California union launches sweeping health care ballot measure campaign

By: - August 26, 2019 4:55 pm

At a press conference unveiling the Stop Surprise Billing and Protect Patients Act, a proposed ballot measure, Fernando Vicino speaks about the need to prevent insurance companies from discriminating against people based on pre-existing medical conditions. Photo by Jeremy Duda | Arizona Mirror

Health care workers would get a substantial pay raise, patients would get new protections against unexpected bills for out-of-network providers, the state would get new powers to enforce anti-infection cleanliness standards and a key provision of the Affordable Care Act would get a new guarantee in Arizona under the provisions of a ballot measure being run by a California labor union.

The campaign for the Stop Surprise Billing and Protect Patients Act represents the third straight election cycle in which the Service Employees International Union-United Healthcare Workers West will try to put a health care-related citizen initiative on the ballot in Arizona. The union, which represents health care workers in California, has spent the past several years pushing ballot measures in other states across the country.

Healthcare Rising Arizona, a new advocacy group, unveiled the Stop Surprise Billing and Protect Patients Act at a press conference in Phoenix on Monday. 

Unlike in 2016, when the union sought to cap salaries for hospital executives as part of an ongoing battle with the California Hospital Association, the Stop Surprise Billing and Protect Patients Act isn’t an outgrowth of any out-of-state labor fight. And the campaign said the union isn’t pushing the proposed citizen initiative in order to set the stage for a future attempt to unionize health care workers in Arizona.

“I don’t speak for UHW West, but my feeling is they’ve demonstrated that they are committed to improving the quality of health care across our country and they are committed to improving standards of living across our country,” said Rodd McLeod, a spokesman for Healthcare Rising Arizona, which is running the ballot measure.

McLeod noted that the union for several years has run ballot measures across the country under the auspices of the Fairness Project, a nonprofit organization it funds. The Fairness Project pushed ballot measures in several states to expand Medicaid coverage, and the union has contributed to measures to increase the minimum wage and require paid sick leave in several states, including Arizona in 2016.

Campaign chairwoman Jenny David, a labor and delivery nurse at St. Joseph’s Hospital in Phoenix, said the campaign reached out to SEIU-UHW for help with the initiative, not the other way around.

Past Arizona elections

The union’s proposed measure on hospital executive pay didn’t make the ballot in 2016. The campaign withdrew the initiative after the Arizona Chamber of Commerce and Industry and other foes challenged the validity of its signatures in court. In 2018, the union started but later halted work on a citizen initiative that would have capped costs for kidney dialysis. 

SEIU-UHW spent more than $2.1 million on its unsuccessful effort in 2016.

Union spokesman Sean Wherley emphasized that SEIU-UHW has pushed or helped fund numerous ballot measures in other states where it doesn’t have members, including the 2016 measure to raise Arizona’s minimum wage. 

“We already demonstrated our sincerity in doing this work,” Wherley told the Arizona Mirror. “SEIU-UHW sees its mission as helping working people and their families improve their lives and standards of living. We believe we cannot be successful if all we care about is our narrow interests, and so we work in the broader public interest as well and have been doing so for nearly a decade.”

Wherley said the union has no plans to seek unionization in Arizona, and that the new ballot measure is unrelated to any labor fights in California or other states. Though SEIU-UHW isn’t pushing similar ballot measures in other states for the 2020 election, Wherley said it may seek to pass it in other states in 2022 and 2024 if it’s successful here.

Pay raises for ‘direct care workers’

The Stop Surprise Billing and Protect Patients Act would provide a 20-percent increase in wages, phased in over four years starting in 2021, for all “direct care workers” in Arizona hospitals. That includes nurses, technicians, aides, non-managerial administrative staff, social workers, and even food service and housekeeping staff in hospitals. 

The new rates would be based on the base wage for each worker in the year before the measure goes into effect. 

health care workers
Health care workers supporting the Stop Surprise Billing and Protect Patients Act, a proposed ballot measure. Photo by Jeremy Duda | Arizona Mirror

David said Arizona’s high turnover rates among hospital employees leave patients with crowded emergency rooms, fewer beds and longer wait times, among other problems. Fewer housekeeping staff, for example, means patients must wait longer for clean rooms.

“As nurses, we depend on the food staff, on the lab, on the housekeeping staff and on the pharmacy. We’re all interconnected,” she said. “I believe that, if we pay people better, we will have less staff turnover. With less burnout and turnover, we’ll have a more stable staff, a more experienced staff, and that will continue the continuity of care.”

According to ZipRecruiter, the national average pay for a direct care worker is $22,903, compared to $22,051 in Phoenix. Another website,, listed Arizona’s average hourly wage for direct care workers as $11.80, higher than the national average of $11.22. Neither website explained what kinds of employees it classified as direct care workers. 

