Medicaid Cuts Reignite Clash Between California Health Worker Unions, Hospitals

The looming effect of national Medicaid cuts has reignited a long-simmering, costly conflict betwixt California’s aesculapian manufacture and 1 of its largest wellness worker unions.

SEIU-United Healthcare Workers West, pinch astir 120,000 members, has put guardant 2 ballot initiatives to headdress nan salary of aesculapian executives and require organization clinics to walk nan bulk of their revenues connected diligent care.

The California Hospital Assn. has responded pinch its ain ballot proposal that would make it tougher for unions to walk money connected governmental initiatives successful nan future. It would require support by a union’s rank-and-file rank for immoderate spending of $1 cardinal aliases much connected statewide measures, aliases $100,000 aliases much connected section ones.

The competing measures, which person drawn capable verified signatures to suffice for nan November ballot, travel astatine a clip erstwhile nan rising costs of healthcare is emerging arsenic a top elector concern.

The Service Employees International Union connection has seized upon affordability angst to resurrect a connection for a headdress connected healthcare executive compensation, which it has grounded to execute aggregate times before. The projected measurement garnered much than 1 cardinal petition signatures.

“This inaugural reflects nan superior situation we look and that affordability is simply a existent thing,” said Vikas Saini, president of nan Lown Institute, a Massachusetts-based healthcare deliberation tank. “I deliberation it besides reflects grassroots anger and a desire to do something.”

Mikey Vaughn, a certified nursing adjunct astatine Cedars-Sinai Medical Center, said nan infirmary often lacks supplies and staffing levels that he and his colleagues request successful bid to do their jobs efficaciously and without undue stress, contempt its estimation arsenic nan go-to spot for nan rich | and famous.

“The executive salary inaugural would, I hope, beryllium utilized to prosecute unit and to really supply amended resources for our patients,” he said. Vaughn is besides a personnel of SEIU-UHW’s executive committee and governmental committee.

Thomas Priselac, then-president and CEO of Cedars-Sinai Medical Center, made $8.8 million successful fiscal twelvemonth 2024, according to nan organization’s astir caller disposable national taxation filing. Kaiser Permanente’s CEO, Gregory Adams, made nearly $13 cardinal successful 2024. Warner Thomas, caput of Sutter Health, made just nether $12 million.

Cedars-Sinai spokesperson Duke Helfand said nan infirmary would beryllium incapable to enlistee and clasp physicians, nurses, and specialists if nan measurement passed, dramatically impairing its expertise to supply healthcare.

“Such a script would beryllium disastrous not only for Cedars-Sinai but for hospitals crossed Los Angeles and California,” Helfand said.

The national wants to headdress compensation astatine $450,000 a twelvemonth for elder infirmary and aesculapian group executives, arsenic good arsenic different administrative and managerial staff. However, nan inaugural does not stipulate really dollars diverted from payroll must beryllium spent.

The national has dubbed nan latest connection nan Health Care Executive Compensation Act of 2026. A coalition of aesculapian industry heavyweights opposing it — hospitals, physicians, and clinics, among others — has rebranded it nan Health Care Endangerment Act.

Carmela Coyle, CEO of nan infirmary association, called nan measurement a cynical governmental ploy.

“It’s bad argumentation and it’s going to person bad consequences crossed California,” she said.

Glenn Melnick, a healthcare economist astatine nan University of Southern California, said moreover if nan inaugural were afloat implemented and salary cuts enacted, he doubts it would trim nan costs of healthcare for patients.

SEIU-UHW does not person an estimated full magnitude nan inaugural would claw backmost from salary packages that transcend nan limit.

Opponents of nan inaugural statement that it doesn’t conscionable target executive pay; it would impact aesculapian practitioners who are besides managers. That could see main aesculapian officers and main nursing officers, arsenic good arsenic heads of surgery, emergency rooms, oncology, obstetrics, cardiology and different specialties, they say.

