North Carolina is home to one of the biggest union battles in the South.
Mission Health in Asheville is fighting efforts to unionize 1,600 registered nurses. The clash pits HCA Healthcare, the largest hospital system in America, against the National Nurses Organizing Committee, the nation’s largest registered nurses’ union.
If the nurses successfully unionize in Asheville, their victory could fuel a wave of union activity across the South, said Dan Bowling, senior lecture fellow of employment law at the Duke University School of Law.
A victory in Asheville could drive further unionization in the state and shift its electoral politics to the left, said Jon Sanders, John Locke Foundation director of regulatory studies.
“There’s a reason we’re a right-to-work state,” Sanders said. “We’ve historically been, and rightly been, suspicious of unions in this state coercing relationships and money out of employees, and forcing them into supporting policies and politicians that individual members may disagree with.”
North Carolina has the second-lowest unionization rate in the country, behind only South Carolina. North Carolina’s rate in 2019 was 2.3%, according to the U.S. Department of Labor’s Bureau of Labor Statistics.
But Mission Health isn’t the only home of union activity in North Carolina. Even though a 1959 state law bars public-sector workers from collective bargaining, university employees are using a union to fight COVID-19 safety measures at the UNC system. A group of UNC employees has filed a lawsuit, arguing they face unsafe workplace conditions.
The N.C. Public Service Workers Union, UE local 150, one of the plaintiffs, also organized campus protests. UE, which formed during the Great Depression, makes no apologies for its confrontational philosophy:
“Modern class-struggle unionism won’t look the same as it did in the 1930s, but we believe the same approach to struggle, which recognizes the fundamental difference of interest between workers and employers in the capitalist system, is necessary,” UE General President Carl Rosen said in an introduction to the recently published booklet “Them and Us Unionism.”
K-12 schools are become a hub of union activism, too. Tamika Walker Kelly, the new president of the N.C. Association of Educators, is one of seven plaintiffs who filed a lawsuit trying to have state courts declare the Opportunity Scholarship Program unconstitutional.
“This will not be lost on anybody in the union movement, should there be a victory [at Mission Health],” Bowling told Carolina Journal. “If the [nurses] win, that’ll be a big deal. … A win would be a very big morale boost not just for unions in the state but around the South.”
North Carolina has successfully resisted unions, which, Sanders says, extract involuntary dues often used for political purposes.
HCA Healthcare, an international for-profit hospital system based in Tennessee, boasted 184 hospitals and $51.3 billion in revenue in 2019. Only 37 of its hospitals have a union presence. The hospital system has publicly opposed forming a union in Asheville.
At Mission Health, nurses have won the ability to hold a union election, a significant step for union organizers and the latest setback for the embattled hospital chain. HCA has starred in a series of controversies ever since it bought Mission for $1.5 billion in February 2019.
HCA committed to 15 obligations when it took over North Carolina’s sixth-largest hospital system. Prominent state leaders have blasted HCA for breaking those promises, including Attorney General Josh Stein, who holds the legal power to sue HCA for breach of contract.
Stein said he received “harrowing” complaints about Mission Health’s quality of care and staffing cuts. He criticized a recent decline in patient safety. He also blasted HCA for surprise billing, after Mission Health charged patients “facility fees” that sometimes added hundreds of dollars to patients’ bills.
“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, an NNOC President, said in a press release.
HCA struck back, saying Mission Health had enough resources and capacity to care for its patients. Mission Health said it had hired more than 100 new registered nurses. Its website listed 207 nursing job openings on Tuesday, Aug. 11.
“We have seen NNU bring unnecessary conflict and divisiveness to our hospital,” HCA said in a statement. “Having a union in place would permanently put a third party between our care teams and hospital management — making communication more difficult. We believe quality care is best served when our patient care team works collaboratively together.”
Elected Democrats have voiced their support for the nurses’ union. But after HCA’s publicity over the winter, Republican lawmakers seemed reluctant to involve themselves with fighting the union.
“[Nurses] are concerned that the cuts HCA has made will impact their ability to do their job,” Sen. Terry Van Duyn, D-Buncombe, told CJ. “We always ask a lot of health care providers. And right now we’re asking them to do really dangerous jobs without the tools they need to do them.”
Much of the energy seems to be on the union’s side in Mission Health, said Bowling.
But the university employees’ lawsuit might not achieve the same success. It faces legal hurdles and a series of unresolved questions about employers’ liability during the pandemic, said Jon Guze, John Locke Foundation director of legal studies. Anyone suing the state requires its consent under sovereign immunity.
“I’d put my money on the state of North Carolina,” Guze said. “Sovereign immunity will make it hard for them to win. It’s possible union involvement will make it a problem. And for better or worse, courts tend to be very deferential to what governments do in terms of protecting people from COVID-19.”
The outcome could influence electoral politics, as unions often donate to Democratic candidates or causes, Sanders said.
“We’ve got a lot of problems in the economy. It would have a negative effect on employees and employers,” Sanders said. “Employees would have lesser income, and employers would have to work with an outside group.”
The National Labor Relations Board will send mail ballots to registered nurses at Mission Hospital on Aug. 18. The board will count their votes on Sept. 16 to decide whether the nurses unionize.