Howard Brown Health Labor Relations Updates

January 5, 2023:

Howard Brown Health has issued a statement on the conclusion of the union work stoppage. Following a three-day labor strike, Howard Brown recommits to working with union staff as they return to work and maintaining its high-quality services and program for patients and the communities it serves. To read the press release, click here.

Media Inquiries:
Wren O’Kelley, Communications Manager,, 872.269.3411


January 4, 2023:

Howard Brown Health has issued a statement in response to an incident that occurred this afternoon at the Brown Elephant Andersonville store. To read the press release, click here.

Media Inquiries:
Wren O’Kelley, Communications Manager,, 872.269.3411


January 2, 2023:

Howard Brown Health announces cost-saving measures to address FY23 revenue shortfall. A workforce reduction is a part of the action plan to strengthen the agency’s position. To read the press release, click here.

Media Inquiries:
Wren O’Kelley, Communications Manager,, 872.269.3411


December 30, 2022:

A Message from David Ernesto Munar, President and CEO

Dear Community,

On Wednesday, Howard Brown Health’s efforts to reach agreement with the union’s bargaining committee reached impasse, which means that Howard Brown and the union are in fundamental disagreement over the urgency of Howard Brown’s revenue shortfall and the need to respond swiftly. Unfortunately, Howard Brown will need to move forward with the proposed workforce reduction on January 3, 2023. This decision is legal and critical for the organization. We will do our absolute best to assist staff during this transition into future career endeavors.

As leadership works to close the $12 million revenue shortfall caused by changes to the 340B federally negotiated pharmacy program and the conclusion of COVID-funding, the organization is working to ensure all its vital healthcare services are available to our patients now and in the future. As the President and CEO, I take the ultimate responsibility for stabilizing our organization and offer my heartfelt commitment to our community to set things right.

During the months ahead we will continue to stabilize our budget, restore operations, and begin to mend labor relations. We are whole-heartedly committed to each of these priorities and will not waver as we move forward together. We are also taking stock of the conditions that led to our current revenue crisis so we may adopt measures to mitigate the risk of destabilization in the future and ensure the availability of our services for years to come.

Moving forward, we must continue to optimize our patient centered investments like our new patient portal and take advantage of all available revenue opportunities needed to close the financial gap this fiscal year. We must build trust with our constituents and with each other. And let us not forget to celebrate our commonalities and the achievements of our colleagues in meeting the needs of our diverse community.

On behalf of our tens of thousands of patients, thank you for your continued support of Howard Brown and our vital patient care.

In gratitude,
David Ernesto Munar

P.S. You can read more about the 340B program here, as well as Howard Brown’s track record on organized labor here.

Media Inquiries:
Wren O’Kelley, Communications Manager,, 872.269.3411


December 23, 2022

Today, Howard Brown Health staff members represented by the Illinois Nurses Association gave notice of their intent to strike commencing Tuesday, January 3, 2023, and ending at 11:59 p.m. on January 5, 2023. Howard Brown values our employees and respects the right of its workforce to strike.

Howard Brown will continue to provide patient care and services, regardless of the strike. In the event of a work stoppage by unionized employees, Howard Brown will implement a contingency plan that ensures all patient appointments are completed or rescheduled as soon as possible, while following all labor regulations.

Howard Brown remains committed to closing a revenue shortfall, minimizing the impact on employees at maintaining the high-quality services and programs. While painful, cost-saving measures will help ensure Howard Brown’s ability to serve patients and communities for decades to come.

The notice of intent to strike follows a series of proposals involving a reduction in Howard Brown’s workforce, including 60 union-represented positions. It is important to note that we are still in the middle of bargaining these proposals with the union with our next negotiation session set for December 28.

While difficult, Howard Brown believes that a workforce reduction is needed to help stem the agency’s losses of over $1 million each month. The losses stem from the unexpected cuts in in pharmacy revenue through the federally negotiated 340B pharmacy program supporting some Howard Brown services.  

The last proposal to the union by Howard Brown included 60 positions proposed for elimination on January 3, 2023. The proposed separation package for laid-off staff members includes two weeks of salary for staff with less than 2 years of employment and four weeks of pay for staff with over 3 or more completed years of employment. Under the proposal, both categories of staff would also receive health insurance and Employee Assistance Program benefits through the end of January. The Union has yet to respond to this last proposal, but has promised to do so no later than our December 28 bargaining session.

We thank our valued staff members in meeting patient needs as we work together towards any necessary changes to protect care for patients now and well into the future.


December 17, 2022

Please see our Frequently Asked Questions (FAQs) on the 2022 revenue shortfall for more information.

There’s a few different numbers referencing the deficit Howard Brown is facing.  What’s the actual deficit?

Through November 30, 2022, Howard Brown experienced a deficit of $5.2 million and is experiencing more than $1 million in losses each month. If not addressed immediately, Howard Brown will have a +$12 million deficit through the end of the fiscal year (June 30, 2023).

