TV and movie watchers can breathe a sigh of relief, with final settlements in sight for the SAG-AFTRA and Writers’ Guild of America strikes. So can car buyers, as the United Auto Workers union finalizes deals with the big three automakers. But these workers were not alone. In just the first eight months of 2023, over 323,000 workers engaged in a labor action against their employers. Bolstered in part by a tight labor market and a relatively strong economy, unions have been demanding better wages, protections, and benefits—including better health plans. Rising health care prices charged by highly consolidated hospital systems have led to family premiums that are now close to $24,000 per year, a decline in the generosity of employer-sponsored health insurance, and suppressed workers’ wages. Unions not only play an important role protecting workers from this cost-shifting, they can also be critical allies for innovative strategies to reduce the unsustainable growth in health system costs.

Unions Help Workers Secure Comprehensive and Affordable Health Insurance

Strikes are predominantly led by unionized workers. A union is an organized group of workers that “collectively bargains” with an employer for better pay, benefits, and other workplace policies. In some industries, unions and employers jointly administer various benefits through Taft-Hartley plans or multiemployer plans. The retirement, health, and other benefits provided through these plans are collectively bargained, and the plans are jointly administered by both employer and union representatives.

Union membership has been declining in the United States, dropping from 20.1 percent of workers in 1983 to 10.1 percent of workers in 2022. Among the varied and interconnected political, cultural, economic, and legal reasons for this trend, states’ “right-to-work” laws have contributed by limiting union resources, leading to significantly lower unionization rates.

Health benefits tend to be a central component of most union contract negotiations, and a decline in unionization can reduce the availability and generosity of health benefits for workers. As the costs of health benefits continue to rise, employers have shifted more of the cost towards workers. High and rising health care costs also suppress wage growth. However, unionized employees can have more of a voice in how these costs are allocated.