The National Labor Relations Act was enacted by Congress in 1935 as a means to govern labor- management relations for businesses engaged in interstate commerce. Under the provisions of the Act, health care professionals, who are employees are permitted to join and participate in a union. Health care professionals who are independent contractors are precluded from unionization. Under current law, health care professionals who contract with managed health care plans are generally considered independent contractors, and are therefore precluded from unionizing or otherwise joining together to negotiate terms related to their employment. Last year and this year, federal and state legislation have been introduced which would amend the definition of employee to permit health care professionals who are currently considered independent contractors to be defined as employees and to allow them to negotiate contract terms. In addition, legislation has been introduced which allows self employed physicians to negotiate jointly terms and conditions of their contract with health plans without fear of antitrust laws.

In 1999, Texas passed a bill which allows competing physicians within a health plan’s service area to meet and communicate for the purpose of jointly negotiating practices and procedures and other terms and conditions of their contracts with health benefits plans. In 2000, 20 states introduced similar legislation. Maryland and District of Columbia have passed legislation. ANA has concerns that some of these bills would allow physicians to collectively negotiate with health plans for contractual terms that would place non-physician providers at a great competitive disadvantage. ANA has opposed federal legislation because of our concerns about the impact this legislation would have on nurses - especially advance practice nurses.