HCA Made $6.8B in 2025. Its Janitors Choose Between Water and Gas.

The Math Is Not Complicated

Esther Reyes has worked as an environmental services technician at HCA-owned Las Palmas hospital in El Paso, Texas, for two years. She is a single mother of three. She makes $16.80 an hour. As The Guardian reports, she described her monthly budgeting process like this: "Sometimes I need to decide, maybe this month I pay the water bill, then another pay for gas, but most of the time I'm not able to pay for everything."

HCA Healthcare, the company she works for, reported $6.8 billion in profits in 2025. That is a 17.8% increase from the year before. CEO Sam Hazen took home more than $26.5 million in total compensation that same year, which works out to 420 times the median HCA employee compensation of $62,955. The woman cleaning the hospital rooms cannot consistently pay her water bill. The man running the company made $26.5 million. Just wanted to make sure those two facts were sitting next to each other.

The Service Employees International Union represents 22,000 of HCA's US workers, and those workers are now in contract negotiations with the company. Their demands are not outlandish: a pathway to a $25 minimum wage, raises that keep pace with inflation, paid sick time, vacation, and better workplace protections. You know, the basics that HCA's $6.8 billion in annual profits could theoretically accommodate.

Nurses Walking Away from Crying Parents in Hospital Hallways

The pay fight is the visible part. The staffing crisis is the part that should terrify you as a patient.

Jody Domineck is a pediatric nurse with over 20 years at HCA Sunrise hospital in Las Vegas, the largest hospital in Nevada, and she serves as secretary-treasurer of SEIU Local 1107. According to The Guardian, she described what chronic understaffing actually looks like in practice: "I personally have had to walk away from a parent when their child was having a procedure, and that parent was crying in the hallway alone. I had to walk away from them because I had to see my other patients, and those are the decisions nurses have to make when they have more and more patients."

That is not an abstraction about policy. That is a nurse, two decades into her career, describing the moment that broke her. She had to leave a crying parent alone in a hallway because the hospital didn't staff enough nurses to let her stay. HCA's response, delivered through a spokesperson, was essentially: the protests are really just about money, not patient safety, and everyone should go back to the bargaining table. Which would be a more convincing argument if the staffing situation were not, in fact, directly affecting patient safety.

Nevada's Governor Already Killed the Legislative Fix

Here is the kicker on the staffing issue. Nevada's Republican Governor Joe Lombardo vetoed a bill in 2025 that would have established safer nurse-to-patient ratios across the state, The Guardian reports. So the legislative avenue is closed. That is why SEIU members in Nevada are now trying to get ratio guarantees written directly into their union contract instead, since the state government decided the hospital industry's comfort mattered more than the ratio of nurses to patients in an ICU.

Picket protests are planned at over a dozen HCA hospitals across California, Texas, Nevada, and Florida. These are not fringe actors throwing a tantrum. These are 22,000 workers, in one of the most physically and emotionally demanding jobs that exists, asking a company swimming in cash to pay them enough to cover their bills and staff their floors safely enough that nurses don't have to choose which patient to abandon.

HCA's Response: We Value Every Team Member

The company's official response, as reported by The Guardian, came from a spokesperson commenting specifically on the Las Vegas negotiations: "At Sunrise Health System, we value every member of our team and remain committed to reaching a fair agreement through good-faith negotiations."

They value every member of the team. The team member making $16.80 an hour and choosing between utility bills. The team whose median compensation of $62,955 sits 420 pay multiples below the CEO. They are valued. They should feel very valued as they hold their picket signs outside hospitals from El Paso to Las Vegas.

HCA also clarified, somewhat pointedly, that the ongoing issues are about compensation and not patient safety. Which is a creative reframing, given that the workers are explicitly asking for staffing guarantees in the contract precisely because understaffing is creating patient safety problems. But sure. It's just about the money.