22,000 SEIU-Represented Workers Enter Contract Talks with HCA Healthcare as Pickets Target Hospitals Across Four States

Twenty-two thousand US workers represented by the Service Employees International Union (SEIU) are in contract negotiations with HCA Healthcare, the largest for-profit hospital system in the United States, with picket protests planned at over a dozen HCA hospitals across California, Texas, Nevada, and Florida The Guardian. The workers' demands center on a pathway to a $25-an-hour minimum wage, improved wage scales, raises indexed to cost-of-living increases, paid vacation and sick time, and strengthened workplace protections.

The negotiations unfold against a sharp disparity between corporate financial performance and frontline compensation. HCA reported $6.8 billion in profits for 2025, a 17.8% increase from 2024, and in early 2026 authorized a $10 billion stock buyback program The Guardian. CEO Sam Hazen received more than $26.5 million in total compensation in 2025, roughly 420 times the median HCA employee compensation of $62,955 The Guardian. HCA employs over 300,000 people across the US and the UK.

The gap between executive pay and frontline wages is concrete at the individual level. Esther Reyes, an environmental services technician at the HCA-owned Las Palmas hospital in El Paso, Texas, earns $16.80 an hour The Guardian. The SEIU, a union of approximately 2 million members with a focus on healthcare, has previously secured a $15.65 minimum wage for its members SEIU. The current $25 demand would represent a substantial step beyond that floor.

Nurse-to-patient ratios have emerged as a second flashpoint. HCA union members are seeking contractual guarantees on staffing ratios in their next agreement, a demand that carries particular weight in Nevada. In 2025, Nevada's Republican governor Joe Lombardo vetoed legislation that would have established safer nurse-to-patient ratios statewide The Guardian. The veto left ratio-setting to the bargaining table, raising the stakes of the HCA contract for workers in that state.

Jody Domineck, a pediatric nurse with more than two decades at HCA Sunrise Hospital and Medical Center in Las Vegas, the largest hospital in Nevada, serves as secretary-treasurer of SEIU Local 1107 The Guardian. Her local is among those pushing to translate ratio demands into enforceable contract language following the legislative setback.

The current pickets build on earlier actions. SEIU-UHW announced that frontline healthcare workers would picket on March 12, 2026, outside HCA's Riverside Community Hospital in California to protest staffing levels SEIU-UHW. That action targeted the same staffing concerns now central to the broader multi-state negotiations.

The convergence of wage demands and ratio guarantees in a single bargaining cycle reflects a strategic calculus. By linking compensation to patient-safety metrics, the SEIU is framing staffing levels not as an operational cost but as a condition of employment that intersects directly with care quality. The $10 billion buyback authorization gives the union a potent rhetorical lever: HCA's capital allocation choices make it difficult to argue that ratio improvements and wage increases are financially prohibitive. Whether that lever translates into contract language will depend on the specifics of bargaining positions at each facility, the willingness of HCA to set ratios contractually rather than through policy, and the degree to which multi-state picket actions generate pressure on management timelines.

The political landscape complicates the picture. Lombardo's veto in Nevada illustrates that legislative pathways to mandated ratios remain contested in Republican-led states, pushing unions toward contract-based solutions even as those solutions apply only to unionized facilities. Workers at non-union HCA hospitals would not be covered by whatever ratio language the SEIU secures, potentially creating a two-tier staffing environment within the same corporate system. That fragmentation is itself a leverage point for future organizing drives, and a reason HCA management may resist precedent-setting ratio language in any single contract.

The outcome of these negotiations will be closely watched across the hospital sector. HCA's scale, profitability, and geographic footprint make it a bellwether for labor relations in for-profit healthcare. A contract that establishes a credible pathway to $25 an hour and codifies nurse-to-patient ratios would set a reference point for SEIU negotiations with other systems. A settlement that falls short of those benchmarks would test the union's capacity to sustain member mobilization across multiple states simultaneously.