President Obama called SEIU President Andy Stern to thank union members shortly after the House of Representa- tives voted 219 to 212 to pass healthcare reform despite every Republican voting against the legislation. On March 23, 2010, at the White House signing ceremony, President Obama told Stern the century-long battle to achieve nearly universal health- care could not have been won without SEIU members’ hard work on its behalf. Le président Obama a appelé Andy Stern, le président de SEIU, pour remercier les membres du syndicat juste après que le House of Representatives ait voté à 219 contre 212 en faveur de la réforme de la sécurité sociale malgré un camps républicain qui était à 100% contre. Le 23 mars 2010, pendant la cérémonie de signature à la Maison Blanche, le Président Obama a dit à Andy Stern que la bataille d'un siècle pour obtenir une couverture médicale presque universelle n'aurait jamais été gagnée sans le travail acharné des membres de SEIU.

1. CHAPTER 34
SEIU Helps Pass Historic Healthcare Reform
Coverage Extended To 32 Million Lacking Insurance
L oretta Johnson had to quit a job with good pay and bene ts
as a deputy courthouse clerk in Lebanon, Virginia, to care
for her terminally ill husband.
technicians, doctors, and other healthcare workers who are SEIU
members deliver quality care to millions of patients.
But those SEIU healthcare providers on the front lines also
After he died, she became an SEIU personal care assistant saw the huge failures of a system in which more than 47 million
who worked “at the bedside every day giving people the same people lacked health insurance and another 47.5 million were
type of care I gave my husband.” But Johnson herself lost health underinsured. Despite bargaining victories that had provided
insurance when she changed jobs and had to rely on a smaller health coverage for many members, there were still tens of thou-
paycheck to cover her own healthcare needs. sands of SEIU workers who lacked a ordable, quality coverage
About 32 million Americans like Loretta Johnson who for their families and themselves.212
faced each day without health insurance got a lifeline thrown to
them when President Obama signed into law the historic health-
care reform bills in March 2010 that had been the top legislative
goal of SEIU for years.
A s the political debate over healthcare reform was playing
out in 2009-2010, Americans were spending more money
per capita on healthcare than any other country in the world.
It was a landmark moment that will rank with major legisla- Yet the United States ranked 38th among other nations in major
tive achievements such as the passage of Social Security, Medi- health indicators, including life expectancy. At the same time,
care, and the Civil Rights Act. healthcare premiums had increased four times faster than work-
President Obama called SEIU President Andy Stern to ers’ wages. And 8 out of 10 of those without insurance were
thank union members shortly after the House of Representa- from working families.213
tives voted 219 to 212 to pass healthcare reform despite every Even insured Americans found themselves unable to pay
Republican voting against the legislation. On March 23, 2010, their growing share of hospital bills, their co-pays and de-
at the White House signing ceremony, President Obama told ductibles, and the cost of lling their prescriptions. Consider
Stern the century-long battle to achieve nearly universal health- the following:
care could not have been won without SEIU members’ hard -
work on its behalf. nancially with a typical medical emergency.
SEIU played such a crucial role in winning passage of the -
legislation in part because, as the largest union of healthcare ruptcy because of a health emergency rose by 2,000 percent.
workers in North America, no group knew the sorry state of
the healthcare system better. Every day, more than one million reform found that half of all bankruptcy cases were con-
nurses, home healthcare providers, nursing home aides, medical nected to medical bills.

2. 254 STRONGER TOGETHER: THE STORY OF SEIU
- Georgeanne Koehler, an SEIU member and hospital worker
age Fortune 500 company projected to spend as much for in Pittsburgh, came to the Capitol steps on a frigid day in De-
healthcare in 2008 as it made in pro ts. cember 2009—her third visit in three months—to tell the story
of how her brother, William, died.
