At least five big questions remain about the secret deal announced with fanfare Tuesday between California hospitals and the largest health care union in the state.
The California Hospital Association and Service Employees International Union-United Healthcare Workers West heralded a “visionary agreement” to work together to address issues of cost, efficiency and quality of care, but offered few specifics.
What is known: There’s a $100 million joint advocacy fund to improvements in health care delivery and increase Medi-Cal payments to providers. There’s also a code of conduct to ensure positive relationships between the union and hospital employers and, in exchange for these measures, SEIU agreed to drop two ballot measures that target CEO pay and hospital prices.
The agreement will unfold over almost four years, ending Dec. 31, 2017, and a range of range of hospitals and health systems are party to the agreement.
That’s about it for details. Here come the questions:
1. If this is about Medi-Cal, what about an initiative proposed for the November ballot that seeks to provide a stable source of funding for the Medi-Cal program and nail down how it is spent? Health care providers and community groups submitted 1.3 million signatures last month to qualify the measure; an announcement is expected any day about whether it will appear on the ballot. Data on the Secretary of State’s website shows a CHA-affiliated committee received more than $51 million in contributions for the measure in the first quarter of 2014 alone.
SEIU-UHW president Dave Regan said in a media call Tuesday the Medi-Cal campaign will be a multi-year effort to get changes through regulation and legislation, but a ballot measure will be pursued in 2016, if necessary. What about the current effort?
2. How can hospitals and a union reform Medi-Cal when the problem is poor federal matching funds? So far, solutions rested on provider taxes to bring down more federal funding. Despite skepticism, one expert says a coalition of SEIU and California hospitals on board with powerful political players like the California Medical Association will carry considerable weight.
3. What about all the people who signed petitions for the hospital pricing and CEO pay measures used to put pressure on hospitals to get the deal?
“It’s a disservice to people who union members got to sign petitions,” said Jamie Court, president of Consumer Watchdog.
It was a pricey political ploy. SEIU raised $5.7 million on behalf of the two measures in the first quarter of 2014 alone, according to filings with the Secretary of State. CHA raised $10.1 million over the same period to oppose them. SEIU had almost $1.8 million left at the end of the quarter; CHA, $9.2 million.
Hospitals have agreed to work with the union on these issues; fixes have been elusive in the past.
4. What did the union really get in exchange for dropping the initiatives? Does the code of conduct ban strikes? Include templates for bargaining? What about enforcement mechanism? As recently as last week, the Wall Street Journal reported SEIU was pushing for help to organize up to 60,000 more workers.
5. Are there any non-SEIU signatories to the deal? SEIU has around 90,000 members in the state. There’s a presumption most will go along. All of Kaiser Permanente and Dignity Health hospitals in the state have signed onto the deal, but they have big contracts with SEIU. Non-union Sutter Medical Center Sacramento and Marshall Hospital in Placerville have signed on. It’s unclear what others will go for it.
Neither CHA nor SEIU is talking about these issues.
“CHA and SEIU-UHW just reached agreement last night,” CHA spokeswoman Jan Emerson-Shea said Tuesday. “There are still many details to address. That will come in the coming days, weeks months. …”
Kathy Robertson covers health care, law and lobbying, labor, workplace issues and immigration for the Sacramento Business Journal.