On January 5, workers at Howard Brown Health Center ended a three-day strike that was spurred by the sudden layoffs of more than five dozen employees at the organization’s clinics. The workers are vowing to continue to fight to reinstate their jobs and have lingering concerns about the organization’s finances and leadership.
The crisis began in November 2021, when workers learned of impending layoffs that were initially scheduled to happen on January 3rd. But several workers who spoke to the Reader say Howard Brown’s management enacted the layoffs without warning four early, on December 30th.
D’Eva Longoria didn’t know that her last day working at Howard Brown would end so abruptly. She was aware she was among the 60 people Howard Brown Health Clinic planned to lay off, but was surprised when her computer screen went blank while she was in the middle of assisting a patient during her last shift. Without warning, Longoria says, everyone being laid off lost access to their work emails, work phones, and the platform the organization uses to speak with patients. Longoria was letting a patient know when they’re next PrEP appointment was, who she isn’t sure will be able to make it now. “I have no way of reaching out to that person. I don’t know their number,” she said.
Longoria has been a PrEP Community Engagement Specialist at Howard Brown since March 2019. She technically worked out of the Sheridan clinic, but her real office hours were spent out in the community, passing out condoms at 71st and Pulaski, doing outreach at La Cueva in Little Village, and talking to queer and trans immigrants newly arrived about how to get queer and trans affirming health care.
Longoria says that management had told those being laid off nothing about what to expect or what to tell their patients. She and the others only just learned they were getting laid off less than a month before. She hopes that people who rely on her for the outreach and programming she does see the video she posted in Spanish on her social media.
Protesters delivered a list of demands to CEO David Munar’s home in December. Jennifer Bamberg
Rumors of mass layoffs began circulating among staff members in early November, according to workers who spoke with the Reader, and on the first day of bargaining between the newly formed union and management, management dropped a bomb after listening to the union side list go over standard union proposals for over an hour. They would start offering buyouts for voluntary separation for 83 positions, offering severance pay based on how long people have been there. No one in the union took it, but an unspecified number of people in middle management did.
The union, representing 440 employees, filed charges against Howard Brown Health over 21 violations of the National Labor Relations Act. Eighty percent of the union submitted ballots and 92 percent voted yes to go on a three-day strike in response.
The organization says it’s facing losses at $1 million per month for the next year due to changes in a federal program called 340B, and the layoffs are necessary to correct course, but workers say they believe the layoffs are part of a union-busting strategy and indicate a deeper crisis of trust with leadership.
“We do not see how we can sustain the level of workforce that we have today without putting the organization and our mission in jeopardy,” said CEO David Munar in an interview with the Reader.
In regards to the question of whether or not the organization is targeting union members, a representative from Howard Brown Health said in a written statement to the Reader that said,“The workforce reduction impacted a significant number of union-represented employees because the large majority of our administrative employees are represented by the union, not because we in any way intend to discourage union participation,” and that they “respect the right of our valued workforce to union representation and have been committed to recognizing their bargaining unit and negotiating a fair contract.”
The union that represents the workers being laid off, however, thinks otherwise. “It’s an opportunistic time,” said the Illinois Nurses Association staff attorney Matt Bartmes. “Essentially, they’ve known about the changes in the 340B pharmacy program, which they attribute as the cause of their budget issues. But they chose to use that as a justification to reduce forces, right as a newly formed union was starting to bargain their first contract.”
The wall-to-wall union was officially recognized by the National Labor Relations Board in August of 2022, and represents a variety of non-nursing roles from case managers to chiropractors, many of whom cited under-staffing and overwork as reasons for getting organized. Materials the union shared with its members in December state that the union had filed Unfair Labor Practice (ULP) charges with the NLRB alleging ten violations of labor laws, including targeting employees active in the union and refusing to bargain in good faith. Unfair Labor Practice charges are among the most serious ones a union can level at an employer, and are investigated by the NLRB’s general counsel.
Howard Brown is the largest nonprofit health clinic in the Midwest dedicated to serving low income LGBTQ patients. It made over $213 million in total revenue during their 2020-2021 fiscal year, and kept $30 million of that after expenses, according to the clinic’s latest financial data. Just eight years ago, the clinic made a fraction of that–keeping only $4 million after expenses.
The secret to its success, and now its financial and existential crisis, is a federal program called 340B. The program allows clinics and hospitals to buy prescription drugs at steep discounts from pharmaceutical companies, but still charge insurers the regular price. Clinics get to keep the change, which can range from a few extra dollars to over $20,000 for just one dose (in the case of some cancer treatments), depending on the drug and the patient’s insurance.
