For the fourth time in six years, the president of New York’s largest health-care union, George Gresham of 1199SEIU, has won the top spot on the “Labor Power 100” list from City & State magazine.

Given the extraordinary clout 1199 that wields in Albany, it’s hard to dispute the editors’ choice.

Here is a recap of some of the recent lobbying victories that have bolstered 1199’s claim to that No. 1 ranking – which often came at the expense of taxpayers, consumers, the union’s putative allies and health workers outside the union’s orbit.

Disrupting home care

As state budget negotiations dragged past the April 1 start of the fiscal year, 1199 engineered a major overhaul of Medicaid’s fast-growing Consumer-Directed Personal Assistance Program, which allows disabled recipients to directly hire, train and manage their own caregivers, who can be their friends or family members.

The 11th-hour proposal, which was approved by lawmakers, called for establishing a single statewide “fiscal intermediary” to handle payroll processing and other technical matters on behalf of CDPAP clients – which would drive hundreds of small intermediaries out of business in a matter of months.

The proposal blindsided many of 1199’s sometime allies in coalitions seeking to bolster funding for home health.

The premise of the overhaul is to streamline an unwieldy program, but it includes provisions that could pave the way for 1199 to unionize CDPAP caregivers – which would represent a big boost to its membership and dues revenue.

Bailing out a benefit fund

Earlier this spring, 1199 quietly arranged to enroll many of its unionized home health workers in taxpayer-funded health insurance through the Essential Plan.

The deal saves an unknown amount of money for the 1199 SEIU National Benefit Fund for Home Care Employees, which has been running deficits in recent years despite other subsidies from the state.

The Hochul administration signed off on the arrangement even though it amounts to an end-run around appears to sidestep the Essential Plan’s eligibility rules, which normally exclude people with access to employer-sponsored health benefits.

Diverting ‘training’ grants

As the Empire Center reported in February, 1199 and some of its affiliated employers have diverted a quarter-billion dollar in Medicaid “training” money into a pair of health benefit funds for nursing home workers.

The Health Department described its Advanced Training Initiative as a way of improving nursing homes care by teaching workers how to recognize the early signs of decline in patients. 

However, federal disclosure reports showed that the money actually flowed to union-affiliated benefit funds, closing gaps in their balance sheets and offsetting contributions that employers would otherwise have had to pay.

It’s not clear that state or federal officials approved this diversion – or whether the training was ever delivered. 

Cutting home-care compensation

As part of last year’s budget, 1199 pushed through a plan that would reduce wage supplements for home-care aides and redirect the savings to yet another bail-out for a union-affiliated benefit fund.

For aides who were not unionized, the cut effectively negated the benefit of minimum wage hikes promised in January 2024.

Rolling back a nursing home spending law

Also last year, 1199 collaborated with a group of nursing home operators to significantly weaken a major reform effort enacted two years earlier with union support.

The 2021 law – passed in response to the high coronavirus death rates among nursing home residents – required operators to spend at least 70 percent of their revenue on patient care, including at least 40 percent on patient-facing staff.

Under a “demonstration project” passed in the closing days of the 2023 session, lawmakers voted to reduce or waive penalties for homes that reduce their use of temporary workers hired through staffing agencies.

Based on publicly available data, the revised standards effectively exempted half of all nursing homes from newly enacted minimum spending requirements.

Pushing Medicaid spending to new heights

In alliance with another Albany power broker, the Greater New York Hospital Association, 1199 has forcefully and successfully pressured lawmakers to allocate ever-larger amounts of state money for Medicaid.

The result over the past five years has been some of the sharpest increases in the history of the program – on top of what was already by far the highest per-capita spending level among the 50 states.

They also secured approval for a vaguely defined tax on health plans, which is expected to bring in billions in extra federal aid and pave the way for still more Medicaid outlays in the future.

One of their chief tactics is mounting alarmist TV ad campaigns, which usually include misinformation about the history of New York’s Medicaid spending and its role in various ills of the health-care system.

Although many of their claims are baseless or misleading, they are often accepted and echoed by elected officials of both parties.