California’s largest health care workers union is no stranger to taking its fights to the ballot – both statewide and locally. In the past five years, it has pitched to voters initiatives on issues ranging from staffing at dialysis clinics to price caps for specific health care providers.

CalMatters reports that this election season, Service Employees International Union-United Health Workers West is targeting the cities of Duarte and Inglewood, where on Nov. 8 voters will decide whether to set a   minimum wage requirement of $25 per hour for some of the lowest paid workers at private hospitals, integrated health systems and dialysis clinics. These workers include patient care technicians, janitorial staff, food service workers and aides, among others.

Union leaders are betting that local wins this November could spur a larger statewide movement. Given California’s shortage of health care workers, supporters say a pay bump may help; opponents say these proposals are too narrow to make a difference and may instead backfire.  

The union tried negotiating a statewide minimum wage with hospital leaders this summer, but that deal fell apart. And in the past, the union has pushed to raise the state’s general minimum wage, such as when it authored a $15 minimum wage measure for the statewide ballot. The union withdrew its measure when Gov. Jerry Brown signed a similar proposal into law.

Residents in a handful of other Southern California cities may have to make a decision on health care worker wages in later elections. For example, city councils in Los Angeles, Long Beach and Downey approved minimum wage hikes for health care workers at private facilities this summer. But an industry-backed campaign temporarily blocked the cities from implementing the ordinances after it collected enough signatures for a referendum. Those city councils either must repeal the ordinance or put the issue up to voters, likely in 2024.

The coalition of hospitals and clinics leading the opposition to the wage initiatives is calling the union’s proposals “deeply flawed” and the pay rate “arbitrary.” The hospital lobby and health systems across the state have poured at least $17 million into campaigns to defeat these two measures, according to campaign filings in Inglewood and Duarte. SEIU-UHW has allocated more than $1.2 million in support.

The opposition campaign’s argument to voters is that the measures are bad policy because they exclude a significant amount of health care workers in these cities. The measure applies only to private hospitals, their affiliated facilities and dialysis clinics, meaning workers employed at public hospitals would be excluded. Workers at nursing homes, private or public, are also not included in the measure.

Duarte’s Measure J would primarily apply to people employed by City of Hope, a private nonprofit hospital and cancer research center. In Inglewood, Measure HC would apply to workers at a number of dialysis clinics and Centinela Hospital Medical Center, a 362-bed facility operated by the for-profit system Prime Healthcare.

If approved, the $25 minimum wage rate could go into effect as early as December. Employers would then have to follow up with cost of living increases starting in 2024. The initiatives prohibit employers from funding the minimum wage hike by laying people off or reducing their benefits.

SEIU-UHW is also behind this year’s Proposition 29, a measure that asks voters statewide – for a third time – to decide on establishing new rules for dialysis clinics, including adding an extra medical provider on site. The union is known to routinely turn to voters and use the initiative process as a negotiating tactic. In the past, the union has proposed ballot measures and then pulled them after reaching agreements with hospital leaders.

In August, the union and the California Hospital Association tried to hash out a last-minute legislative deal that would boost the minimum wage for workers in both public and private facilities statewide (ranging from $19 to $24 an hour, depending on location) in exchange for the union’s support for a request to delay seismic upgrades due in 2030. But those negotiations fizzled.