Dennis Rivera, the president of New York’s largest health care union, announced yesterday that he would step down, but not without issuing a surprisingly pointed broadside against Gov. Eliot Spitzer’s planned cuts in health care spending.

In 17 years as president of 1199 S.E.I.U., the state’s most politically powerful union, Mr. Rivera has been perhaps the most formidable and visible labor leader in New York politics.

He announced that he was leaving his post to become chairman of a new one-million-member national health care union being established within his local’s parent, the Service Employees International Union. Mr. Rivera said the new organization would help unionize more health care workers and make the service employees a more potent political force, especially in the push for universal health coverage.

Mr. Rivera, whose Manhattan-based local has nearly 300,000 members, said he would step down on June 15, when his term ends. He added that he was not leaving sooner because he wanted to protect his members and the state’s hospitals from the cuts that Mr. Spitzer was expected to propose tomorrow.

Mr. Rivera, 56, often tangled — most times successfully — with Govs. Mario M. Cuomo and George E. Pataki to fight health care cuts. But now he sees a major fight looming with Mr. Spitzer after the new governor warned last Friday that health care spending must reflect the patients’ needs and not politics and entrenched interests — a statement that Mr. Rivera interpreted as an attack on 1199.

”I don’t think the patients in New York State and our health care institutions are served by basically identifying us as villains because we are the ones who give health care to patients every day,” Mr. Rivera said. ”We don’t want to have a war with Eliot Spitzer. We don’t believe in having a war with anybody. We believe in having a constructive dialogue. But on the other hand, we’re not going to be a punching bag for anybody.”

The remarks were particularly candid for a leader whose union has largely refrained from taking on Mr. Spitzer directly since his landslide election victory. But Mr. Rivera warned that his union might sponsor a campaign of newspaper ads and commercials against Mr. Spitzer and his proposed cuts. When 1199 undertook a campaign in 1996 against cutbacks proposed by Mr. Pataki, the governor’s popularity ratings plunged and he eventually relented. Later, Mr. Rivera and Mr. Pataki became allies, and in 2002, 1199 endorsed Mr. Pataki, a Republican, for re-election.

In a speech last Friday, Mr. Spitzer said he would seek billions of dollars in Medicaid and other health care savings when he unveils his budget tomorrow. He specifically criticized a deal that Mr. Pataki struck with 1199 in 2002 that provided some $2 billion in additional health care spending, much of it for raises for the union’s members.

”The problem,” Mr. Spitzer said, ”is a system — co-opted by entrenched interests — that resists making hard choices to change the status quo.”

Mr. Rivera said that it was ”sad and unfortunate that while Democratic governors across the nation are expanding health care access and proposing universal health care, Mr. Spitzer has taken a different posture that is more consistent with right-wing Republicans.”

The new union, S.E.I.U. Healthcare, will combine more than 30 locals across the country and will seek to set nationwide standards for health care workers and do more lobbying in state capitals and in Washington on behalf of those workers.

Sounding exhilarated about his new job, Mr. Rivera said he saw opportunities to double the number of health care workers who are unionized. He outlined plans to have the service employees’ new union create a political action committee that would have a budget of $40 million every two years, making it one of the nation’s largest PAC’s.

”It is a time of enormous opportunity,” Mr. Rivera said. ”I believe we can obtain in the next two years, certainly with a new Congress and president, universal health coverage in the United States.”

In his new position, Mr. Rivera will be one of the front-runners to succeed Andrew Stern, president of the Service Employees International Union. Mr. Rivera said that his strategy as head of S.E.I.U. Healthcare would be similar to his strategy in New York State: form alliances with hospitals and health executives to fight against cuts and fight for broader and better coverage.

In New York, 1199 often joined the Greater New York Hospital Association to push for major changes, like the creation of Family Health Plus to provide health insurance to more low-income children.

”The way we look at it, Dennis is not stepping down, he’s stepping up,” said Kenneth E. Raske, president of the hospital association. ”He’s looking for a platform that can amplify the kind of significant work that he has done in New York.”

When Mr. Rivera, a former union organizer in his native Puerto Rico, became 1199’s president in 1989, it had 78,000 members and was bitterly divided. Sometimes the police intervened to prevent the factions from fighting. Now, 1199 is solidly united and nearly four times as large, having unionized tens of thousands of workers and merged with more than a dozen locals.

If the state budget is completed early, allowing him to step down before June 15, Mr. Rivera will be succeeded by George Gresham, 1199’s secretary-treasurer. Mr. Gresham, 51, who joined 1199 as a custodian at Presbyterian Hospital, plans to run for the presidency.

Mr. Rivera said 1199 had shown its willingness to compromise by agreeing to the hospital closings and other cuts that a special state panel, known as the Berger Commission, proposed in November. ”The Berger Commission will impact more than 15,000 health care workers in New York State and more than 57 institutions,” he said. ”For Eliot Spitzer to do more cuts on top of that is outrageous.”

Edmund J. McMahon, the director of the Empire Center for Public Policy, an affiliate of the Manhattan Institute, a conservative policy group, said he was happy that Mr. Rivera was moving on.

”If you want to get an idea of how important Dennis Rivera is, much of what Governor Spitzer has to do this year is to undo what Rivera accomplished with Governor Pataki and the Legislature,” he said. ”Depending on your perspective, he did a lot or he did too much. He’s casting a long shadow.”

Mr. Rivera has clashed with Mr. Spitzer by endorsing the Republican candidate in the race for an open State Senate seat on Long Island. Mr. Rivera is close to Joseph L. Bruno, the Senate majority leader, who is a Republican and has often helped 1199 by blocking health care cuts.

Mr. Rivera, whose union normally gives more than 90 percent of its political money to Democrats, said it was important to back the Republicans, who narrowly control the Senate, ”because we believe that checks and balances are important at this very difficult moment.”

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