The Bill Stripping Your Nurse of Workers' Comp

Introduction

The nurse caring for you at a hospital has no guaranteed minimum wage, no workers' comp if she gets hurt, and no unemployment insurance if she gets cut, under a bill that Clipboard Health and ShiftKey lobbied into existence. Ohio H.B. 277 strips all four labor protections from healthcare workers at once. It's already been sent to the governor, and they're running the same play in 16 more states.

How a Single Bill Rewrites the Definition of "Employee"

Ohio H.B. 277 is a 114-page bill that amends seven existing sections of state code in one motion. Read the title and you can see the whole machine: it specifies "that a health care worker is not the employee of a health care worker platform or health care facility for purposes of specified laws under certain circumstances." The "certain circumstances" being, basically, the existence of an app.

The receipts here are unusually concrete because the bill names which laws it's gutting. Section 4111.14 is the Ohio constitutional minimum wage, and the bill adds a new exclusion saying gig healthcare workers are no longer "employed" for the purposes of the minimum wage. Section 4111.03 covers overtime; Section 4121.01 covers workers' compensation — each rewritten to exclude the same category of worker. Section 4141.01 covers unemployment compensation, with the new language stating bluntly: "'Employment' does not include service performed by a health care worker, with respect to a health care worker platform or health care facility for work booked through a health care worker platform." Two more sections (4123.01 and 5747.01) clean up the workers' comp definitions and state income tax treatment.

A 114-page bill that amends seven sections of state code in one motion is a coordinated legal rewrite dressed up as a labor-flexibility debate. Clipboard Health (valued at $1.3 billion) and ShiftKey (valued at $2 billion) have spent more than $1.1 million combined on federal lobbying since 2023 while running parallel campaigns in 17 statehouses. The Ohio version cleared both chambers. Georgia's H.B. 991 passed House committee on January 29, and the Pennsylvania, California, Missouri, and Wisconsin versions are at various stages of the same script: take Uber's 2019 California argument, swap "driver" for "nurse," tell legislators it's a technology question rather than a labor question, and let the trade group fly the lobbyists in.

The New York Tell

Here's the part that tells you the whole story. In 2025, New York passed S.B. 3355, which classified gig nursing platforms as healthcare staffing agencies, the legal status that comes with employer responsibilities under labor law. Three companies responded the same way: Clipboard Health, Nursa, and KARE shut down their New York operations entirely.

Sit with that for a second. These platforms publicly argue that they exist to solve a nursing shortage, that they bring labor flexibility to facilities, that they save costs, and that they're built around worker preferences for contractor status. New York didn't ban them and didn't cap their rates. The state simply said that if you dispatch nurses, you have to treat them as employees, like every other staffing agency. Rather than comply, three of the largest platforms walked away from the country's fourth-most-populous state.

Walking out of New York rather than payrolling the nurses tells you what the business model is actually selling: not a matching algorithm, but the gap between contractor costs and employee costs. Once a state forces them to absorb that gap, the math stops working. The $1.1 million in federal lobbying buys the right to keep that delta intact at scale.

What the Workers Actually Earn

The Roosevelt Institute interviewed 29 gig nurses and nursing assistants between November 2023 and September 2024 (15 RNs, 14 CNAs, 27 of them women, average age 33). Four of those 29 workers earned so little they qualified for Medicare or Medicaid. Workers bid against each other for shifts, and the lowest bidder wins, which the academic literature now calls "algorithmic wage discrimination."

STAT News reported on a CNA in rural Pennsylvania who took home less than $8/hour after roughly $7 in per-shift platform fees. Pennsylvania's minimum wage is $7.25/hour. Employed CNAs in the same state typically earn closer to $20/hour. The bid-auction model plus per-shift fees produces sub-minimum-wage take-home pay even before the Ohio bill formally exempts platforms from minimum wage law. One of the workers Roosevelt interviewed worked a shift while sick with COVID-19 because cancelling would have lowered her algorithmic rating.

ShiftMed's "reliability score" penalizes workers for cancelling shifts, arriving late, or leaving early — exactly the flexibility the platforms claim to offer. CareRev's "Smart Rates" use financial vulnerability signals, including payday loan data, to set the lowest acceptable per-shift rate, which academic researchers call "surveillance wages." The payday-loan input is the part that stuck with me — the system prices the discount based on how desperate it can detect you are.

The Coalition Doing the Lobbying

This is where the story goes one layer deeper than most coverage. The platforms aren't running 17 state lobbying campaigns alone. They're members of the Coalition for Workforce Innovation, a trade group launched in 2019 that explicitly seeks "broad adoption" of independent contractor status "across all positions, platforms, and industries."

