How to make health care affordable for more Rhode Islanders? Look for the union label.
Dozens of Lifespan employees gather for the announcement of the health system's name change to Brown university Health during a press conference in the lobby of Hasbro Children's Hospital on June 20, 2024. Rhode Island has nearly 15,000 unionized health care workers. (Photo by Alexander Castro/Rhode Island Current)
The Rhode Island health care system faces a number of significant threats to its viability. In Washington, D.C., Congressional Republicans are proposing significant cuts to Medicaid spending, while locally, for-profit hospital owners are filing for bankruptcy protection and state leaders grapple with the fallout. As labor leaders, we share the concerns of many Rhode Islanders about the condition of our health care system. In our small state of just over 1 million people, over 50% of us are insured through either Medicare or Medicaid. In our hospitals, over 70% of patients are covered by public health care plans. That leaves only 25% of hospital patients covered by commercial insurance, well below our neighboring states of Massachusetts (30%) and Connecticut (29%).
What most Rhode Islanders might not know: The next largest group of insured Rhode Islanders get their health care from a union-negotiated health insurance plan, whether they are a union member or not. Even though there are about 9,000 unionized state employees, approximately 33,000 people are insured through union plans. It's not only because of the dependents we cover, but also because our plan also covers non-union workers like managers and supervisors, as well as their families.
In the Ocean State, there are close to 15,000 unionized health care workers; so, not only are our members consumers of health care services, but we are also providers of health care. We have a vested interest in making sure our health care system is as strong as possible. That is why we believe all Rhode Islanders who are concerned about the state of our health care system should encourage more workers to join labor unions where they work. To us, increased unionization is a key component to a strategy ensuring every Rhode Islander has access to affordable health care services while simultaneously addressing a health care funding crisis that seems to get more precarious by the day.
As a recent poll commissioned by the Rhode Island AFL-CIO found, there is strong public support for unions in the Ocean State, with more than eight in 10 Rhode Islanders agreeing that unions 'are necessary to protect the working person.'
There are just over 500,000 Rhode Island based non-farm jobs in the state according to the Rhode Island Department of Labor and Training. About 80,000 of these jobs are protected by collective bargaining agreements. We know from sources like the U.S. Department of Treasury that not only do unions raise the wages of their members by 10 to 15%compared to similar non-union jobs, but that all workers in markets with a heavy union presence see economic improvements. On top of that, 96% of union members have employer- provided health insurance compared to just 69% of non-union workers.
We have a vested interest in making sure our health care system is as strong as possible. That is why we believe all Rhode Islanders who are concerned about the state of our health care system should encourage more workers to join labor unions where they work.
Now imagine there were 10,000 more union members in Rhode Island by the end of 2025. If the average wage paid to a Rhode Island worker averages $65,000 per year, and these workers, through collective bargaining, could increase their wages by 10%, that would mean the individual worker would see a salary increase of $6,500. In a state with just over 1 million people, that means an additional $65 million in economic activity, leading to increased tax revenues from income and sales taxes. It would also mean these 10,000 workers, and their dependents, would be much more likely to have commercial health insurance. This could equate to as many as 25,000 fewer people on Medicare, meaning our hospitals would receive adequate payments for the services they provide, instead of relying on low reimbursement rates from public health insurance plans.
Please don't misunderstand our point of view. As trade unionists, we believe that in a perfect world, there would be some form of national health care system where every American's health care would be provided for without concern for the cost to the patient and their family. But we don't live in a perfect world, and Rhode Island is confronting a crisis today.
According to Rhode Island General Laws § 28-7-2, '…it is declared to be the public policy of the state to encourage the practice and procedure of collective bargaining.' This section of law refers not only to the public sector workers, but to those in the private sector as well. It is why the AFL-CIO refers to Rhode Island as a 'labor state' and why, we think, we can use the power of organized labor to help address Rhode Island's health care crisis. That is why we are calling on the collective leadership of the state — elected officials, business, community, and other civic leaders — to join with us during the next few months as the General Assembly debates next year's state budget and encourage as many Rhode Islanders as possible to join with their coworkers and negotiate for better wages and benefits. The entire state of Rhode Island would be better off if more of our proudly working-class state were part of organized labor.
