About a dozen protesters stood in the rain on an Asheville sidewalk at Mission Health on Friday, Aug. 21. Some held umbrellas or “Vote No” signs. A white banner draped over the medical center’s logo urged nurses, “don’t give your voice away.” Passing drivers occasionally honked car horns.
Mission Health, the state’s sixth-largest hospital system, is fighting efforts to unionize 1,600 registered nurses across 18 counties in western North Carolina. The battle pits HCA Healthcare, Mission Health’s owner and the nation’s largest hospital network, against the National Nurses Organizing Committee, the largest registered nurses’ union in the U.S.
Union election ballots were mailed Aug. 18. The ballots will be counted in mid-September.
Protesters and union organizers say patient safety is at stake. Union backers argue Mission Health is failing to protect nurses and patients from the coronavirus pandemic. Union opponents say a strike would cause more harm to patients, with short staffing and neglect possibly killing some.
The election’s outcome will have massive ramifications for western North Carolina. HCA controls almost half of the health care services and providers in 11 counties in the region. It’s a big player in seven other counties. Union organizers say the hospital has cut corners, eroding patient safety. Opponents say they depend on Mission Health, and the union activity is designed to cause the most harm to HCA, making patients an afterthought.
One antiunion protester, who wasn’t identified, said her family depended on the hospital for emergency treatment. “As nurses, we took an oath to do no harm. When you choose to go on strike and leave patients in the hospital uncared for, that means those patients are left to suffer and struggle to survive,” she told the camera livestreaming the protest. “Those patients could lose their lives.”
Union organizers say the hospital is causing the damage.
“These outrageous conditions are a disgrace. There is no excuse for HCA or the Mission administration to be subjecting its frontline caregivers or patients to jeopardy,” Malinda Markowitz, NNOC president, said in a news release.
But nurses and patients are stuck, with few health care alternatives in the region, said Jon Guze, John Locke Foundation director of regulatory studies.
Neither the nurses nor their patients will have much freedom to go elsewhere. The hospital system’s dominance makes the battle over a union problematic.
Mission Health holds a dominant 49.5% market share across 11 counties, according to Modern Healthcare. The system’s own consultant called it “the only major producer of hospital services in Western North Carolina,” said an Urban Institute 2015 report on the system.
At the time HCA took over Mission Health, economists worried about the “frenzy” of hospital consolidation sweeping the U.S. and western North Carolina. They feared consolidation would create monopolies, drive up prices, and possibly compromise care. Hospital care is already the largest driver of high health care costs in the nation.
North Carolina’s regulators allowed the acquisition, hoping to protect quality and access by requiring HCA to sign onto 15 obligations.
But after HCA took over Mission Health, its grade in patient safety fell from an “A” to “C” in little over a year. It recovered in spring 2020 to a “B,” according to the hospital watchdog Leapfrog. Attorney General Josh Stein said he received “harrowing” complaints about its quality of care. HCA also came under fire for surprise billing after charging some patients hundreds of dollars in “facility fees.”
“One could argue that this push to unionize is a natural response to cartelization,” Guze said. “Under these circumstances, when there’s only one provider, it doesn’t just leave consumers without choice. It also leaves employees without choice.”
Union organizers promise nurses greater negotiating power.
“Conditions at the hospital are such that patient care is suffering,” organizers wrote in a July letter to hospital administration. “The COVID-19 pandemic has exacerbated all existing issues and we are on the verge of a local health care crisis if steps to alleviate the situation are not immediately taken.”
Union opponents were skeptical. They argue a national union will take away nurses’ voices.
“I’m concerned about what happens to the community when they dial 911 and we may happen to be on strike at the time,” another protester told the camera. “You can make changes here, and it doesn’t cost you part of your check to do so.”
Whatever the outcome, consumers will pay more for medical services.
“The consolidation is going to raise health care costs. Unionization is going to raise health care costs,” Guze said.