The CWI's healthcare-platform members include CareRev, Nursa, KARE, MedCurate, Medely, and HealthBar. Its non-healthcare members include Amazon, Walmart, and Uber, alongside trucking, delivery, finance, and multi-level marketing companies. When Ohio H.B. 277 invents the new legal category of "health care worker platform," that template lands inside a coalition where Uber sits next to Clipboard Health and Amazon sits next to MedCurate. A healthcare carveout that holds up in court becomes the template the same coalition can drop into trucking, warehouse, and whatever's next on the contractor list.

The National Employment Law Project documents the coalition's four-part strategy: policy advocacy, legal challenges to worker-protective rules, "flexibility" messaging, and business organizing to normalize non-employee labor. The Ohio bill, the Georgia bill, and Colorado's 2022 platform-preemption law are synchronized outputs from one of the most coordinated employer-classification campaigns running in the United States, not separate state-level decisions that happen to look alike.

The Federal Backstop Is Also Coming Off

While the state-by-state rollback runs, the federal floor is dropping at the same time. On February 26, 2026, the Trump Department of Labor proposed rescinding the 2024 independent contractor rule under the Fair Labor Standards Act, replacing it with a two-factor analysis emphasizing "nature and degree of control" and "opportunity for profit or loss." That's the same legal framework that has historically allowed platforms to argue their workers are contractors.

State lobbying campaigns are easier when the federal classification rules are getting friendlier at the same time. Even where state law might still classify a worker as an employee, the federal FLSA floor is the backstop that catches misclassification claims like the $9.3 million Steadfast Medical Staffing ruling, about $5 million of which was unpaid overtime owed to roughly 1,100 nursing professionals the company had misclassified. With the federal rule on its way out and 17 state rewrites in flight, the legal apparatus that produced that ruling is being dismantled from both ends at once.

Who Benefits

Two parties capture the savings. The platforms avoid workers' compensation premiums (typically 3 to 8% of payroll for healthcare classifications, which is high-injury), unemployment insurance contributions, employer-side FICA (7.65%), overtime liability, and on-the-job injury exposure. ShiftKey operates in over 10,000 facilities. SSM Health alone filled 21,000 platform shifts in a single quarter. At that scale, the per-shift savings translate into tens of millions of dollars annually in avoided employer costs, and the bid-auction takes care of suppressing the gross labor cost on the way in.

Healthcare facilities capture the rest. ShiftMed claims 30 to 40% cost reduction versus travel nursing. A Colorado nursing home paid KARE Technologies $2.9 million annually in 2022; a Chicago hospital paid CareRev $2.7 million in 2023; the Kentucky VA pays ShiftKey $1 million annually. None of those numbers include benefits, workers' comp, or employment taxes, because the platforms have been built so the facility owes none of that on the labor.

The losers are the workers (no wage floor, no injury coverage, no unemployment safety net, and per-shift fees deducted from take-home pay), the patients (the Lien 2023 study links gig staffing to higher catheter use and medical errors), and the state insurance funds that lose employer contributions. The transfer is precise: about 11 to 16% of payroll moves from employers and public funds onto the backs of the lowest-paid workers in the room.

The Shortage Story Doesn't Survive the Numbers

Platforms justify all of this by gesturing at a nursing shortage. The numbers don't support that framing. The US currently has more than 5 million licensed registered nurses, an all-time high, along with 3.3 million currently employed, 1.4 million nursing assistants, and 187,000 open positions. HRSA's November 2024 ten-year projection shows 22 of 50 states with a registered nurse surplus by 2037, and the agency frames the gap as a working-conditions problem rather than an absolute supply problem.

Roosevelt's research found that 94% of nurses report moderate to severe understaffing, 73% of registered nurses report emotional drain multiple times weekly, and more than 100,000 RNs left the profession during COVID. Younger workers entered to make up the count, which is why the absolute headcount held even as the conditions broke. The platforms built a business on monetizing the broken conditions: lower wages, no benefits, surveillance ratings, per-shift fees pulled from the worker's pay, and on-the-job injuries paid out of pocket. That's a working-conditions crisis being sold back to facilities as a billable feature.

What Happens at the Governor's Desk

If Ohio's governor signs H.B. 277, the country has its first explicit statutory category, "health care worker platform," designed to live outside minimum wage, overtime, workers' comp, and unemployment law. Sixteen more state legislatures are watching to see what happens, and the federal independent contractor rule is being rescinded in parallel. The same coalition that includes Amazon and Uber gets a template it can apply to every other industry where the only thing standing between contractor reclassification and the employer's cost structure is a definition.

What's the legal definition of "employee" actually worth, if a billion-dollar app can lobby seven sections of state code into pretending it doesn't apply? Watch what happens at the Ohio governor's desk.