The headlines tell the same story.

More than 11,000 Bay Area janitors protest rising health care costs. Two thousand San Joaquin County employees strike over a 30 percent premium hike. Nursing home workers in Fremont and Hayward walk out after losing all benefits. San Francisco Airport hotel van workers organize to seek health coverage.

In 2003, more than half of work stoppages in California have been over health care benefits. And who pays for rising premiums and co-pays is increasingly a sticking point in even routine labor negotiations, according to a report released by the Center for Labor Research and Education at the University of California, Berkeley.

“It’s the major issue and its coming up in all our negotiations,” said Sal Rosselli, president of SEIU 250, the largest health care worker union in Northern California, representing 85,000 employees.

Soaring health care costs mean employers are paying more to cover their workers—and often passing on those costs. State health insurance premiums went up by 13 percent in 2002, according to the Labor Center report, while workers’ annual contributions to family health care rose 32 percent.

“More and more of a worker’s compensation is going towards health care costs,” said Ken Jacobs, a labor specialist at UC Berkeley.

Dora Hernandez has been a certified nurse’s assistant at Park Central Rehabilitation Center in Fremont for 23 years. As a longtime employee with seniority, she paid nothing for her health care. That changed in July when the nursing home was sold to a new owner. Now, workers—who typically make $11 an hour—must pay $788 a month for their family’s health coverage, through Kaiser Permanente.

“That’s more than a whole paycheck,” Hernandez said. “Most of us will have to drop our health care.”

Hernandez and fellow workers will stage a 24-hour walkout on Labor Day in protest.

Labor groups argue that when workers like those at Park Central lose health benefits, everyone pays.

About 55 percent of people on Medi-Cal—the state-run health insurance for the poor—are working family members. Those Medi-Cal enrollees cost state taxpayers $2.8 billion a year, according to the Labor Center report.

Alleviating this taxpayer burden, labor groups contend, can be accomplished by requiring employers to provide health insurance.

This idea has gained traction in Sacramento. This week, legislators are expected to report out of conference committee a final bill mandating that employers provide health insurance or pay into a state pool that would purchase the insurance. Proponents of this “pay or play” bill include Senate President pro tem John Burton, D-San Francisco, and state Sen. Jackie Speier, D-San Mateo. Gov. Gray Davis has not yet taken a position on pay or play. Only one other state—Hawaii—requires employer-based coverage.

The California Chamber of Commerce opposes pay or play, saying it is just another reason for businesses to leave the state.

“Rather than swelling the ranks of the uninsured, mandated health insurance will swell the ranks of the unemployed,” said Richard Costigan, chamber vice president of government relations.

Labor groups said because the vast majority of businesses do provide health insurance, a mandate will simply level the playing field.

“As the bill is written now, employers with less than 25 workers are exempt and all employers get a tax write-off on health care,” said Jose Tengco, campaign media director for the California Labor Federation. “California will still be a good place to do business.”

While health care will likely continue to be a major factor in labor negotiations, not all organized workers are losing ground.

The California Nurses Association has won not only health care coverage for members, but also health benefits for retirees. The union recently negotiated retirement health benefits for 35,000 nurses—including those at many Bay Area hospitals, such as Kaiser Permanente, Eden Medical Center in Castro Valley and Washington Hospital in Fremont.

Membership to CNA has doubled over the past six years—now representing about 55,000 nurses—and a nursing short-age has given CNA leverage.

“For the most part, health care is something employers can’t take away from us,” said Liz Jacobs, spokeswoman for the CNA.