The fight over the Employee Free Choice Act, a.k.a. “card check” legislation, is just heating up in Washington. This has been the focal point of labor-policy discussions recently. Notably less attention has been paid to the role that unions are playing in shaping Obama’s ambitious health-care agenda.

In the long run, health care could prove to be a more important issue for unions than card check, according to Roger King, a veteran labor lawyer who has worked for a slew of major business interests, including General Motors and various health-care companies. “The unions’ interest in health-care reform is more than just health-care reform; obviously, they’re in the business of organizing workers,” King told National Review Online. “The more federal control, the more governmental control, the easier it is to put pressure on employers either not to resist unionization or, if you’re already unionized, not to be difficult at the bargaining table.”

There have been a number of specific developments in the last few weeks that suggest the unions will be playing a major role on the issue. But for the time being, there are more questions than answers about exactly what that role will be.

Two weeks ago, the American Federation of State, County, and Municipal Employees (AFSCME) and the Service Employees International Union (SEIU) pulled out of a health-care-reform dialogue that had been set up by the White House. The Obama administration had brought together some 20 different groups from across the health-care industry to try to forge some consensus on how reform should be pursued. Why the unions pulled out of the closed-door meetings is still unknown.

The episode does, however, illustrate the difficulties of finding common ground in health care. Insurers and many employers remain firmly opposed to Democratic plans, backed by liberal interest groups, to provide insurance through the government in addition to requiring employers to help foot the bill for health insurance.

Where the unions, particularly the politically savvy SEIU, fit into this debate is hard to tell. “The SEIU and other unions are at varying positions on whether a universal-health-care, single-payer system is desirable,” King said. He added that while it seems easy to look at the walkout and guess that the business community is at loggerheads with the unions, it’s not so simple. “[SEIU head] Andy Stern has been more aligned from time to time with the business community than have some of the other trade unions,” he observed.

What specifically they want out of health-care-reform legislation is hard to tell. There is some reason to believe that unions aren’t necessarily invested in pursuing a radical approach to health care. New Jersey Democratic congressman Rob Andrews, the chairman of the House Subcommittee on Health, Employment, Labor, and Pensions, is known to be very close to the union movement. So far, Andrews seems to be in favor of disrupting the employer-based health-care system as little as possible.

On March 10, Andrews initiated the first of a series of subcommittee hearings on “Strengthening Employer-Based Health Care.” While Andrews is concerned about employers shifting health-care costs onto employees, his first hearing was set up to explore ways for the government to provide incentives to encourage employers not to drop out of health-care purchasing pools as costs rise, which would reduce purchasing power for all. In his opening statement at the hearing, Andrews said, “I believe that an all-employer-participation component is an essential element to health-care reform.” He added that, compared to many of the reform options on the table, encouraging employer health-care pools “is seen as the less disruptive method to reforming our health-care system.”

While few would dispute that unions are still trying to push health care to the left, there may be some recognition within the union movement that they will do better by concentrating their efforts on what is politically attainable right now. Meanwhile, the president has made it clear that while he is especially committed to health-care reform, the disastrous economic situation is making expensive reforms less and less feasible. If a major union push were responsible for helping pass health-care reform, not only would it be a win for the unions, but the president might feel deeply indebted. Even indebted enough to support passage of the politically radioactive card-check legislation.

Indeed, late last week the Washington Post reported that the SEIU had spent so much money first on supporting Obama’s election campaign and now on furthering his ambitious agenda that it was having to take controversial cost-cutting measures. According to the Post, the SEIU is laying off 75 union organizers and replacing them with private contractors, an act that Malcolm Harris of the Union of Union Representatives, the union that represents the SEIU’s own workers, called “completely hypocritical.” In a move so recursive it is almost hard to fathom, the Union of Union Representatives has filed a complaint with the National Labor Relations Board against its union employer.

Then over the weekend, Washington Post columnist Ruth Marcus opined that “it’s crunch time for health-care reform.” She quoted Republican senator Charles Grassley as saying, “If [health-care reform] isn’t done this year, it won’t be done for the next four years.” If the president needs his union supporters to pull out all the stops, it would seem that now is the time for him to call on them.

“If the president wants that to happen I think that will happen,” King said. “If the union movement wants him to get particularly active on additional labor legislation, including the Employee Free Choice Act or other initiatives, he’ll make it clear that they need to do some things for him.”

One problem from the Left’s perspective is that the unions are rife with power struggles and infighting just now, and, even for the president, getting them to unite for a common cause could prove difficult. This is especially true of the SEIU, the most politically powerful union in the country, which appears to be taking the lead on both card check and health-care reform. The SEIU and Andy Stern are embattled to an almost unprecedented degree — both within the union and in regard to its relationship with other politically powerful unions, particularly as a result of the SEIU’s 2005 decision to pull out of the AFL-CIO. However, just last week the SEIU resolved one of its longest-running and most acrimonious disputes when it ended its turf war with the California Nurses Association. Stern could be making an effort to get his ducks in a row in order to focus on the legislative fights ahead.

Whatever happens to health-care reform moving forward, it’s clear that unions are going to play an important role. For opponents of big labor, a disproportionate focus on stopping card-check legislation could mean they will be caught flat-footed when the unions advance their agenda on the health-care and other fronts.

– Mark Hemingway is an NRO staff reporter.