The average salary for registered nurses in Arizona is $75,110 and the average hourly wage is $36.11, which ranks 15th in the United States, according to the website Nurses Salary Guide. 

‘Surprise’ medical bills and pre-existing conditions

Arizona lawmakers in 2017 passed a law aimed at curbing “surprise” medical bills, which allows people to challenge out-of-network bills of more than $1,000 with the Arizona Department of Insurance. But the Stop Surprise Billing and Protect Patients Act will go further. 

McLeod said the new proposal would scrap the dollar threshold, and bars insurers from charging patients more for services provided by out-of-network facilities, or by out-of-network providers at in-network hospitals. The surprise billing provisions \also include ambulance service.  

Under the section on cleanliness, hospitals would be required to meet nationally accepted standards for preventing hospital-acquired infections such as MRSA. The ballot measure would authorize the Arizona Department of Health Services to fine hospitals $500 per day for each violation of the infection standards. 

According to the U.S. Centers for Disease Control, such infections kill about 99,000 people per year. At Healthcare Rising Arizona’s press conference, Delores Stoeser spoke about the MRSA infection that killed her husband after he was treated for a lung infection. Stoeser, too, suffered an infection following back surgery. 

“When we have underpaid and overworked nursing care and housekeeping, we are all going to be in danger. This is a very, very serious situation that is life-threatening and needs to be addressed,” Stoeser said.

McLeod pointed out that the federal government cut Medicare payments to 15 Arizona hospitals in March due to patient safety issues, including infections. 

The Affordable Care Act already prevents insurance companies from refusing coverage or charging more to people who have pre-existing medical conditions. But a federal lawsuit brought by Republican officials in 20 states, including Arizona Attorney General Mark Brnovich, could strike down that provision. And Republicans in Congress still hope to overturn the Affordable Care Act, a goal they were unable to achieve before Democrats took control of the U.S. House of Representatives in the 2018 election.

David described the initiative’s protections for people with pre-existing conditions as a “backup plan” in case the Affordable Care Act’s provision is repealed or struck down. McLeod also noted that a 2018 rule change by the U.S. Department of Health and Human Services allowed states to allow short-term plans that don’t include pre-existing condition coverage, an opportunity Arizona lawmakers took advantage of during the 2019 legislative session. 

Hospital industry: out-of-state fixes not needed

The Arizona Hospital and Healthcare Association, an industry group representing hospitals, took aim at the proposed initiative, especially its provisions on salaries and cleanliness. 

Ann-Marie Alameddin, the group’s president and CEO, disputed Healthcare Rising Arizona’s assertion that turnover among nurses and other direct care workers is unacceptably high, and said the turnover rate in Arizona is consistent with other industries. 

The bigger problem facing the industry is a workforce shortage, she said, and AzHHA has lobbied for policies that will strengthen the pipeline of qualified employees.

As to the provisions on hospital-acquired infections, Alameddin said Arizona already exceeds the national average on the five benchmarks cited in the initiative. According to the CDC, Arizona was better than the national average on four benchmarks in 2017, worse on one and met the national average on two others. 

“We always have to improve patient safety and quality measures, and we’re working hard to do that. This doesn’t do that. It creates a lot of administrative burden,” Alameddin said. “The violation and the penalties are really severe. Honestly, I think it would have a significant impact on a lot of hospitals if these penalties were enforced.”

Alameddin repeatedly emphasized that the initiative was coming from an out-of-state union that has a history of using Arizona ballot measures as bargaining chips for labor disputes in California. She said her organization believes that the new measure, like the failed hospital executive pay measure in 2016, has similar origins, though she said the group hasn’t yet identified any issue that the new initiative could be tied to. 

“It certainly hasn’t organically risen in Arizona through our health care system. It’s coming in from out of state,” she said.

Healthcare Rising Arizona must collect 237,645 valid signatures by July 2, 2020, to qualify for the ballot in next year’s general election.

Alameddin said the hospital association will fight the ballot measure. She couldn’t yet say what kinds of resources it would commit to the campaign.

The Arizona Chamber of Commerce and Industry is also likely to fight the measure, though spokesman Garrick Taylor said its board of directors has not yet taken a formal position.

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Jeremy Duda
Jeremy Duda

Associate Editor Jeremy Duda is a Phoenix native and began his career in journalism in 2003 after graduating from the University of Arizona. Prior to joining the Arizona Mirror, he worked at the Arizona Capitol Times, where he spent eight years covering the Governor's Office and two years as editor of the Yellow Sheet Report. Before that, he wrote for the Hobbs News-Sun of Hobbs, NM, and the Daily Herald of Provo, Utah. Jeremy is also the author of the history book “If This Be Treason: the American Rogues and Rebels Who Walked the Line Between Dissent and Betrayal.”