Labor Unions Champion Insurance, Care For HIV

Two San Francisco labor unions have implemented HIV care programs which could serve as models for other organizations. The programs concern insurance coverage for HIV treatments, and a long-term union effort to improve HIV care at a major medical center.

Restaurant Workers Win HIV Coverage

Local 2 of the San Francisco Hotel Employees and Restaurant Employees Union has become the first trade union in the U. S. to acquire and fulfill a health benefits contract which includes substantial and explicit coverage for members with AIDS/HIV- related expenses.

The contract language specifying the coverage was won over a year ago by the 12,000 unionized workers in the City's pivotal hotel and restaurant industry. However, the benefits became available only recently, after the first employer contribution was made in November of 1990.

The Local 2 fund will reimburse for experimental as well as prescription drugs, co-insurance payments and deductibles, lab work, homecare, non-disposable medical equipment, and even non- medical expenses such as food, rent, utilities, and transportation. Coverage is provided by a special fund created from monthly, progressive contributions from employers, and will compensate for any legitimate health care refused reimbursement by the employee's regular insurer.

We spoke to Jack Gribbon, who works for the Local and who designed the care package. He is familiar with the specific difficulties in negotiating health benefits for his members, and for union contracts in general. Antagonisms over health coverage were integral to four of every five labor disputes in this country in 1989.

Mr. Gribbon said that in spite of the model language of his union's contract, many people with HIV continue to be marginalized or ignored in health care benefits negotiations. He shared with us an anecdote typifying inadequate HIV coverage in union contracts, from last year's conference of the International Foundation of Employee Benefits. These annual conferences are attended by trustees representing business, labor, and community service agencies. When the dilemma of how to cover HIV infection as a pre-existing condition came up for discussion, someone suggested that HIV simply become a basis for complete exclusion from insurance coverage. Mr. Gribbon, together with allies at the conference, strongly protested and proposed the exact opposite: that people with HIV or AIDS be able to expect the same comprehensive coverage afforded their co-workers. Mr. Gribbon would like to see other employers and unions use the Local 2 fund to negotiate the language of their own health care contracts.

Hospital Workers Take Stand For Patient Care

Local 250, Hospital and Institutional Workers Union of the Service Employees International Union (SEIU), has fought for over five years for the needs of members with HIV, for workplace safety, and for the patients served by the Local. This fight has been waged through the Local's "AIDS Education Committee," which is open to participation from any union member and has enjoyed strong backing from both local and national SEIU leadership. The committee's "Train the Trainer" programs have helped Local members distinguish between real risks for exposure to HIV and irrational fears, and to respect the rights of patients while assuring the safety of caregivers.

The first achievement of Local 250's AIDS Education Committee was the creation of an inpatient AIDS ward at Kaiser Hospital in San Francisco, a development which greatly improved the medical care for patients there. Previously, Kaiser patients hospitalized with AIDS-related complications often experienced inconsistent care, marred by inexperience with treating HIV on the part of some attending physicians and by fears of "catching" AIDS on the part of some hospital staff.

Kaiser-Permanente is a health maintenance organization (HMO) with clinics and medical centers throughout California and, to a lesser degree, several other states. HMOs operate as a combined health insurer and health-care provider; they are expanding in the United States. This writer was employed at the San Francisco Kaiser facility in 1986, a year before joining the staff of AIDS TREATMENT NEWS. When dissatisfaction with the care of persons with AIDS became a serious issue, we met with several co-workers to enlist the support of our union, of the San Francisco Human Rights Commission, and of sympathetic Kaiser doctors, nurses, and technicians, to effect a change in Kaiser's AIDS care.

A series of negotiations with the hospital administration led to an acknowledgement that the problems were unacceptable. Plans were developed for a ten-bed ward devoted exclusively to caring for patients with AIDS, and the ward was to be staffed by caregivers fluent in the latest standards of AIDS treatments.

Kaiser implemented the plan in good faith, with input from the union and from employee representatives. A comprehensive AIDS-care orientation was provided to everyone who volunteered to work on the ward. We have since heard generally good reports of the ward from the San Francisco PWA community. Kaiser's outpatient care has not always shared this response. In fact, repeated negotiations between Kaiser and a community activist group called KPAU (Kaiser Patient Advocacy Union) produced less progress and more friction on both sides than did the earlier situation. We plan creport on the status and goals of Kaiser, and of KPAU, in a future article.