He was a 57-year-old pizza deliveryman who was found
A ll the statistics and the harsh Congressional debate about
reining in healthcare costs at times obscured the human
costs of failing to enact reform. But SEIU and its allies repeat-
slumped over his steering wheel after his de brillator battery ran
out. He couldn’t a ord to replace the expensive battery after los-
edly focused national attention on those who had su ered un- ing his health insurance when he was laid o in 2003 from his
bearable pain from the failures of a healthcare system dominated job as an electronics technician. With his arrhythmia viewed as a
by private insurance companies concerned too often only about pre-existing condition, no insurance company would cover him.
their bottom-line pro ts. Georgeanne Koehler carried a bag lled with her brother’s
SEIU Secretary-Treasurer Anna Burger told the story of EKG charts as she visited Congressional o ces as part of SEIU’s
SEIU Healthcare 775NW member Pat DeJong. Her husband lobbying e ort for healthcare reform. She also carried around a
Dan, a fourth-generation rancher from just outside Libby, Mon- folding chair as part of her own “No More Empty Chairs” cam-
tana, died from Hodgkin’s lymphoma. paign during the holiday season. “ is Christmas we’re going to
“During his treatment, the medical bills became so unbear- have an empty chair at the dinner table,” she said.
able, Dan and Pat were forced to sell their family’s farm and apply e SEIU Healthcare Pennsylvania member was not al-
for Medicaid and food stamps,” Burger recalled. After Dan died, lowed to unfold the chair by the Capitol police, but did deliver
Pat still had no health insurance from her job as a home care work- about 1,000 holiday healthcare postcards urging the Senate to
er and no ranch to sell if she developed her own health problems. pass healthcare reform.
About the same time Koehler made her way to the o ces of
Pennsylvania’s Senators and Representatives, Loretta Johnson also
found herself on Capitol Hill pushing hard for healthcare reform.
U.S. Senate Majority Leader Harry Reid and a group of
powerful Senators invited the Virginia home healthcare worker
to join them at a crowded press conference to unveil core ele-
ments of the bill that later passed. Johnson, the only speaker
who was not a Senator, appeared as a representative of SEIU and
its 2.2 million members.
When Majority Leader Reid introduced her at the podium,
she praised the Senators for a bill that put America one step clos-
er to real healthcare reform, but then said: “Now, in my opin-
Loretta Johnson, an SEIU personal care assistant, joined U.S. Senate Major- ion, there’s probably some room for improvement.” She called
ity Leader Harry Reid and Senators Tom Harkin and Christopher Dodd at a
Capitol Hill press conference in December 2009 to unveil the elements of the for an end to the huge control of insurance companies over the
healthcare reform legislation that later became law. Johnson called for an end
to the lack of accountability of the big insurance companies.
healthcare system and urged passage of legislation that would

3. SEIU HELPS PASS HISTORIC HEALTHCARE REFORM 255
make sure “people can a ord the care they need.”
It was a moment in the long debate that recognized both
SEIU’s role for many years as a driving force in advocating a
S EIU advocated major healthcare reforms throughout much
of its history. It had encouraged President Clinton’s e ort
to develop legislation, but that initiative failed to gain traction
progressive healthcare system and, at the same time, highlighted during his rst term in the early 1990s. In 2002, SEIU estab-
the plight of so many Americans, such as Johnson, who lacked lished Americans for Health Care (AHC), a project that sought
any health insurance coverage and su ered as a result. to unite healthcare workers, consumers, small business owners,
and others to push for broad-based healthcare reforms.
AHC, which became the largest grassroots healthcare re-
T he new healthcare reform legislation did not include all the
provisions urged by SEIU, but many elements supported
by the union did end up in the bill.
form organization in the country, ran state-based campaigns in
20 states and signed up nearly half a million healthcare voters na-
e law put new pressures on insurance companies, for ex- tionwide. e group was critical in passing landmark healthcare
ample, preventing denials of coverage due to pre-existing condi- legislation in Maryland, New Hampshire, and Maine.
tions such as diabetes, asthma, or high blood pressure. It also In addition to work at the state level, SEIU and its allies
banned annual and lifetime limits on insurance coverage and made some progress during the administration of President
contained guaranteed issue and renewal requirements. George W. Bush, although much of the e ort involved blocking
Young adults were able to stay on their families’ insurance actions that would have made the healthcare system even worse.
plans until age 26, rather than lose coverage after they left home Several victories that did advance reforms included:
or graduated from college.
e new law provided for the creation of insurance ex- had funding shortfalls for State Children’s Health Insurance
changes at the state level where the uninsured and self-employed Programs so eligible children didn’t lose coverage.
could purchase coverage that t their needs. A guaranteed pack- -
age of bene ts including free preventive care had to be included tects workers from discrimination based on the results of
in all those plans. genetic testing.
