so tirelessly to rebuild our economy from the bottom up and middle out,” AFL-CIO President Liz Shuler said in a press release at the time.
The two-million-member SEIU was equally complimentary of Biden in its own endorsement just two months earlier. “From his first day in office, when he fired the anti-union [National Labor Relations Board] General Counsel [Peter Robb], to the Executive Order that he signed . . . to lift up care workers, he has delivered for working people,” the union noted at the time.
Biden also supported the growth of unions by backing the Richard L. Trumka Protecting the Right to Organize (PRO) Act, which would prohibit employers from requiring or coercing employees to attend meetings to discourage union membership, along with other measures.
Last fall, the President joined striking autoworkers on a picket line outside a General Motors facility west of Detroit, Michigan. Grabbing a bullhorn, he told the workers to “stick with it” and continue their fight for better wages and benefits.
It was an extraordinary show of support for a labor union by a sitting President who has long positioned himself as a champion of the working class. While working-class voters had been a Democratic mainstay since the era of President Franklin D. Roosevelt, many have drifted toward Republicans in recent years.
David Lienemann/Official White House Photo (Public domain)
Then-Vice President Joe Biden and his wife Jill Biden thank nurses during a Christmas Day visit to Walter Reed National Military Medical Center in Bethesda, Maryland, 2013.
An April 2023 HarrisX poll for Deseret News found that 64 percent of registered voters who identify as working class said the country is on the wrong path, compared with 27 percent who said it was on the right one. About two-thirds of respondents said they were concerned about inflation. Fifty-two percent said their personal financial situation was getting worse, compared with 20 percent who said it was improving. About 40 percent of working-class voters said the Republican Party best represents their interests and views, compared with 36 percent who favor the Democrats.
Labor unions can help reverse this situation because they are “the boots on the ground of the progressive movement,” says Rob Baril, president of the New England Health Care Employees Union (SEIU 1199 New England), which represents 29,000 health care workers in Connecticut and Rhode Island.
“We will work very hard in 2024 to make sure that the struggle for fair wages, paid leave, and other workplace protections that previous generations of working-class voters took for granted don’t get lost in the contests,” Baril tells The Progressive.
Although only 10 percent of U.S. workers belong to a union, Baril predicts that unions—which currently are experiencing a resurgence—will have a profound impact on the outcome of this year’s federal and state races. A Gallup poll last August found that 88 percent of Democrats, 69 percent of Independents, and 47 percent of Republicans approved of unions in 2023. The percentage of Democrats who want to see unions have more influence reached a six-year high, according to the poll, reaching 61 percent.
The COVID-19 pandemic was a game changer for labor organizations, especially health care unions, because it highlighted the imbalanced relationship between employers and workers, Baril says.
Many Americans began to question why workers in health care, retail, and other fields didn’t receive a livable wage, benefits, or protective equipment, despite putting their lives on the line every day, he adds.
SEIU 1199 New England responded by winning raises and improved benefits for workers at nursing homes, group homes, and day programs for people with disabilities, Baril says. Many of the workers were young people, women, immigrants, and people of color.
“Our victories showed voters from diverse backgrounds that the economy can be structured to work for them so that they will turn out on Election Day,” he predicts.
Dubbed the “Little Union that Could” by The Atlantic, NNU and its predecessor associations have helped underfunded Democrats who support a health care system for everyone win for three decades. In 2010, NNU helped defeat billionaire Meg Whitman, the former CEO of eBay who spent $140 million of her own money in the California gubernatorial race against Democrat Jerry Brown.
Dressed in red scrubs, the nurses showed up at Whitman’s rallies—with an actress dressed as Queen Meg—to denounce the billionaire’s proposals to roll back patient safety provisions, her attacks on immigrants, and her proposed cuts to education.
Neon Tommy (CC BY-SA 2.0)
Nurses dressed in red scrubs, with an actress dressed as "Queen Meg," rally against Meg Whitman, California, 2010.
“That campaign taught us a lot about persistence that we will use in the battleground states in 2024,” Ross tells The Progressive. “Identifying voters who are receptive to the candidates’ message is key, so we will do outreach via text to four million voters across Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania, Wisconsin, and Ohio. There will be a second round of texts to supporters we identify, and then a third round of 250,000 Nurses for Biden mailers.”
But the battle won’t be easy. “In addition to multimillion-dollar hospital systems, insurance carriers, and pharmaceutical companies,” Ross says, “private equity firms are coming up with huge amounts of funds to contribute to campaigns and hire consultants to prepare sophisticated media campaigns for candidates who put profits before people in health care.”
The nurses have an advantage, though: According to Gallup, most people consider nursing to be the most ethical occupation, so when they discuss the price of medications, long-term care, or other matters, voters pay attention.
Building a broad movement for transformational social change will also be crucial, Ross says. “Presidents cannot do the job alone. They need elected officials at the state and local levels to pass legislation on issues like health care reform and social justice.”
In 2022, NNU endorsed many progressive Democrats for Congress, such as Senate candidate Alex Padilla of California and Representatives Jan Schakowsky of Illinois, Maxwell Alejandro Frost of Florida, Mark Pocan of Wisconsin, and Pramila Jayapal of Washington State. Rashida Tlaib of Michigan and Ilhan Omar of Minnesota, who faced stiff opposition in their races, also received NNU support.
The Committee of Interns and Residents plans to educate voters about how Biden and the Democrats changed the course of the pandemic, Naranjo says, saving lives and championing policies that will benefit young people and others who might be inclined to sit out the election.
“Resident physicians on average carry $250,000 in medical school debt while essentially earning less than the minimum wage, so we can be a strong voice in making voters aware of Biden’s unprecedented actions to erase student debt,” she adds. “We can also point out what the Biden Administration has done to ensure gender equality and address social determinants leading to persistent disparities in care for people of color, the LGBTQ+ community, and immigrants.”
She notes that nearly two dozen Republican-controlled state legislatures took advantage of the 2022 Supreme Court ruling that reversed Roe v. Wade to pass abortion bans, “so we will address how the lack of comprehensive reproductive care will affect tens of millions of women.”
As a KFF poll published in December highlighted, voters also want candidates to talk about the affordability of health care, the future of Medicare and Medicaid, low prescription drug costs, and access to mental health care. Says Ross: “Thanks to Biden, Medicare is now able to negotiate the price of certain high-cost drugs. A month’s supply of insulin for seniors is capped at $35. But there is still much to be done, so we will be thinking of the 2025 campaigns the day after the 2024 election ends.”