California Nurses Association
Nurses join “Our First Stand: Save Health Care,” a National Day of Action protest in San Francisco, on January 15, 2017, to demand that the new administration protect and expand Medicare to all Americans.
The big red buses are ready to roll. Throughout this spring, National Nurses United, the nation’s largest professional association of registered nurses, will be hitting the road to urge legislators in Washington, D.C., and several state capitals to oppose Republican plans to repeal the Affordable Care Act.
The union, which now represents nurses in all fifty states, is headquartered in Maryland. It has 185,000 members nationwide. The NNU was the first national union to endorse Senator Bernie Sanders in his bid for President, and its members campaigned on his behalf.
“We were disappointed by the loss of Senator Sanders because he shares our position that health care insurance is a public good, rather than Trump’s view that it is a commodity sold on the market,” says Jean Ross, union co-president. “From day one of the campaign, we recognized that health care would continue to be a major issue after the election, so we will be working harder than ever to maximize the number of Americans who have health insurance.”
Now the group is setting its sights on trying to protect President Obama’s signature health care law, which has added twenty million Americans to the insurance rolls. If the Affordable Care Act is repealed, about eighteen million people would become uninsured within a year; by 2026, that number would grow to thirty-two million, according to the nonpartisan Congressional Budget Office. Premiums would dramatically increase as well.
The union will also call on voters across the country to build support for its long-term goal of replacing private health insurance coverage with a universal health care system.
NNU members have been active in state politics for decades, helping to pass legislation to improve patient protections as well as bills on housing, education, and other safety net measures that make a difference in patients’ lives, according to Deborah Burger, the union’s co-president.
“Participating in our first presidential campaign taught us that championing these issues isn’t enough,” Burger says. “Everywhere our buses stopped, people told us that despite the [Affordable Care Act] and state measures, they cannot get the care they need because insurance companies are still making the decisions.”
Working on the Sanders campaign underscored the need to question the conventional wisdom that Democrats are proponents of health care reform and Republicans are opponents.
“We discovered that on important issues like reducing the cost of medications, there is little difference between Republicans and Democrats like former Secretary of State Hillary Clinton and the leadership of the national Democratic Party,” she explains.
As a result, she predicts, the NNU will make better choices in selecting sponsors for its bills, picking ones who won’t cave in to pressure by the insurance companies and pharmaceutical manufacturers.
Burger sees the next two years as a “unique opportunity” to address flaws in the health care financing system, as President Donald Trump’s contradictory statements and Congressional Republicans’ vague replacement proposals have increased public awareness, and opposition. Ross agrees: “The public will be scrutinizing proposals as Trump and Republicans in Congress seek to achieve their goal of operating a system based on market principles.”
Brad Fitch, president and chief executive officer of the Congressional Management Foundation, a nonpartisan group that works to improve Congressional operations and enhance citizen involvement, notes that a recent Gallup poll found, for the fifteenth consecutive year, that nurses are the single most respected profession.
“They have established a reputation for honesty and ethics, which will be a major plus in the upcoming debates in Congress over the repeal and replacement of the ACA,” Fitch says. “The nurses’ union also excels in developing citizen involvement, which our research shows can make a major difference in passing legislation.”
About one in five Americans (19 percent) named health care as their top issue in 2017 when asked an open-ended question on a Kaiser Health Tracking Poll released January 6. Three quarters of respondents opposed repeal of the ACA, at least until the details of a replacement plan are known.
“Millions of elderly and disabled Americans who depend on Medicare and Medicaid for their health care were left confused when Trump said during the campaign that he would save these programs by making the country rich again,” says Ross of the NNU. “Millions more were terrified that they would be left without coverage or unable to pay for care when Trump signed an executive order on Inauguration Day that directs the Secretary of Health and Human Services and other agencies to begin dismantling the law.”
And legislation passed on January 13 by Congress will allow Republicans to end major provisions of the ACA without facing a Senate filibuster. To prevent the law’s dismantling, the NNU plans to work with health professionals, labor activists, farmers’ organizations, and other groups.
“We have a lot of public education to do,” says Ross. “Trump has created the erroneous impression that popular provisions, like the one prohibiting insurance companies from denying coverage to people with pre-existing conditions, can be maintained while unpopular financial mechanisms to support the law are eliminated.”
If federal agencies use Trump’s executive order to stop enforcing the individual mandate, Ross explains, it would throw the individual insurance market into a downward spiral. Eventually, the entire system would collapse because the costs of those with serious health conditions would not be offset by the premiums of young, healthy individuals who require few health services.
