22,000 Healthcare Workers Push HCA for $25 Wages and Staffing Guarantees
Roughly 22,000 US healthcare 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. Picket protests are planned at over a dozen HCA hospitals across California, Texas, Nevada, and Florida The Guardian. The workers are asking for a pathway to a $25-an-hour minimum wage, improved wage scales, raises tied to cost-of-living increases, paid vacation and sick time, and stronger workplace protections.
The negotiations come amid a stark gap between the company's financial performance and what its frontline workers earn. 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 (a buyback is when a company uses its own money to repurchase shares from the market, which tends to boost the stock price) 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.
That pay gap 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 focused on healthcare, has previously secured a $15.65 minimum wage for its members SEIU. The current $25 demand would go well beyond that floor.
Nurse-to-patient ratios — how many patients each nurse is responsible for at one time — have become a second major sticking point. HCA union members want contractual guarantees on staffing ratios in their next agreement. That demand carries particular weight in Nevada, where Republican governor Joe Lombardo vetoed legislation in 2025 that would have set 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 turn 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 broader context here is one of strategic framing. By linking pay demands to patient-safety metrics in a single bargaining cycle, the SEIU is casting 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 own spending choices make it difficult to argue that ratio improvements and wage increases are financially out of reach. Whether that lever produces actual contract language will depend on the specifics of bargaining at each facility, HCA's willingness to set ratios contractually rather than through internal policy, and how much pressure the multi-state pickets generate on management's timeline.
The political landscape adds another layer of difficulty. Lombardo's veto in Nevada shows that legislative paths to mandated staffing ratios remain contested in Republican-led states, pushing unions toward contract-based solutions — even though 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 campaigns, 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 reach 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 hospital systems. A settlement that falls short of those benchmarks would test the union's ability to sustain member mobilization across multiple states at the same time.
