Sunday, September 30, 2012

Obamacare’s “Gotcha” For The Health Care Sector

(By Mallory Factor, Forbes Magazine, September 6, 2012)

One of the great mysteries of modern politics was the high level of union support for the Patient Protection and Affordable Care Act, known as Obamacare. When President Obama was elected, Obamacare was already one of the unions’ top legislative priorities. Government unions spent tens of millions and used enormous political capital to pass Obamacare. Yet, universal health care should not be a core issue for unions because most union members have more than adequate health care coverage. So why the overwhelming support for Obamacare from the government employee unions?

Many commentators point to the concessions President Obama gave to the unions right before Obamacare passed in Congress in March 2010. To solidify union support, Obama agreed to a seven year moratorium on taxing the famed Cadillac health care plans that many union members receive—which increased the cost of Obamacare by $120 billion. But this concession does not explain the overwhelming union commitment to pass Obamacare which began before the President was even elected.
The real reason for stalwart union support for Obamacare is that the law throws the door wide open for unionizing most of the 21 million health care workers needed to implement Obamacare. Right now, only about one and a half million of America’s health care workers are unionized, less than 10% of all health care workers. Many health care workers are self-employed or work in small offices, and can’t be unionized under current law. But the unions have several plans to overcome this hurdle, with the ultimate goal of unionizing every health care worker in America.

The first plan is to drive more doctors, nurses and other health care workers to fold their private practices into large hospitals. Once employed by hospitals, health care workers can be unionized as private hospital workers or as government employees if they work for government hospitals. This plan is working great for the unions–by next year, for example, only 33 percent of doctors will be in private practice, down from 57 percent in 2000.
The second plan is to use a new organizing model to unionize self-employed people like the remaining health care workers in private practice. Service Employees International Union (SEIU), American Federation of State, County and Municipal Employees (AFSCME) and other government employee unions have tested this organizing model out on health care providers and in-home childcare providers over the last decade. These care providers are partially or fully paid from government programs that subsidize the cost of their clients’ care. The unions’ allies in state government use the fact that these care providers receive payments under government program to treat them as “government employees” who can be unionized. In 10 states, care providers have been unionized and forced to pay union dues of almost a hundred dollars a month, which are automatically deducted by the government from their payments.

The Obamacare legislation dramatically increases the number of health care workers receiving payment for their services under a government program—whether from the growing number of Medicaid patients or from patients insured by government-run insurance plans under the public option. The government employee unions can then enlist pro-union state governments to treat these health care workers as “government employees” and unionize them just like they unionized the care providers.  As we move closer to a single payer system, many more health care workers will be compensated through government programs. Eventually, virtually all health care workers (except perhaps Park Avenue plastic surgeons) will receive at least part of their compensation from a government payer, and using union logic, can be treated as “government employees” who can be unionized. It is such a simple plan really.

The stakes for the unions are huge. For every million additional health care workers unionized in the 27 non-right-to-work states, the unions stand to earn a billion dollars in dues.  When the history of the labor movement is written, Obamacare’s passage will mark the beginning of the second great rise of unionism in America, to the detriment of the American taxpayer.

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