The financial imbalance will destabilize the organization and threaten patient care if not addressed immediately. 

How have other community health centers who rely on 340B dealt with the funding shortage?

Other FQHCs have been dealing with similar but not identical revenue shortfalls.  Howard Brown’s 340B program relies on Truvada, which recently went to generic formulary, and antiretroviral medications. As one of the top 20 340B programs in the nation, 340B has played a greater role in our overall trajectory, covering operational expenses.

How has Howard Brown advocated against changes in the 340B program?

Howard Brown has been actively working since 2020 to stop changes in the 340B program with a coalition of organizations led by the National Association of Community Health Centers (NACHC). Under the leadership of Director of Advocacy, Tim Wang, Howard Brown will continue to advocate for this critical funding not just for our agency, but for all FQHCs across the country. Howard Brown has held briefings for government agencies and elected officials, pushed for enforcement against pharma, advocated for the passage of federal and state legislation that supports 340B, etc.

Are there ways that our community members can advocate around 340B?

Yes. and are helpful tools for identifying what you as an individual can do. Howard Brown will continue to notify its community of opportunities to advocate around 340B through its advocacy blog, newsletter, emails, and social media.

If Howard Brown received donations to help fill the gap, would that help solve the revenue shortfall?

Howard Brown has shared the revenue shortfall with its community including donors. Philanthropy should not be used to address an ongoing structural change in operating revenue, which requires improving and enhancing the overall operations of the organization. 

Why is Howard Brown decreasing the size of the behavioral health department? How will it increase access to services by decreasing staff numbers?

Under a model that centralizes care teams within clinics, Howard Brown expects to be able to better serve its community. Across all departments, including Behavioral Health, we have identified issues with siloing services that create patient confusion and inefficiency in the delivery of care. We are choosing to simplify and improve workflows. By improving operations, we will be able to see more patients.

The agency is cross-training staff to eliminate siloes, building in patient assessments, and ensuring that there are staff within the care teams across clinical sites. The challenge of small teams with a singular specialty is that schedules are restricted, sites lack equitable access to personnel, and patients lack access to care.

Why is Howard Brown building a large clinic on Halsted even after knowing about revenue gap? How will Howard Brown expand services at the new building on Cornelia if it is cutting staff?

Howard Brown has been planning the development of new clinics for more than five years, and is contractually obligated to finish the Halsted building. The completion of the building will create expanded revenue and increase access to HIV-specialty care.

Opening the new building will afford Howard Brown the chance to reach new patients with primary care, dental care, and other services – new visits that will help the agency financially through billing revenue and pharmacy revenue and help better express the agency’s mission. 

Additionally, the new site’s primary care practice will take physicians from Sheridan and Halsted and move their panels, as well as the staff associated with those care teams, into the new building. The agency also plans to slowly grow into the space, opening the second floor first, and eventually adding the third floor of primary care services.

Is the Executive Leadership Team taking a paycut? 

ELT is taking a net 6% reduction in pay effective December 1, 2022. As with staff across the agency, competitive compensation is important to retain staff and ensure expertise in leading the agency. Howard Brown will continue to pay its leadership at a rate comparable to similar work in similar size organizations. The leadership team has set a goal to achieve 25 – 30% of the cost-saving goal from administrative allocations. 

Howard Brown Health staff expanded as a response to the COVID-19 pandemic. What was the plan to make these staffing numbers sustainable?  

 In 2020 during the COVID-19 pandemic, Howard Brown made a choice to grow our staff to serve our community.  We were among the most responsive community health centers supporting the public health in the city. The agency also made an effort to keep every staff person on payroll in a time where so much was unknown. We are incredibly fortunate that we have not had to make cuts until now.  

While we were aware of 340B changing, we could not predict the speed and scale of the changes. Thanks to our dynamic 340B operations and compliance team, Howard Brown’s 340B program has grown to one of the top 20 in the nation which has allowed for sustainability of the agency over the last ten years. 

Howard Brown did not begin seeing major shifts in 340B revenue until new restrictions were put in place in Summer of 2022. Additionally, the introduction of generic Truvada (PrEP) has created pricing instability and unpredictability for the past two years for both name brand and generic PrEP products. 

In 2019, we reported seeing 30,013 patients across our network of clinics and had 428 staff. In 2020, while in the heart of the pandemic, we saw 27,336 patients with 507 staff. In 2021, Howard Brown returned its patient numbers to pre-pandemic levels seeing 30,430 patients with 617 staff. In 2022, the agency has more than 720 staff and has seen approximately 31,310 patients. We share these data points, which can be accessed via a nationally recognized annual reporting database called the Uniform Data System, to create a shared understanding of the growth the agency experienced in serving the community during two public health crises, the COVID-19 pandemic and the MPV outbreak.   


