Reflecting Democratic Principles in Healthcare: How H-CAP Advances Equity, Worker Power and Justice

The intersections of civic engagement, democracy, and worker power, choice, and autonomy are inextricably linked. 

Over the past four decades, the aggregate decline in worker power and organization has not only eroded workers’ standing in the economy but also fundamentally threatened democracy. More representative workplaces — where workers are empowered to exercise their voice — allow individuals more opportunities to develop and exercise civic skills. In turn, labor organizations represent workers’ interests internally within workplaces and externally in our communities. 

The healthcare sector is the largest employment field in the U.S and one of the most critical for our communities. Yet, too often, the people who care for us face systemic barriers: low wages, unsafe conditions, limited advancement, inequitable access to training, and are too frequently denied a voice in the workplace. 

At H-CAP, we believe the path to a stronger healthcare system and more representative workplaces begins with investing in workers’ voices, rights, and power.

Unionization as a Pathway to Democracy and Growth

Workers form unions not only for fair pay and benefits, but also for a meaningful voice at work and real career opportunities. Our Labor-Management Training Partnerships (LMTPs) strategically encourage unionization for workers who have been denied educational and training opportunities due to structural racism and situational or economic barriers to employment.

LMTPs are unique: they are mainly funded through collective bargaining, meaning workers are choosing to invest in themselves and their future by forming training organizations. By advocating for worker-centered training, unions are exercising democratic power in a way that strengthens individuals, employers, and the collective.

Through LMTPs, H-CAP and our partners create pathways for workers - especially BIPOC women and immigrants who have faced structural racism and economic exclusion. 

Embedding Democracy in the Workplace

LMTPs operate through joint governance, meaning that unions hold equal votes alongside employers, ensuring that worker voice is central to decision-making in matters such as program structures and policies. This stands in stark contrast with employer-controlled training organizations and many state and local workforce development boards, which are predominantly governed and led by employer representatives. 

Through these democratic structures, H-CAP supports over 222,000 workers each year in building skills, shaping policy, and influencing the future of healthcare and the workforce.

From Minnesota to the Nation: Advancing Standards and Policy

In Minnesota, unionized workers advanced a sectoral strategy that led to the creation of the Nursing Home Workforce Standards Board, which secured higher wages and premium pay for nursing home staff across the state. 

H-CAP is now collaborating with local unions to build a state-based LMTP—an example of how worker-centered training can elevate standards, expand equity, and shape public policy for the collective.

We are investing in long-term organizing infrastructure by developing democratic labor-management partnerships. With our partners, we support local and statewide coalitions, nurture new leadership among frontline workers, and collaborate with training institutions and policymakers to institutionalize equity. 

This infrastructure supports broader efforts to fight authoritarianism and economic injustice by strengthening democratic participation from the ground up.

The Time is Now to Build for the Future

The future of healthcare will be shaped not only in hospitals and clinics, but also among workers, union halls, training partnerships, and community coalitions. 

By embedding democratic principles into the very structure of workforce development, we are proving that when workers have a voice, the entire system benefits - including people receiving care, families, workers, employers, and communities alike. Now is the moment to invest in this model nationally and ensure the healthcare workforce of tomorrow is both equitable and just.