Nurses at five Allina Health hospitals will vote Monday whether to authorize potential strikes or accept three-year contracts in a showdown over Allina's insistence that they give up their union-protected health insurance and move to their employer's standard benefits.

A "no" vote would empower negotiators with the Minnesota Nurses Association to set strikes at one or more of the hospitals — Abbott Northwestern and Phillips Eye Institute in Minneapolis, United in St. Paul, Mercy in Coon Rapids and Unity in Fridley.

Allina would receive a 10-day notice of the location and duration of any strike to hire and train temp nurses.

"It is our fervent desire not to have a strike at our facilities," said Christine Moore, Allina's senior vice president of human resources. "We don't think a strike benefits anybody."

The health system set the stage for such a possibility by pressing its 4,800 contract nurses to drop the option of union health plans — plans that are falling out of favor at many companies because of their high premiums but small or no deductibles — and presenting a final offer last week that would phase them out.

The laser focus on health plans has frustrated union negotiators and nurses, who as a result couldn't make traction on other issues such as nurse-to-patient staffing levels and safety in an era of increasing workplace assaults on nurses.

"They were adamant; unless we brought a proposal to transition off the MNA plans, all four of them, they didn't want to discuss any other proposals," said Angie Becchetti, a nurse on the bargaining committee.

In some ways, the negotiation distills 20 years of change in U.S. health care financing to a single vote.

Gradual shift in plans

The design of the MNA health insurance was more common in the 1980s and 1990s; two of them have bimonthly premiums of $72 to $116 for individuals, but no deductibles for in-network care and broad doctor networks. Over time, employers including Allina have moved toward the opposite — lower premiums, higher deductibles, and narrow doctor networks to cut costs.

Allina's Basic HSA would only cost $34 per paycheck for individual coverage, but the union nurses on that plan would face annual deductibles in excess of $3,000 before receiving any benefit (other than free preventive services such as cancer screens).

Some nurses would pay less under the Allina plans, and some would pay more, but all would receive financial incentives to be judicious in health care spending, Moore said.

Overall, however, Allina foresees savings if nurses make the switch. Union nurses use costly emergency department care 28 percent more than others covered by Allina plans, according to data provided by the health system, because the $40 copay in the most popular union plan offers little incentive to use cheaper retail or urgent care when appropriate. Moore said nurses are less likely to choose cheaper generic drugs, as well.

Allina expects savings of $10 million per year by switching nurses to its two cost-sharing plans, or a low-cost plan that pays only for care provided by its own hospitals and clinics.

Union officials worry that nurses will end up paying that $10 million — instead of a health system that nets revenue of $100 million to $300 million.

In a blog, the MNA's Mathew Keller, a nursing policy specialist, argued that nurses should receive richer health benefits, considering they suffer more on-the-job injuries than do construction workers.

Many require treatment but don't qualify for workers' compensation, he said. "Employers who are responsible for exposing nurses to such high rates of illness and injury have an obligation to provide reasonable health insurance," Keller said.

Union nurses in the Children's, Fairview and Health­East systems reached three-year deals earlier this year — keeping benefits unchanged.

Moore said nurses at competing hospitals have had more years to switch off the union plans on their own — so those health systems didn't have the same incentive as Allina to confront the problem.

Zero-deductible plans have been phasing out across many industries as veteran workers retire, and young healthy workers opt for plans with low premiums, Moore said, but Allina can't wait for that transition to happen organically.

"We really need to be good models of how best to consume health care in this modern context," she said, "and as such we need to get our nurses on our core health plans."

The last nursing strike in the Twin Cities involved 12,000 nurses from 14 hospitals and lasted one day in 2010. The union's core demand at the time called for hospitals to adopt nurse-to-patient staffing ratios to ensure adequate patient care and safety.

Nurses relented on the ratio demand when the hospitals sweetened their offer on pension and benefits and promised to engage them in discussions of staffing concerns.

Debate over staffing ratios moved to the Legislature by 2013, when the nurses and metro hospitals agreed on the latest contract (which expired June 1) with little acrimony.

Staffing shortages remain common, though, and threaten good patient care, Becchetti said. "We need to address the problem at hand for our patients."

Jeremy Olson • 612-673-7744