Medicaid was expanded under healthcare reform to provide
health insurance to an additional 16 million low-income people. support to many e ective state programs to prevent and
SEIU fought successfully for an end to sex discrimination treat HIV/AIDS.
in health insurance. Previously, women could be charged more -
than men for the same coverage under individual policies. tion to make sure drugs that are approved are actually safe.
e new law provided increased investments to train nurses,
primary care doctors, and public health professionals. It also additional quality measures in an e ort to help patients and
created state-level consumer assistance programs to help patients their families compare facilities.
understand and defend their new rights.
Some experts estimated the legislation would create or save SEIU had strongly opposed Bush in the 2000 campaign in
more than 2.5 million jobs through 2020, in part by reducing part because he dismissed the need for real healthcare reform.
healthcare costs for employers. e union’s early backing of Howard Dean in the 2004 race for

4. 256 STRONGER TOGETHER: THE STORY OF SEIU
Andy Stern wrote in 2006 in his book, A Country at Works,
about the decline of the employer-based healthcare system and
called for a new approach built around the same basic tenet as
the educational system: universal access.
“If every child is guaranteed a public education, every
American must be guaranteed access to a ordable healthcare,”
Stern argued. “ en we can integrate the nest research, doc-
tors, and hospitals in the world into a delivery system that con-
trols costs and o ers the highest quality.”
Among the models Stern urged as worthy of being adapt-
ed to the broader system included the healthcare plan enjoyed
by members of Congress themselves, the U.S. Defense De-
partment’s healthcare program known as TRICARE that cov-
SEIU pushed all the presidential candidates in 2007 to provide detailed plans
for healthcare reform. Barack Obama unveiled his initiative at the University ers more than nine million members of the military and their
of Iowa Hospital and Clinics in Iowa City where he met with SEIU members. families, and the Medicare system, which could be expanded to
cover everyone.
the Democratic presidential nomination grew out of the fact
Stern described the large number of countries that have
that Dean was a medical doctor committed to pushing health-
some form of universal healthcare and also report better health
care reform.
outcomes at lower cost. Signaling the growing frustration felt by
Candidates campaigning in New Hampshire were greeted
many, the SEIU president wrote:
at the Manchester airport by a large poster of an SEIU nurse
“If all of these nations can gure out universal plans that
challenging them to spell out their plan to reform healthcare.
meet their nations’ interests, why can’t America do the same?
e union conducted a healthcare reform march across the
Americans deserve a fair debate, not an endless one on how best to
Golden Gate Bridge during its 2004 convention. More than
provide universal, a ordable, quality healthcare.”214
17,000 activists—led by Stern, Burger, Mary Kay Henry, and
In July 2006, SEIU wrote a letter to every Fortune 500
other top leaders—signaled that the issue would be a top priority
CEO asking them to make healthcare reform a national prior-
for SEIU voters in the fall.
ity. A surprising number responded. While they did not agree
Senator John Kerry had strong SEIU support against
with many of the speci cs that progressive healthcare reformers
Bush in the general election, but the Bush victory ruled out
advocated, it was becoming clear that major corporations faced
any major healthcare reform for another four years—necessi-
huge outlays for their workers’ healthcare as costs continued
tating the smaller, incremental approach that led to the gains
to escalate. In ation in healthcare costs cut into the bottom
described above.
line, hurting pro ts and raising labor costs without improving
SEIU also used the Bush years to try to stimulate think-
actual bene ts.
ing about what reforms should be enacted once America had
Following long discussions among Stern, Secretary-
elected political leaders committed to them. SEIU President
Treasurer Burger, Executive Vice President Mary Kay Henry,

5. SEIU HELPS PASS HISTORIC HEALTHCARE REFORM 257
SEIU Healthcare leader Dennis Rivera, and other top o cials, -
SEIU released its Vision for Reform in 2007. It outlined 10 viding care that is cost-e cient and medically e ective.
fundamental principles to guide the union’s work to promote
healthcare solutions: are necessary to increase quality and reduce costs.
-
care coverage for all Americans. Piecemeal reform is not must be available to consumers.
a solution.
service, reduce out-of-pocket costs, and maximize oppor-
foundation for 21st century healthcare reform, particularly tunities for individuals to receive assistance in home- and
given the competitive challenges of a global economy. community-based settings, rather than in hospitals and
nursing homes.
doctors and healthcare plans without gaps in coverage or -
access, and the delivery system must meet the needs of sponsibility for nancing the system.
at-risk populations.
