By DON McINTOSH, Associate Editor
In the long and bitter battle between TriMet and Amalgamated Transit Union Local 757, the biggest fight is health insurance. TriMet wants bus drivers, mechanics and others to pay a much bigger share of the costs, which are by all accounts sky-high — up to $28,966 a year to cover an employee and his or her spouse and children on Regence Blue Cross Blue Shield.
Neither side created America’s grossly overpriced health care system, but that only explains why costs are high to begin with, not why they’re higher than average at TriMet.
But now a foundation-funded initiative — and the intervention of Portland City Commissioner Steve Novick — has a chance to bring the two parties together to grapple with the underlying issue: why so many TriMet workers and their families have health problems, and why they’re so expensive to treat.
In April, the nonprofit business group known as the Oregon Coalition of Health Care Purchasers (OCHCP) received a $50,000 seed grant from the Robert Wood Johnson Foundation to galvanize a community to address its health issues. OCHCP executive director Jill Freeman reached out to TriMet and Local 757 leaders and met with each side separately. Freeman, a former benefits administrator for Les Schwab and Jeld-Wen, was given access to the underlying data about how 3,500 TriMet workers, managers and retirees use health care — so she could better understand why costs are so high.
On Dec. 5, Freeman presented her findings to a meeting attended by 30 leaders from the union, TriMet management, and Novick’s office, as well as health experts. The numbers were shocking.
TriMet workers have diabetes and high blood pressure at rates twice as high as the general population served by Kaiser Permanente. They have greatly elevated rates of depression and coronary artery disease. They go to the emergency room more often. And they smoke at a rate significantly higher than the general population.
“Data tells a story,” Freeman said. Just not necessarily a story where the sick are to blame for their illnesses. Are there things about TriMet as a workplace that are worsening worker health?
[pullquote]I feel like the union has an amazing opportunity here to drive a culture of health. It would be great if the cost of health care within TriMet got to a point where employees could start to see raises — instead of costs related to health care.” — Jill Freeman[/pullquote]Smoking, for example, can be a response to stress, and is more common in stressful occupations. More frequent visits to the emergency room may suggest that work hours make it difficult to see a primary care physician and get preventive care.
Union leaders have been telling TriMet for years that the nature of the work, and some management decisions, are contributing to workers’ health issues. Bus drivers perform a sedentary job, in a vibrating workspace, with all the attendant stress of maneuvering a large vehicle safely through traffic, watching for people at bus stops, and interacting with passengers, while trying mightily to be neither earlier nor later than the schedule dictates. And worse, drivers go for hours without the ability to easily take bathroom breaks, and suffer for it. Many chronic conditions are worsened by dehydration.
“If you’re knowingly going to be in a situation where you won’t be able to use the rest room for many hours, you change the way you hydrate yourself,” Freeman said.
TriMet hasn’t solved the bathroom breaks issue, but it has taken other measures: It maintains gyms at multiple garages, offers yoga classes, provides healthy snacks in vending machines, and pays for smoking cessation, weight loss support programs and chronic condition management support programs.
“TriMet has put a considerable amount of investment into the health and welfare of their employees and their employees’ families,” Freeman told the Labor Press.
But utilization of available health plan programs is low. Freeman says it will take union and management working together to turn that around.
Something will have to change to transform a culture of stress and mistrust.
Novick’s involvement may help, by bringing the two sides together. At the Dec. 5 meeting, participants came up with a menu of approaches to improving worker health. One approach would be to employ “hot spotters” — identifying individuals with chronic conditions who would benefit from health coaches and specialized attention. The Atlantic City, New Jersey, casino workers union UNITE HERE Local 54 pioneered that approach, which came to national attention in a much-read 2011 article by Atul Gawande in the Atlantic Monthly. Another would be for TriMet to hire nurse practitioners or other medical professionals directly and make them available on site.
“Why are shifts so complicated?” Freeman asked. “What if replacement drivers, instead of sitting in the bull pen in the bus barn, were out in the field, easily accessible? What if there was free lunch delivery to every TriMet driver? What if there was an apple and an orange in their pouch when they picked up the keys to get their bus for their shift?”
On Dec. 12, Novick, Local 757 President Bruce Hansen and TriMet general manager Neil McFarlane delivered a panel presentation about their work to an audience of several hundred at a conference organized by Freeman’s group, at which the headliner was Oregon governor John Kitzhaber.
Hansen told the Labor Press it was the first time McFarlane had been personally involved in the effort. But it’s a start.
The next step will be for the stakeholders — labor and management — to pick one of those ideas and get to work. Once they do so, likely in January, Freeman said she would seek grant funding to implement it.
“I feel like the union has an amazing opportunity here to drive a culture of health,” Freeman said. “It would be great if the cost of health care within TriMet got to a point where employees could start to see raises — instead of costs related to health care.”