Wall Street Journal (12/02/13) Kris Maher

The nation’s largest health care union is threatening to mount ballot initiatives in California and Oregon that it says would lower health care costs, but industry officials say the real goal is to pressure hospitals into making it easier for the union to organize thousands of workers. Proposed measures in both states would cap executive pay and limit how much hospitals can charge consumers. Both sides say they are prepared to spend millions on opposing campaigns if the measures get on the ballots in November 2014.

However, the Service Employees International Union says it could back off if the industry agrees to work with the union. Hospitals can join with the SEIU, or “get into some very high-stakes policy and political engagements,” says Dave Regan, who heads the SEIU’s biggest local in California. Experts say the SEIU appears to be ramping up the tactic of waging negative public campaigns to win agreements from employers, including organizing accords, by setting the stage for a direct appeal to voters. The potential showdown comes as the U.S. Supreme Court is weighing the legality of pacts in which employers agree not to oppose union organizing, known as neutrality agreements.