-
care bene t similar to one that is available to federal
employees.
W ith the union’s set of principles for healthcare reform in
place, SEIU activists set out to make America’s grow-
ing healthcare crisis a major issue in the 2008 presidential cam-
paign (see Chapter 27). e kicko occurred in March 2007 in
promote health, control costs, and eliminate economic and Nevada, where SEIU organized a forum sponsored by the Uni-
racial disparities. versity of Nevada–Las Vegas (UNLV). It was the rst national
healthcare debate of the campaign. Seven of the Democratic
candidates outlined their views and faced tough questioning
from some of the hundreds of SEIU workers who were there.
e gauntlet thrown down by SEIU was simple: any presi-
dential candidate hoping to get the o cial support of more than
two million members had to o er a detailed, comprehensive
plan to provide healthcare to every woman, man, and child in
America. e response: all the major Democratic candidates
produced healthcare plans and the issue became a major focus
on the campaign trail.
Over many years, SEIU helped win gains by forming co-
alitions and working closely with allies around speci c issues.
Mary Kay Henry, then-SEIU executive vice president and head of the union’s
While agreeing to disagree on many points, SEIU saw value in
healthcare division, joined children and parents lobbying for the State Childen’s partnerships on important legislative issues with both friends in
Health Insurance Program (SCHIP) in 2007. President George W. Bush had
vetoed two attempts to expand health coverage for uninsured children. the progressive community, but also with others who might be

6. 258 STRONGER TOGETHER: THE STORY OF SEIU
strange bedfellows—particularly certain business groups. are skimping on preventive care because they can’t a ord it, or
On the progressive side, SEIU joined with Healthcare for they delay going to the doctor. We’ve become a nation of the
America Now (HCAN), a coalition of the nation’s largest grass- walking wounded.”
roots organizations, including Change to Win, AFSCME, AFL- In Spring eld, Missouri, the Road to American Healthcare
CIO, U.S. Action, Planned Parenthood, and about 1,000 other Tour held a forum for veterans from Iraq, Korea, Vietnam, and
groups representing 30 million people demanding comprehen- World War II who spoke out against Senator McCain’s consis-
sive healthcare reform. HCAN proved to be a crucial force in tent record of voting to deny funds for veterans’ healthcare.
the ultimate victory of healthcare reform. “If we’re going to send our soldiers to war, and we’re go-
ing to spend billions of dollars a day on a war, then we need
to take care of the soldiers who go and ght those wars,” said
W hile working in partnership with others, SEIU contin-
ued its own vigorous e ort to make healthcare reform a
top issue in the 2008 campaign. ousands of SEIU member
Akeam Ashford, an Iraq war veteran. He pointed out that Mc-
Cain voted against full funding for veterans’ healthcare in 2004,
political organizers and sta deployed around the country dur- 2005, 2006, and 2007.
ing primary/caucus season working for Barack Obama, who had In August 2008, SEIU conducted a series of nationwide ac-
won SEIU’s endorsement. tions questioning health insurance industry tactics. e union’s
SEIU activists consistently found that voters talked about big purple bus played a role in Oregon where it pulled up to the
their problems with the healthcare system—their lack of health state Capitol in Salem for a press conference at which the union
coverage, or high co-pays and other out-of-pocket costs, denial and its ally, Oregon Action, presented evidence indicting the
for previously existing health problems, and many others. health insurers there. ey outlined how the insurance industry
SEIU regularly ran paid television ads in targeted markets used deliberate tactics designed to maximize pro ts by raising
that drew sharp distinctions between the Republican and Demo- premiums, co-pays and deductibles; refusing coverage or charg-
cratic positions on healthcare and what those di erences meant ing exorbitant rates to people with pre-existing conditions; and
to working families. even retroactively denying coverage to people with insurance.
