Safety-net CEOs face tough choices amid rising labor costs

One Brooklyn Health CEO Sandra Scott discusses navigating financial pressures and labor negotiations to sustain operations.

Published on Feb. 19, 2026

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One Brooklyn Health, a safety-net health system in New York City, recently had to cut over 50 non-clinical administrative roles, including leadership positions, as part of a broader realignment to ensure long-term financial sustainability. CEO Sandra Scott says the system faces challenges from rising labor costs, federal revenue cuts, and a patient population heavily reliant on Medicaid and Medicare. Amid contract negotiations with the nurses' union, Scott says transparency and collaboration are key to balancing fair wages and benefits with the system's financial constraints.

Why it matters

Safety-net hospitals like One Brooklyn Health serve vulnerable populations and often operate with negative margins, requiring subsidies to balance their budgets. Navigating rising labor costs and federal policy changes that threaten to reduce hospital revenue is critical for these institutions to remain viable and continue providing care to their communities.

The details

One Brooklyn Health, formed in 2016, serves mostly Medicaid and Medicare patients across its three medical centers and affiliated facilities. CEO Sandra Scott says changes introduced by the One Big Beautiful Bill Act to premium subsidies and Medicaid eligibility are projected to reduce hospital revenue across the U.S. by $68.5 billion in 2026 and 2027, with New York losing $4.3 billion. Compounding this, supply and workforce costs are rising, with labor expenses up 5% year-over-year across the U.S. In January, One Brooklyn Health's nurses had delivered strike notices, and the system had to cut over 50 non-clinical administrative roles to ensure financial stability. Scott says transparency and collaboration with labor partners are key to navigating these challenges.

  • In January 2026, One Brooklyn Health's nurses delivered strike notices.
  • In February 2026, One Brooklyn Health cut over 50 non-clinical administrative roles, including leadership positions.
  • The One Big Beautiful Bill Act is projected to reduce hospital revenue across the U.S. by $68.5 billion in 2026 and 2027, with New York losing $4.3 billion.

The players

One Brooklyn Health

A safety-net health system in New York City, formed in 2016, that serves mostly Medicaid and Medicare patients across its three medical centers and affiliated facilities.

Sandra Scott, MD

The CEO of One Brooklyn Health since January 2024.

New York State Nurses Association (NYSNA)

The largest nurses union in New York state, which delivered 10-day strike notices to 12 hospitals in January 2026.

Nancy Hagans, BSN, RN

The president of the New York State Nurses Association.

Ari Moma

The lead of One Brooklyn Health's negotiating team.

Vivienne Phillips, RN

A member of One Brooklyn Health's negotiating team.

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What they’re saying

“Some of the provisions in HR-1 — particularly in New York state — threaten to limit the number of people that have access to healthcare, and that means our uncompensated care is likely to go up.”

— Sandra Scott, MD, CEO, One Brooklyn Health (Becker's Hospital Review)

“The safety-net hospitals that care for New York City's most vulnerable patients are doing the right thing by guaranteeing healthcare benefits for nurses and agreeing to stronger safe staffing standards and protections from workplace violence.”

— Nancy Hagans, BSN, RN, President, New York State Nurses Association (Becker's Hospital Review)

“We really worked hard to be collaborative in our negotiations, and that kind of work must continue at all institutions so that we can avoid more contentious negotiations in the future.”

— Sandra Scott, MD, CEO, One Brooklyn Health (Becker's Hospital Review)

What’s next

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The takeaway

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