Life Without Deductibles: How One Union Has Curbed Health Care Costs

Published December 23, 2019 at 9:00 AM CST

In this Feb. 9, 2018, file photo, a nurse hooks up an IV to a flu patient at Upson Regional Medical Center in Thomaston, Ga. (David Goldman, File/AP)

Members of this health plan pay nothing for doctor’s visits, lab tests or hospitalizations. Could this be a model for the rest of the country?

Guests

Noam Levey, writes about national health care policy out of Washington, D.C., for the Los Angeles Times. ( @NoamLevey)

Brian Lang, president of the Local 26 Union since 2011. ( @BrianLang123)

Listen To Our Recent Conversations With Noam Levey On American Health Care

From The Reading List

Los Angeles Times: “ Not everyone has eye-popping deductibles: How one union kept medical bills in check” — “Even as soaring insurance deductibles wreak financial havoc on millions of American families, some workers have managed to dodge the affordability crisis.

“In Boston, a labor union representing the city’s hotel workers offers its members health coverage with no deductible and family premiums just a tenth of the U.S. average.

“Workers and their families pay nothing out-of-pocket for doctor visits, tests and hospital stays. Even the most expensive specialty drugs cost just $12 per prescription. Generics are $1.

“The push by Unite Here, Local 26, to protect Boston hotel workers highlighted the challenges of protecting patients from medical bills, as workers were forced to make difficult choices. But the union’s success — in one of the most expensive healthcare markets in the country — also suggests that Americans may not have to settle for huge deductibles that have put medical care out of reach for millions.

“‘Everyone says we can’t do anything about costs, or we just have to get patients to put more “skin in the game,”‘ said John Brouder, a longtime health benefits consultant who worked with Local 26 to develop its health plan. ‘This union showed that’s not true…. It’s a very profound and important message.’

“Delivering that peace of mind wasn’t easy. Starting in 2013, when the new health plan debuted, Local 26, which provides coverage for roughly 9,000 union members and their families, had to confront the biggest cause of soaring insurance premiums and deductibles: the high price of U.S. medical care, particularly at hospitals.

“It required union members to make a trade-off that many, at first, found unpalatable — giving up access to some of the city’s best known, and most expensive, hospitals.”

Los Angeles Times: “ Why some unions are nervous about ‘Medicare for all’” — “The Culinary Health Center is a beige, two-story office building on Las Vegas’ east side, miles from the casino glitz of the Strip and not much to look at by Sin City standards. The surprise is what happens inside, and how it gets paid for, which would probably make most American workers’ jaws drop.

“On a recent Friday, the parking lot was full as union members and their family members, some with children, visited the facility for primary and pediatric checkups, dental procedures and eye tests and eyeglasses, almost all of which are offered at no cost. There’s no emergency room, but X-ray, ultrasound and CT scan equipment awaited use in the building’s 24-hour urgent-care wing, free of cost to union members, along with a pharmacy that offers free generic medications.

“In the hallways, there are few markings indicating the facility is operated on behalf of the Culinary Workers Union Local 226, which represents 60,000 hotel and casino workers in the key early primary state and general election swing state of Nevada. But there’s a phrase printed on the front door symbolizing the powerful union’s pride in its unique healthcare setup: ‘Exclusively ours.’ ”

Washington Post: “ Opinion: Unions shouldn’t use their health insurance as a weapon against universal coverage” — “Imagine a world where elementary school attendance was limited to those children who had a parent whose job offered, or whose union had negotiated, this benefit. While this scenario is patently absurd, it’s exactly the policy we’ve accepted for access to health care. And during this Democratic presidential primary, it has been particularly troubling to see unions, whose original purpose was to help workers collectively gain access to better pay and benefits, use their own negotiated health plans as a weapon against the push for universal health care — and to see candidates contorting themselves in response.

“The origin of the decision to link health care to employment, rather than having universal health insurance through the government, is in specific anti-inflationary policies enacted in World War II. An executive order froze pay, and employers, with the support of unions, used health insurance benefits as a way to increase total compensation and attract workers without running afoul of the law. Unions have bargained for health insurance ever since and have used their success in obtaining high-quality health care for their members as a measure of the overall advantage of union membership and representation.

“But the desire to keep health care at the bargaining table is ultimately shortsighted and defensive. If unions are to survive and grow in the long run, they need to emphasize a voice on the job, dignity at work and broad economic gains, not narrow benefits. If workers join or support unions in order to attain one specific benefit, this support is unlikely to be sustainable. Indeed, many employers offer improved health insurance in order to deter their workers from organizing, heading off efforts that could more broadly shake up their workplaces in favor of employees.”

This article was originally published on WBUR.org.