Pennsylvania health systems may be compelled to unionize by Medicaid contracts

MM Curator summary

[MM Curator Summary]: PA union organizers just got access to a $16B bargaining chip by tie-ing Medicaid provider payments to workers being union-ized.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


(The Center Square) – The Pennsylvania Department of Human Services is drafting Medicaid contracts that could compel health-care providers to unionize, making it more difficult for low-income patients to access health care and threatening more than a dozen hospital systems’ participation in Medicaid.

The HealthChoices Medicaid Managed Care agreements would take effect in July and would prevent a managed care plan from including in its network a provider that has had a work stoppage within five years – unless the provider has signed a collective bargaining agreement.

Effectively, health care providers would be compelled to unionize to be able to provide Medicaid services. If providers would not unionize after the provision takes effect, the threat of a work stoppage in the future could jeopardize their Medicaid participation.

The contracts concern the physical health portion of Pennsylvania’s Medicaid contracts, which were worth more than $16 billion in FY2021-22. Pennsylvania has almost 2.8 million Medicaid enrollees and the state’s Medicaid contracts have been worth $65 billion over the last 5 years, according to the Pittsburgh Post-Gazette. 

In testimony at a House Appropriations Committee hearing on March 9, Snead said the new provision’s language “was a collaboration between the administration and SEIU.” The language in the contracts is still in the process of negotiation and not finalized, though Snead noted the department wants to have a finalized version by April 1.

“My concern with all of this is that it could potentially limit health care options for low-income individuals,” said Sen. Kristin Phillips-Hill, R-Jacobus. 

“I think that the Wolf administration is taking us down a very dangerous path,” Phillips-Hill said. “It really comes down to putting patients at great risk to access their care.”

The provision had been little-noticed until it came up during committee hearings in the General Assembly.

“I think it was something the administration hoped would fly under the radar. They certainly did not want to bring this to the General Assembly,” Phillips-Hill said.

The Hospital and Healthsystem Association of Pennsylvania, which represents 240 hospitals and health systems, sent two letters to DHS in response to the provision. In the letters, HAP expressed concerns that the provision would “Improperly inject a subsidiary policy goal – mandating health care unionization – into a program that is designed to provide access to care to vulnerable and low-income Pennsylvanians.”

“From our perspective, the purpose of Medicaid programs should be to promote access to care and the state should be working to reduce hurdles for Medicaid patients to obtain care, not to cut off hospitals or other providers,” said Jeffrey Bechtel, senior vice president for health economics and policy at HAP.


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