Like a lot of Oregonians who have battled serious health problems, Nicole Lewis is struggling to pay her medical bills.

In 2014, doctors diagnosed Lewis with stage II lymphoma. The chemotherapy to treat her cancer was debilitating, and Lewis, 29, missed work for eight months while undergoing treatment.

She had medical and short-term disability insurance through her employer, which replaced part of her normal paycheck while she was out. She was getting about $1,000 a month in disability payments and spending $890 of that on rent.

Lewis says the co-pays for her treatment overwhelmed her, and she's now facing collection notices for $3,600 she still owes.

The irony: The hospital coming to collect most of that money is also her employer.

Nicole Lewis
Nicole Lewis

For seven years, Lewis, 29, has been employed by and gotten insurance coverage through Legacy Health, one of the state's largest and most successful health care providers. She currently works in nutrition services at Legacy's Randall Children's Hospital in North Portland.

"I work in a hospital, and my insurance hardly covers anything—care or prescriptions," Lewis says. Although her cancer is in remission, she still needs regular check-ups. "I have to get scans every month, and every time, it's $500 out of my pocket," she adds.

Lewis' predicament is becoming more common. Although government figures show that a higher percentage of Oregonians have health insurance today than at any other time in decades, they increasingly face high deductibles, co-pays and other out-of-pocket payments.

And health care costs continue to rise faster than wages, leaving people like Lewis squeezed—even though she works for a hospital. Local and national studies have found that medical bills are a leading cause of personal bankruptcy, even for people with insurance. And the problem is now at the center of one of the state's largest labor disputes.

Since June, Legacy has been at the bargaining table with Service Employees International Union Local 49, which represents about 800 Legacy workers, including Lewis. The two sides are at an impasse. The existing contract between the two organizations expired June 30, and they agreed to federal mediation, taking place this week. Workers have already voted to authorize a two-day strike Nov. 8 and 9 if that mediation fails.

Although SEIU is seeking a pay increase for the certified nursing assistants, custodians and housekeepers that SEIU represents, Local 49 political director Felisa Hagins says the bigger concern for workers is the cost of their health care beyond what's covered by insurance. Employees such as Lewis must cover 20 percent of their treatment costs, which can be crippling.

The union also resents Legacy's purchase, for a reported $247 million, of PacificSource, a health care insurer, in October 2015. "One month, employees got an email celebrating the purchase," Hagins says. "The next month, they got an email telling them their insurance costs were going up."

Legacy spokesman Brian Terrett says the hospital believes its insurance plan is fair and competitive. "Our plan is as good or better than the plan SEIU offers its own employees," Terrett adds. "We feel like we're offering them a great program."

SEIU's Hagins says Terrett's comparison is wrong. "SEIU 49 has a fully paid family health care plan through Kaiser," she says, "that has $5 co-pays, $10 co-pays for specialty care and a $75 emergency-room charge if you don't get admitted."

Terrett says he cannot comment on the specifics of Lewis' case, but he says there's no reason for any employee to be in collections with Legacy, because the hospital offers charity care and payment plans based on a patient's ability to pay.

"One of the things we're trying to do is educate members of SEIU about ways to avoid collections," Terrett says. "We don't want any of our employees or anybody else to be in that situation."

More than 13,000 people work for Legacy, making it one of Oregon's largest employers.

Although it's organized as a nonprofit like nearly all Oregon hospital systems, Legacy earned $126 million in net income last year, according to its audited financials. And Legacy's CEO, Dr. George Brown, topped a recent Portland Business Journal list of the highest paid health care executives in the region. Brown's compensation was $2.3 million in 2016.

"There's clearly a disconnect between executive pay and the pay for these workers who are working to help people get well," Hagins says. "People making a million or big salaries can afford to pay 20 percent of the cost of their care. Low-paid workers cannot."

Hagins says Legacy is profiting by squeezing money out of lower-paid workers such as Lewis, who makes about $19 an hour (which translates to $38,000 a year).

Although Legacy and SEIU are battling at the bargaining table, they are also linking arms to defeat a hospital tax repeal headed for the January 2018 ballot.

Both the hospital and the union worry that if the tax repeal succeeds in January, it will cost Oregon between $840 million and $1.3 billion in health care funding, and 350,000 Medicaid recipients will lose coverage.

Meanwhile, Lewis is waiting to hear whether she'll be out on strike soon. She says no matter how the negotiations turn out, her experience with big deductibles and collection agents after years at Legacy has soured her on her employer.

"What happened to me is horrible," she says. "We [Legacy] own the insurance company, and they could give employees a better deal. It makes me want to look for another job."