Do Unions Still Shape the Healthcare Debate?

A survey released this week came to the unsurprising conclusion that people are having a hard time paying for healthcare. The totally nonrandom sample of more than 26,000 people who took the online survey skewed heavily toward the insured (77 percent), unionized (57 percent), college educated (80 percent), and white (86 percent). If anybody should be able to afford healthcare, it would be these folks, right? So it was interesting to see that a third of them said they'd skipped getting necessary medical care because it was too expensive, and half of those with health insurance said it doesn't cover what they need at a price they can afford.

The AFL-CIO, which sponsored the survey with an affiliated outreach group called Working America, has its eye on the upcoming election season, of course. "We're going to take this survey into the election and raise it with candidates at all levels," says Heather Booth, director of the healthcare reform campaign for the AFL-CIO. But with organized labor representing only about 15 percent of workers in the United States today, it's worth asking what role it plays in protecting healthcare benefits or setting the agenda for healthcare reform. Are labor unions still relevant?

To be sure, union representation still has a positive impact on worker benefits. Ninety-nine percent of companies with at least some union workers offered healthcare benefits last year compared with 57 percent of companies with only nonunion workers, according to the Kaiser Family Foundation's 2007 Employer Health Benefits Survey. And employees at companies with unionized workers paid just 21 percent of the healthcare premium for family coverage on average, according to Kaiser, versus 32 percent for employees at nonunion firms. But the days are long gone when labor unions, representing mostly auto workers and other highly paid manufacturing employees, had the muscle to negotiate generous agreements for comprehensive, affordable healthcare coverage that set the standard for other companies to follow.

A different picture of organized labor is now emerging, one of collaboration rather than confrontation. The agreement last year between Wal-Mart CEO H. Lee Scott Jr. and Andy Stern, head of the Service Employees International Union, to work together toward universal healthcare put paid to the notion that the interests of management and labor are necessarily opposed on this issue. (It's worth noting here that the SEIU broke away from the AFL-CIO in 2005 over differences in strategic priorities.)

"What seems to be going on is that labor is accepting the concept of shared responsibility for healthcare going forward," says Len Nichols, director of the health policy program at the New America Foundation, a Washington think tank. Rather than simply protecting its own, organized labor has become increasingly receptive to the idea that it must work with business and government to find healthcare solutions, says Nichols.

Unions may have less clout at the bargaining table, but in the political arena organized labor is still a force to be reckoned with, say experts. Labor unions buy advertising and invest in public education campaigns that can influence public opinion. "They're able to marshal and focus the messages that the general public will see," says Nichols.

Labor leaders are also frequent advisers to campaigns on a range of workplace issues, and the funding they provide can help elect candidates, particularly at the congressional level, says Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health. On a more prosaic level, unions field volunteers on the ground for a variety of unglamorous but essential activities, like driving people to the polls, going door-to-door for candidates, and sending out mailings. "There really isn't a grass-roots healthcare group," says Blendon. "That's what unions are helpful for."