December 16, 2022

A message from Chef Fresh Roberson, Board Chair

Dear Howard Brown Community,                                            

For nearly 50 years, Howard Brown has saved and changed lives, including my own. As a patient for nearly 20 years and more recently as Board Chair, I am committed to Howard Brown continuing to save lives for another 50 years into the future. Under my leadership, the entire Board is dedicated to making sure our vital organization takes important steps to secure our organization’s future. 

Howard Brown continues to face a $12 million revenue shortfall from 340B pharmacy revenue. This is a critical moment in our organization’s history. In this moment, the commitment from every corner of our organization, from the Brown Elephant to our care teams to our Board of Directors, will help us succeed.  To be successful, we must prioritize our patients and clients as we examine our clinical operations, agency goals and initiatives, strategic plan, and much more.   

We will be making significant changes to protect patient care as we address the revenue shortfall.  These changes will create uncertainties and stress, especially for Howard Brown’s committed  staff. I don’t take this lightly. And with every tough choice, we get closer to the goals: securing Howard Brown’s ability to meet the needs of our patients now and well into the future; better operations for a more fulfilling patient experience; and healthcare that is affirming and culturally competent. Those goals are only possible with our dedicated staff. 

We employed a record number of people in 2020 and 2021, quickly adding over 200 new positions to help with COVID-19 health education, outreach, testing partnerships, vaccination events, enhanced infectious control measures, telehealth, mobile services, contact tracing, and other services. I am proud of what we accomplished during that unprecedented time. We have been reluctant to reduce our staffing levels in case another public health emergency should occur.  Changes in 340B pharmacy revenue—and an end to federal COVID relief funding—have sadly left us with very tough choices.   

Making these difficult adjustments is urgent.  With losses exceeding $1 million per month, inaction now will shortchange our shared future. Adjusting to smaller teams—and saying goodbye to trusted co-workers—will impact the entire organization and be extremely challenging.  The affirming care our staff provide our patients is vital, and we’ll work together to continue to support our communities in every way we can. By supporting our care teams and leaning into patient-care as a driver of our entire agency operations, we will make Howard Brown stronger.  Comparable data from peer organizations shows that we can.  

Thank you for the care, concern, and generosity you have shown for Howard Brown’s mission to affirming and culturally competent healthcare. 

Chef Fresh 

PS: You can learn more about the 340B pharmacy program here.    


December 14, 2022:

Vote on Authorization to Strike

The union is publicizing that it is calling for a strike authorization vote. To strike is our staff’s right, and Howard Brown Health will respect that right. Howard Brown has a commitment to bargaining in good faith, and to keep patients and the community up-to-date.


December 7, 2022:

A Message from David Ernesto Munar, President and CEO

Dear Community,

I am writing today to share an update on Howard Brown Health as it navigates a challenging time. Across the country, LGBTQ+ and HIV-serving healthcare organizations like Howard Brown are navigating significant shifts in pharmacy revenue that now allow pharmaceutical companies to keep a greater share of federally negotiated savings through the 340B pharmacy revenue program.

A message from David Ernesto Munar, President and CEO of Howard Brown Health

Much like our sister organization Fenway Community Health Center in Boston, and other FQHCs across the country, we are feeling the pressure of changes with pharmacy revenues. Over the last ten years, this funding supported program expansion, personnel, and operations. With federal funding for COVID-related services ending, we are work toward lowering our operating expenses and enhancing our earned revenue.

Right now, we are facing a $12 million revenue shortfall which we are taking urgent measures to address.

Howard Brown’s leadership is exploring multiple mechanisms to help close the revenue gap, of which 75% is sought from non-personnel cost-cutting measures. This includes strategies to boost revenue generated from medical visits and other efficiencies such as the implementation of a new electronic medical record. Our urgent plan to close the revenue gap will not impact Howard Brown’s commitment to quality, culturally compassionate healthcare, and Howard Brown has no intention of eliminating services.

While a reduction in workforce is required to close the revenue gap, no positions will be let go until after Jan. 1, 2023. We are working collaboratively with leaders across the agency and our union to advance compassionate plans for departing employees and continuity plans to reset teams for success in meeting patient needs. In all cases where changes may impact union members, Howard Brown will bargain with the union first and in good faith.  

Howard Brown will continue to address financial challenges with integrity. We pledge to show our values in a plan that is thoughtful and respectful– keeping our patients and mission at the forefront.

While we face new challenges, our commitment to serving our patients and clients is unwavering. We are confident that we can emerge from this challenge stronger than before and in a way that ensures our communities will be able to count on us in the next 50 years and beyond.

In gratitude and respect,

David Ernesto Munar

President and CEO

For more information, see our previously published statements about the ongoing work to address the fiscal crisis:

Press statement – Saturday, December 3, 2022

Blog post – Wednesday, November 23, 2022

340B Information and Advocacy Blog Post – September 28, 2022


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