As the 2008 Democratic and Republican national con- In Spokane, Washington, members of SEIU Local 925
ventions approached, SEIU launched “ e Road to American joined the bus tour in front of health insurer Premera Blue Cross
Healthcare,” a nationwide bus tour. It made hundreds of stops seeking greater transparency into the rm’s nances and rejec-
throughout the nation, such as Tucson, Arizona, where orga- tion rates. “I’m so glad we did that!” said Paula Hall, a child care
nizers set up a canopy in the city’s Main Library Place and in- worker from Spokane and Local 925 member. “ e way I see
vited passersby to take shelter from the desert sun and listen as it, health insurance companies are answering to their sharehold-
SEIU members joined with elected o cials and talked about the ers, so they focus more on pro ts than on patient care. is has
healthcare crisis. to change.”
“A lot of folks are hurting and one of the last things folks Even before Barack Obama’s victory in November 2008,
need is continued increases in healthcare premiums, co-pays, and SEIU had launched its “100 Days for Change” campaign aimed
deductibles—but that’s what’s happening,” said Dave Mitchell, at pushing through the union’s post-election legislative priorities,
president of SEIU Arizona’s Pima County chapter. “People with healthcare reform at the top of the list.

7. SEIU HELPS PASS HISTORIC HEALTHCARE REFORM 259
Treasurer Burger said as the campaign was launched. She said
the union would push strongly for healthcare reform as President
Obama pledged to see it through Congress at the onset of his
new Administration.
Change at Works helped build strong pressure in target
states in 2009, but momentum for healthcare reform on Capitol
Hill slowed as President Obama deferred to certain Congress-
ional leaders to craft the speci cs of the legislation.
Democrats who chaired relevant committees in both the
Senate and the House chose to engage in long, drawn-out dis-
Medical doctors who belonged to SEIU Healthcare’s Committee of Interns cussions with Republicans over the healthcare reform bills’ de-
and Residents joined the union’s Road to American Healthcare tour in August
2008. e union doctors saw every day on the job the huge problems of a tails. Months and months of talks to win at least a few Republi-
healthcare system in dire need of reform.
can votes for the legislation led nowhere, even after a number of
Much of the normal work of the union was set aside, in- huge compromises that disappointed progressive forces.
cluding a number of important organizing drives, so that more Advocates of a single-payer healthcare system, similar to
than half of the International Union sta and about 40 percent those of many other countries that deliver quality care at a lower
of all local union sta (excluding organizers) could work on cost, were angered when Democrats rejected the concept before
post-election accountability. Locals also engaged their members the debate had begun.
in the e ort, which was run similar to a political campaign, with Later, the debate shifted to a “public option” through which
doorknocking and phonebanking, house parties and meet-ups, a government-funded health insurance plan would compete with
town hall meetings, and outreach to community and religious private insurance companies to help keep premiums and other
coalition partners. e goal was to ratchet up pressure on Con- costs more reasonable. Consumers in a number of states faced
gress to build support for healthcare reform and other SEIU leg- insurance monopolies in which only one or two companies con-
islative priorities, such as the Employee Free Choice Act. trolled the local market for health insurance. SEIU supported
e e ort evolved into SEIU’s major national campaign the public option, which was included in the House bill passed
called “Change at Works” that kicked o in January 2009 in late 2009, but it was not in the Senate version of the legisla-
with a state-by-state e ort to pass comprehensive healthcare re- tion that became the basis for the nal healthcare reform law.
form, ensure approval of the economic recovery package, and Much of the debate in late 2009 was shaped by the fact
guarantee workers the freedom to choose a voice at work. that Democrats supporting healthcare reform needed 60 votes
SEIU targeted 35 states and hired campaign directors for out of the 100-member Senate in order to force an end to
each of those states. e union created a “war room” at its head- debate and bring a bill to an actual vote. Senate rules pro-
quarters in Washington, D.C. Bruce Colburn coordinated the vided for a libuster that meant 41 Senators could block pas-
health reform e ort. sage of legislation even though a majority of Senators favored
“If we’re going to revive the American Dream, we have to that legislation.
build an economy that works for everyone,” SEIU Secretary- e drive for healthcare reform su ered a major setback in

8. 260 STRONGER TOGETHER: THE STORY OF SEIU
August 2009 when Senator Edward Kennedy, the leading advo-
cate of universal healthcare, died after a 15-month struggle with
brain cancer.