Clinics that serve the LGBTQ+ community made huge profits via 340B over the past several years thanks mostly to PrEp, or pre-exposure prophylaxis, a world-changing class of HIV-preventing drugs that work better than condoms at protecting people at high risk of acquiring HIV. The Center for Disease Control and Prevention (CDC) credits the drugs with helping drive the modest but not insubstantial eight percent decrease in estimated annual HIV transmissions in the US between 2015 and 2019.
Gilead Sciences, the maker of the original name-brand versions of PrEP, Descovy and Truvada, had provided huge cash reimbursements to clinics for uninsured patients that take the brand-name PrEP through a charity program called Advancing Access. But on January 1, 2022, Gilead drastically lowered the amount of those reimbursements.
Not only that, but Truvada went generic with nine different drugs in that class in October 2020, which made the drug more accessible to more people, but struck a blow to Federally Qualified Health Centers’ (FQHCs)’ pocket books. Generics fetch next to nothing compared to brand-name drugs under 340B.
Clinics used to be able to make upwards of $1,600 for just one 30-day supply for a single patient. And according to Munar, Howard Brown prescribes PrEP to around 4,000 patients across the city, many of them uninsured. The profit is considered “unrestricted funding”, so clinics are allowed to use the money for anything, as long as it benefits all patients, from clinical costs and lab tests, advertising, gender affirming care counselors, outreach workers, and other services.
Workers at Howard Brown say that the organization knew about this loss of revenue years in advance but did little to prepare. Munar told the Reader that leadership thought they “had more time to study our operating teams, but the 340B situation has expedited the need to do that.”
According to the workers, leadership chose to invest nearly $50 million into a new clinic on the north side at the expense of improving care for mostly poor, mostly Black patients who depend on the organization’s crumbling clinics on the south side, all while using the crisis as a cover for union busting.
The successes of PrEP have been uneven, and transmission rates for Black and Latinx populations nationwide, and especially on Chicago’s south side, are failing to plunge at the same rate as gay white men and white men who have sex with men.
New HIV diagnoses in Chicago rose by 2 percent in 2021 after years of decline. And while the highest rates of people living with HIV who engage in care live on the city’s north side, the neighborhoods with the highest incident rates of individuals newly diagnosed with HIV overwhelmingly live on the south side.
Although Howard Brown’s four clinics on the south side are smaller and have fewer staff than those on the north side, a third of the positions cut by leadership worked at the south side clinics. Cynthia McDonald, a case manager for people below the age of 26 living with HIV, worries what will happen to her clients now that she’s been laid off.
“I’m really afraid patients will fall out of care because I’m not there to help them navigate things,” she said.
McDonald’s position was funded in part by the Ryan White HIV/AIDS Program, a federal program that supports public institutions and non-profits with grant funding to provide HIV care and treatment. In a statement emailed to the Reader, a representative from Howard Brown said, “Howard Brown’s Ryan White HIV case management program has historically not been covered 100 percent by federal grant funds. By moving to 100 percent grant funding for Ryan White positions, the organization was able to reduce the group by 1 full-time position.”
McDonald thinks she was laid off for reasons other than financial. “I had up a sign that said, ‘Proud Union Home,’ and I have been outspoken in the past,” She said, adding that she’s attended every bargaining session between the union and management when they’re held on her days off. “Any person that has been honest about the malfeasance of management, specifically of the [Executive Leadership Team], have been placed on [the layoff] list,” she said.
Shakia Flowers feels the same way. Her position as a behavioral health consultant at the 63rd Street clinic in Englewood was also cut. She’s also on the union’s bargaining committee. Four members of the union’s 20-person bargaining committee were among those laid off, which she says is no coincidence.
“There are several members who have been laid off, myself included, who were elected by our peers to represent [them]. It’s our job to speak up for the 63rd Street Clinic. And [management’s] response is to lay me off,” Flowers said. “I was a very vocal person in terms of speaking out against the issues that people are facing at Howard Brown.”
Howard Brown’s profits have shot through the roof since becoming an Federally Qualified Health Center in 2016, which allowed the clinic to participate in the 340B program. According to their most recent tax data, a whopping 86 percent of their profits came from the program alone. Those massive windfalls allowed the organization to expand services to the city’s south and west sides by opening five new clinics and building a permanent new home for their youth center on the north side.
In a written statement to the Reader, a representative from Howard Brown said that they have used these profits to “invest in supporting programs that run at deficit, charity care for patients, infrastructure and technology improvements, site acquisition, clinic improvements, and capital planning,” meaning, the construction of a $50 million clinic on the north side.