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For proponents, the ideas behind the work requirement are simple: Crack down on fraud and stand on the principle that taxpayer-provided health coverage isn't for those who can work but aren't. The measure includes exceptions for those who are under 19 or over 64, those with disabilities, pregnant women, main caregivers for young children, people recently released from prisons or jails — or during certain emergencies. It would apply only to adults who receive Medicaid through expansions that 40 states chose to undertake as part of the 2010 health insurance overhaul. Many details of how the changes would work would be developed later, leaving several unknowns and causing anxiety among recipients who worry that their illnesses might not be enough to exempt them. 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The bill the House adopted would require Medicaid enrollees to show that they work, volunteer or go to school at least 80 hours a month to continue to qualify. A disability exception would likely apply to Furman's son, who previously worked in an eyeglasses plant in Illinois for 15 years despite behavioral issues that may have gotten him fired elsewhere. Furman said government bureaucracies are already impossible for his son to navigate, even with help. It took him a year to help get his son onto Arizona's Medicaid system when they moved to Scottsdale in 2022, and it took time to set up food benefits. But he and his wife, who are retired, say they don't have the means to support his son fully. 'Should I expect the government to take care of him?' he asked. 'I don't know, but I do expect them to have humanity.' There's broad reliance on Medicaid for health coverage About 71 million adults are enrolled in Medicaid now. And most of them — around 92% — are working, caregiving, attending school or disabled. Earlier estimates of the budget bill from the Congressional Budget Office found that about 5 million people stand to lose coverage. A KFF tracking poll conducted in May found that the enrollees come from across the political spectrum. About one-fourth are Republicans; roughly one-third are Democrats. The poll found that about 7 in 10 adults are worried that federal spending reductions on Medicaid will lead to more uninsured people and would strain health care providers in their area. About half said they were worried reductions would hurt the ability of them or their family to get and pay for health care. Amaya Diana, an analyst at KFF, points to work requirements launched in Arkansas and Georgia as keeping people off Medicaid without increasing employment. Amber Bellazaire, a policy analyst at the Michigan League for Public Policy, said the process to verify that Medicaid enrollees meet the work requirements could be a key reason people would be denied or lose eligibility. 'Massive coverage losses just due to an administrative burden rather than ineligibility is a significant concern,' she said. One KFF poll respondent, Virginia Bell, a retiree in Starkville, Mississippi, said she's seen sick family members struggle to get onto Medicaid, including one who died recently without coverage. She said she doesn't mind a work requirement for those who are able — but worries about how that would be sorted out. 'It's kind of hard to determine who needs it and who doesn't need it,' she said. Some people don't if they might lose coverage with a work requirement Lexy Mealing, 54 of Westbury, New York, who was first diagnosed with breast cancer in 2021 and underwent a double mastectomy and reconstruction surgeries, said she fears she may lose the medical benefits she has come to rely on, though people with 'serious or complex' medical conditions could be granted exceptions. She now works about 15 hours a week in 'gig' jobs but isn't sure she can work more as she deals with the physical and mental toll of the cancer. Mealing, who used to work as a medical receptionist in a pediatric neurosurgeon's office before her diagnosis and now volunteers for the American Cancer Society, went on Medicaid after going on short-term disability. 'I can't even imagine going through treatments right now and surgeries and the uncertainty of just not being able to work and not have health insurance,' she said. Felix White, who has Type I diabetes, first qualified for Medicaid after losing his job as a computer programmer several years ago. The Oreland, Pennsylvania, man has been looking for a job, but finds that at 61, it's hard to land one. Medicaid, meanwhile, pays for a continuous glucose monitor and insulin and funded foot surgeries last year, including one that kept him in the hospital for 12 days. 'There's no way I could have afforded that,' he said. 'I would have lost my foot and probably died.' ___ Associated Press writer Susan Haigh in Hartford, Connecticut contributed to this article.
