Search results

Unions and worker cooperatives have long represented distinct approaches to building worker voice. This paper draws from observations of the work of the “Co-op Exploratory Committee” of 1199SEIU, the nation’s largest union local, which is seeking to expand the development of unionized worker cooperatives. Described by Martin Luther King, Jr, as his “favorite” union, 1199SEIU has a storied history of organizing frontline healthcare workers and includes large numbers of women of color and immigrant workers among its membership. Since 2003, it has also represented workers at Cooperative Home Care Associates, the nation’s largest worker cooperative. Drawing from discussions among union officials, co-op leaders, and rank-and-file union members about the potential role of unionized worker cooperatives within the labor movement, the paper examines the creative tension between stakeholder and democratic logics in efforts to expand this model. It argues that continued union decline, heightened interest in economic alternatives, and systemic frailties exposed by Covid-19 may create new opportunities for building unionized worker co-ops at scale.

While there is established research that explores individual innovations across countries or developments in a specific health area, there is less work that attempts to match national innovations to specific systems of health governance to uncover themes across nations.

We used a cross-comparison design that employed content analysis of health governance models and innovation patterns in eight OECD nations (Australia, Britain, Canada, France, Germany, the Netherlands, Switzerland, and the United States).

Country-level model of health governance may impact the focus of health innovation within the eight jurisdictions studied. Innovation across all governance models has targeted consumer engagement in health systems, the integration of health services across the continuum of care, access to care in the community, and financial models that drive competition.

Improving our understanding of the linkage between health governance and innovation in health systems may heighten awareness of potential enablers and barriers to innovation success.

Purpose – Medicaid funding for long-term services and supports (LTSS) is a key avenue for community access for people with disabilities and others. Between 1997 and 2009, the boundaries of community access were redrawn and redefined with the introduction of a series of 13 bills to change how Medicaid requires states to fund LTSS. Although they did not successfully pass into law, their presence is felt in the language of the Community First Choice (CFC) Option, part of the Patient Protection and Affordable Care Act (PPACA) of 2010. This chapter documents and analyzes the changes in the concept of community access as reflected across these bills and the CFC.

Methodology – The text of these 13 bills and the CFC were compared with attention to structure, order, and meaning. Documents were hand coded and electronically searched. Codes were entered into atlas.ti for comparison and analysis.

Findings – Four significant changes in the conceptualization of community access emerged: (1) who deserves access to community, (2) what community access entails, (3) why people deserve access to community, and (4) how community access should be organized. With the exception of the reasons why people deserve access to community, the expanded concept of community access illustrated across these bills is reflected in the text of CFC.

Originality/value of the chapter – This chapter contributes to the limited literature that documents and analyzes the historical development of community access across policy documents. In addition, it highlights the relevance of incremental analysis to understanding social change through the legislative process.