Oregon Activists Look to Grassroots Approach to Win Universal Health Care

By Peter Shapiro for Labor Notes

With health care premiums rising three times faster than workers’ income, more and more unions have come to see the existing health care system as unsustainable, despite their best efforts at the bargaining table.

In Oregon, activists are responding by rejuvenating a dormant campaign to win a health care system that covers everyone—and pays for it by cutting out the insurance companies. The concept is called “single payer.”

This isn’t the first time that Oregon activists have tried to win single payer. Ten years ago, they put an initiative on the ballot, but despite initially promising polls, the measure was trounced—victim of a flood of insurance company money and the sharp opposition of the Oregon AFL-CIO, which called it a threat to union health plans.

Times have changed.

When Portland Jobs with Justice began making the rounds of local union halls in 2008, urging support for national single-payer legislation sponsored by Representative John Conyers, the response was generally sympathetic. The national AFL-CIO has endorsed single payer on principle, and current state President Tom Chamberlain has been a consistent supporter.

The current focus isn’t just gaining endorsements, however.

Three activists from the Vermont Workers Center toured Oregon in December at the invitation of local Jobs with Justice chapters to spread the word on how they won landmark legislation laying the groundwork for a single-payer health care system in their state.

Their essential message: take it to the grassroots. Don’t split hairs over policy analysis. Don’t try to win over legislators who have heard all the arguments but haven’t felt the heat from their constituents. Don’t even use technical terms like “single payer,” unless you’re talking to people who already know what it means.

Instead, talk about health care as a human right—something everybody should have, regardless of the state of their bank account or their immigration papers, their medical condition, their job, their age, race, or gender, or whether some insurance underwriter thinks they’re a “good risk.” Seek out the people in all walks of life who have been burned by the health care system, get their stories, and turn them into effective activists and advocates.

For three years Vermonters built support in every corner of the state through one-on-one surveys, photo petitions, and public meetings where politicians were invited to hear testimony, comparable to the Workers’ Rights Board hearings that are a standard part of the Jobs with Justice toolkit.

The Vermonters’ tour made a tremendous impact, from metropolitan Portland to rural communities in eastern Oregon. Not everyone agreed with every aspect of the VWC approach, but everyone was talking about it. By the end of January, a new statewide coalition had convened to “create a comprehensive, affordable, publicly funded, universal health care system serving everyone in Oregon and the United States.”

By April, the coalition had a name—Health Care for All-Oregon—and close to 50 affiliates, including several statewide unions, immigrant rights groups, and community organizations ranging from the Rural Organizing Project to Elders in Action to Sisters of the Road (which advocates for the homeless).
Some, like Physicians for a National Health Program (PNHP) and the Mad as Hell Doctors (whose cross-country tour in 2009 brought the message to a host of new audiences), make single payer their main focus. The majority of affiliates have other priorities, but have come to understand that the collapse of our health care system threatens everything else on their agenda.

The Oregon Latino Health Coalition, which has labored tirelessly under the radar to secure medical services for the state’s 150,000 undocumented, recognized immediately that the Health Care for All human rights framework provides an opportunity for open advocacy without being isolated or marginalized. In voting to affiliate, the Representative Assembly of the Oregon Education Association noted that the skyrocketing cost of teachers’ health benefits is draining money out of the classroom and has left the union increasingly vulnerable to attack.

State vs. National

For unions, perhaps the biggest sticking point has been the question of state vs. national legislation. When Congress passed the Affordable Care Act in spring 2010 and ended, for the time being, the prospect of any genuine national health care reform at the federal level, Portland Jobs with Justice made a strategic decision to pursue state legislation as a way to keep single payer before the public.

Working with state Representative Michael Dembrow (who is also a Teachers union officer and Jobs with Justice member), with activists from the 2002 initiative campaign, and with PNHP and the Mad as Hell Doctors, we drafted a bill that attracted a dozen legislative co-sponsors. In March 2011, supporters of the Dembrow bill staged a mass rally on the Capitol steps followed by a dramatic two-hour hearing before the House Health Care Committee. The legislation didn’t make it to the House floor, but it has more than proved its value as an organizing tool, energizing new activists across the state.

Some single-payer supporters question how far it can be implemented at the state level. They point to a host of federal laws and regulations that would need to be waived, and the difficulty of achieving the cost savings of a truly universal risk pool when the program stops at the state line.

This has in fact been a problem in Vermont, whose new law, while a giant step in the right direction, falls short of single payer. (Many Vermonters remain outside the risk pool, and funding, while administered by the state, still comes from multiple sources.) Unions with multi-employer Taft-Hartley health plans, which often cross state lines, worry that a statewide risk pool will not be viable enough to maintain the level of coverage they currently enjoy.

For this reason, Portland Jobs with Justice has made national legislation the ultimate objective, and has taken the position that the best union health plans set the standard by which any public plan should be assessed. Significantly, the “insurance exchange” provisions of the Affordable Care Act directly undermine Taft-Hartley trusts, by giving small employers a way to bypass unions and buy inferior, cut-rate insurance coverage for their workers. For unions, the Affordable Care Act is no solution: even if it survives the current Supreme Court challenge, its lack of cost controls and other internal contradictions will render it unworkable.

The challenge for us is to be ready with an alternative that has popular support, and the more states join Vermont in projecting such alternatives, the better.

Health Care for All-Oregon wants to bring everyone together to hammer out a strategy that works for all. The immediate task in Oregon, though, is not legislation but building the kind of mass base that changes the political climate in the state and makes legislation possible.

Efforts to pass single-payer bills in Vermont go back 20 years, but it was only after the Vermont Workers Center did three years of organizing around the principle of health care as a human right that they got results. Now that the Oregon coalition is up and running, we’ll see how much of Vermont’s game plan can be successfully exported.

Peter Shapiro is an organizer with Portland Jobs with Justice.