The NNU and its allies will also lobby lawmakers to retain the taxes on health insurers and pharmaceutical manufacturers, which have helped finance expansion of Medicaid coverage for low-income Americans.
Trump’s executive order has Burger worried because it resurrects a favorite proposal of Republicans: allowing insurance to be sold across state lines. They claim this would increase competition among insurance providers, causing premiums to decline.
But Burger contends that selling insurance across state lines doesn’t work for either insurance companies or patients. Although the Georgia legislature approved legislation in 2011, no out-of-state company has entered the Georgia market because companies found it impossible to set up profitable contracts with health providers.
The NNU also opposes selling insurance across state lines on the grounds that it would create a race to the bottom, allowing insurance companies to decamp to the least regulated states while forcing states like California, with stronger patient protections, to accept lower standards.
And the union continues to battle the hospital industry over nurse-patient ratios. Currently, most states have no limit on the number of patients that nurses can be tasked with caring for at one time. On February 14, NNU members rallied in Ohio in support of a newly reintroduced bill to set a patient-care limit.
The Ohio bill is modeled on a law in California that passed in 1999 after a thirteen-year fight, with NNU leading the charge. Staffing levels were enacted in 2004 and almost immediately came under attack from California Governor Arnold Schwarzenegger. But this effort was beaten back.
“The union led 107 protests in 371 days in California and several other states,” recalls Burger, who is also president of the California Nurses Association. “Over 30,000 teachers, nurses, firefighters, and public workers rallied in Sacramento, the state capital, and Los Angeles, on one day alone.”
Although studies have shown that improving the ratio of nurses to patients decreases the death rate and complications like pneumonia and urinary tract infections among patients, hospitals have argued that mandated ratios will cause labor costs to soar. Those concerns are magnified under Trump, who has made clear his desire to side with employers over workers.
Warns Burger, “The bad old days of the 1970s, when the quality of care suffered in California because nurses cared for as many as a dozen patients, might return.”
California Nurses Association
Hundreds of California nurses join community activists at a rally on February 22, 2017, in Sacramento to celebrate the introduction of a Medicare for All-style bill for California residents.
Another focus of NNU’s activism, opposition to right-to-work laws, is now in place in more than half of the states, which serve as a major deterrent to the recruitment and retention of union members. The union is worried about its own members as well as the broader community.
The Economic Policy Institute reports that in addition to lower wages, workers in right-to-work states are less likely to have employer-sponsored health care and employer-provided pensions.
Opposition to right-to-work laws should be a unifying issue for labor and the Democrats, says Taylor E. Dark III, author of The Unions and the Democrats: An Enduring Alliance. But he notes that they have an uphill battle, given Republican dominance of state legislatures.
“If the Democrats are in the minority in state legislatures, there is little they can do, no matter how unified they are,” says Dark, associate professor of political science at California State University, Los Angeles.
“A big problem nowadays is that the Republicans just don’t care about union support anymore, so when they get control of state government, it can be a disaster for unions, such as in Wisconsin,” he adds. “This is the result of a more polarized party system and there is little that can be done about it unless unions start growing again and become a threat to Republican officeholders. Seems unlikely.”
But the NNU is optimistic. It has organized thirty hospitals and added 10,000 workers since 2012. It has also been a significant supporter of progressive Democrats like Sanders and Minnesota Representative Keith Ellison, who are trying to reform the party and attract working-class voters who have drifted to the Republicans. And it aggressively opposed Trump’s nomination of fast-food magnate Andrew Puzder as Secretary of Labor, who was forced to withdraw.
In 2016, the union’s super PAC, National Nurses United for Patient Protections, raised and spent more than $8 million, according to the Center for Responsive Politics. More than half of this money went out as independent expenditures on Sanders’s behalf. While this pales in comparison to other super PACs—Priorities USA Action, for instance, spent $133 million helping Clinton, mostly on ads bashing Trump, while Get Our Jobs Back spent $50 million praising Trump—it’s not bad for an individual union, higher even than spending by the National Education Association.
Burger finds other reasons to be optimistic, especially given what she regards as the union’s successful efforts on behalf of the Sanders campaign.
“By knocking on doors and talking one-on-one to voters, we helped Sanders—a Senator from a small state who many people had never heard of before the campaign—win more than thirteen million votes in primaries and caucuses in twenty-two states,” she says. “Keeping on will reap positive results for our patients and their families during the Trump Administration.” ω