A small group of very conservative Democrats in the Sen-
ate, including Senators Ben Nelson of Nebraska and Blanche
Lincoln of Arkansas, refused to commit to voting to end the li-
buster and allow the reform bill to come to a vote. ey sought
special favors at the expense of the broader public and at times
seemed to carry out the agenda of the insurance companies that
had in icted so much damage on their constituents.
But nally the Senate adopted a healthcare bill that fell
short of what SEIU had wanted, but nevertheless appeared to
mean that reform would become the law of the land. All that
remained was to conform that Senate bill and the version passed
weeks earlier by the House.
When Congress recessed for the holidays in December, vidual premiums as much as 39 percent. Anthem also sought
President Obama and the Democratic and Republican leaders massive premium hikes in Connecticut, including 24 percent for
in the House and Senate indicated the nal compromises in the individual policies (rejected by the state) and in Maine, where
House and Senate versions were likely to be nalized shortly af- the company sought a 23 percent increase.
ter Congress returned to business in early 2010. Anthem’s greed was not alone. Rate hikes by insurance
companies that had been proposed during the healthcare reform
S cott Brown’s upset victory in January 2010 over Martha
Coakley in the election to ll the U.S. Senate seat in Mas-
sachusetts—vacant due to the death of Senator Edward Ken-
debate included Blue Cross/Blue Shield of Michigan, which
sought premium hikes of 56 percent. Regency Blue Cross/Blue
Shield in Oregon demanded a 20 percent increase.
nedy—sent shockwaves through Washington, D.C. ese incredible rate increases provoked particular outrage
e Republican upset in the special election meant the in the midst of the deep economic recession in which many peo-
GOP had 41 Senate votes to sustain a libuster and block fu- ple had lost their employer-provided health insurance and had
ture legislation. Many pundits and political observers thought been forced to seek individual coverage that was the core of the
healthcare reform was dead. proposed rate hikes.
Insurance companies, which spent millions of dollars on And the insurance rms’ rate hikes came while they were
lobbyists to try to shape healthcare reform to their liking, be- reporting huge pro ts. WellPoint, UnitedHealth Group, Cigna,
lieved they had won a victory with the stalling of the legisla- Aetna, and Humana together took in $12.2 billion in pro ts in
tive process. ey moved immediately with huge rate increases 2009, up 56 percent over 2008.215 From 2000 through 2009,
across the country. Anthem Blue Cross of California (owned by pro ts for the 10 largest insurance companies increased 250 per-
for-pro t WellPoint Inc.) announced it would be raising indi- cent—10 times faster than in ation.

9. SEIU HELPS PASS HISTORIC HEALTHCARE REFORM 261
e raw greed of the insurance companies, unleashed by the important social legislation since the passage of Medicare in the
apparent defeat of healthcare reform, provoked a massive back- 1960s underscored how far the union had come.
lash that helped to breathe new life into the legislative e ort. From a small group of underpaid and overworked janitors
Republicans continued their e ort to scrap the legislation, in Chicago nearly 90 years earlier, SEIU had evolved into a 2.2
which had been debated for a year before being passed with only million-member powerhouse that delivered at the bargaining
one Republican vote in the House and no Republican votes in table, the ballot box, and in the halls of Congress.
the Senate. e outcome occurred even though a number of One mark of the union’s e ectiveness was the increasingly
Republican proposals had been included in the Senate version as shrill volume of attacks from right-wing talk show hosts such
part of Democrats’ attempts to attract bipartisan support. as Glenn Beck and Rush Limbaugh, whose hate- lled attacks
Democrats nally adopted healthcare reform in March, on Stern, Mary Kay Henry, and SEIU became a staple of their
2010, but Republicans vowed to repeal the historic healthcare programming in 2010.
bill even before President Obama signed it into law in front But for every snarl from a Glenn Beck, there was a smile
of a White House audience including SEIU President Stern, from an SEIU member such as Loretta Johnson, who with the
SEIU Healthcare leader Dennis Rivera, 1199/SEIU United healthcare reform law could nally look forward to living with-
Healthcare Workers-East President George Gresham, and other out the fear of having no health insurance. So, too, could 32
SEIU activists. million Americans who lacked healthcare coverage before SEIU
President Obama’s sincere thanks to SEIU leaders and and so many other allies worked together to change history for
members for the crucial role they played in winning the most the better.
ousands attended a Labor Day rally for healthcare reform in Boston on September 7, 2009.