It would beryllium up to each hospital, wellness strategy and expert group to study which unit members transcend nan headdress and by really much.

Ultimately, who is taxable to nan salary headdress “probably will person to beryllium battled retired successful court,” Coyle said . “That’s why we are throwing everything we tin astatine it.”

The 2nd SEIU-UHW ballot initiative, connected organization clinics, is already successful court. The California Primary Care Assn., which represents clinics, revenge a federal lawsuit successful April seeking to invalidate it earlier it reaches nan November ballot.

The projected measurement would require federally designated organization clinics to walk astatine slightest 90% of their revenues connected activities straight related to their ngo of providing attraction for low-income populations. If it were to pass, much than 90% of those session organizations would beryllium connected nan hook for penalties totaling $1.7 cardinal successful nan first twelvemonth unsocial and “would look likewise crippling penalties each year,” according to a report commissioned by nan superior attraction relation and conducted by nan Berkeley Research Group, an world consulting company.

Louise McCarthy, president and CEO of nan Community Clinic Assn. of Los Angeles County, said galore pivotal services nan clinics supply — specified arsenic translator and proscription — would apt not beryllium counted toward nan spending requirement.

“They are targeting a group of what they spot arsenic employers and we spot arsenic nan information net,” she said.

The suit cites nan harm to clinics and claims nan projected spending request would interfere pinch national authority.

Renée Saldaña, a spokesperson for SEIU-UHW, characterized nan suit against nan inaugural arsenic “a really hopeless effort by nan session manufacture to effort and debar accountability.”

SEIU-UHW, proud of its governmental activism, is besides down a arguable billionaire tax connection that would enforce a one-time 5% levy connected California residents pinch fortunes complete $1 cardinal to backfill nan backing spread created by national cuts coming down nan pike nether Republicans’ One Big Beautiful Bill Act. The law, passed past July and signed by President Trump, is projected to compression astir $1 trillion from nan Medicaid wellness sum programme for low-income group by 2034, including arsenic overmuch arsenic $30 cardinal annually successful California.

The infirmary association, nan organization session group and nan California Medical Assn., which represents physicians, are neutral connected nan wealthiness taxation connection frankincense far. But Saldaña said each 3 of nan union’s ballot proposals necktie into an overarching strategy to antagonistic nan widening healthcare disparities caused by nan national law.

“We judge nan superior interest of healthcare providers, including executives, should beryllium to service nan community, heal patients, and not beryllium successful healthcare conscionable to enrich themselves,” she said connected nan projected salary cap.

Over nan years, nan national has submitted dozens of section and statewide ballot initiatives, including ones to headdress nan salary of infirmary executives, modulate dialysis clinics, and raise nan minimum costs of healthcare workers.

The infirmary relation calculates that SEIU-UHW has spent astir $125 cardinal connected section and statewide initiatives since 2012. But healthcare manufacture groups person spent acold much opposing them. The infirmary relation information shows that nan national spent astir $36 cardinal connected 3 ballot proposals to modulate nan dialysis industry, but dialysis companies poured successful $302 cardinal to conclusion them, according to authorities run finance records.

The union’s ongoing governmental efforts “threaten diligent entree to value wellness care,” according to nan infirmary association’s ballot initiative, which could limit really overmuch unions walk connected early ballot measures.

Saldaña hinted astatine a imaginable suit should that measurement pass, saying “we don’t spot nan ineligible viability” of it. The proposal, she said, is an effort “to soundlessness nan front-line healthcare workers.”

Ultimately, a ballot inaugural won’t cure nan ills that plague healthcare successful nan United States, said nan Lown Institute’s Saini. What’s needed, he said, is “an information and reimagination of healthcare.”

Wolfson writes for KFF Health News, a national newsroom that produces in-depth publicity astir wellness issues and is 1 of nan halfway operating programs astatine KFF — an independent root of wellness argumentation research, polling, and journalism.