Cross-Domain Policy Feedback: The Institutionalization of Collective Bargaining Rights for Health Care Workers

Abstract This article considers a significant but overlooked set of policy developments in the latter half of the twentieth century: the extension of collective bargaining rights to most health care workers, many of whom were formally excluded for three decades under the 1947 Taft-Hartley amendments. Drawing on primary sources including archival records, an exhaustive review of congressional testimony, and rulings from the quasijudicial agency governing private sector industrial relations, this article shows that health care workers did so in two interrelated processes. First, in coordination with the civil rights movement, workers mobilized and used both disruptive and legal social movement tactics. Second, in doing so they drew the state into and revealed its position in the collective bargaining process between workers and health institutions, facilitating what is conceptualized as cross-domain policy feedback. Cross-domain policy feedback occurs when a policy in one domain (e.g., public health spending) influences the politics of a policy in a seemingly separate one (e.g., labor and employment relations). Such effects, this article suggests, are likely to occur when a policy is relatively large in scale, implicates actors with a diverse set of interests, and offers significant ambiguity and discretion in its implementation. Empirically, this article is the first to chart the institutionalization of collective bargaining rights for health care workers, among the largest group of private sector employees in the postindustrial economy. It also offers a new theoretical and conceptual framework through which to study the ways by which public policies reshape political dynamics—an enduring research agenda for students of American politics and policy.