text: While 1199 has done well by its membersboosting their pay, benefits, and job securityit imposes diffuse costs on the public. The union's vested interest in elevated levels of government health-care spending has had negative policy consequences over the years, particularly with respect to Medicaid, which supports, on average, one-third of the annual revenues at the five largest medical centers in New York City, all of which employ 1199 members. (Another third, on average, comes from Medicare.) According to the Kaiser Family Foundation, New York State spent $54 billion on Medicaid in 2013, more than one-third of the state budget and the second-highest amount among the states (after California, which has nearly twice as many people).