In 1974, Congress again amended the NLRA to extend its coverage to non-profit hospitals and establish some special procedures covering collective bargaining in the health-care industry.84 In addition, Congress broadened the term "health-care institutions" to include "any hospital, convalescent hospital, health maintenance organization, health clinic, nursing home, extended care facility, or other institution devoted to the care of sick, infirm or aged persons." The effect of these amendments was to bring both profit and non-profit hospitals as well as most other health-care institutions under coverage of the NLRA.

The 1974 Health Care Amendments created a religious freedom exemption for health-care workers. Under the exemption, any health-care industry employee who has religious objections to joining a labor union can neither be required to join nor to financially support a union as a condition of employment. The exemption was a political concession made to large health-care providers operated by religious institutions such as Seventh Day Adventists to secure their approval of the bill.

Under Section 19 of the 1974 Health Care Amendments, an employee "who is a member of and adheres to established and traditional tenets or teachings of a bona fide religion, body, or sect which has historically held conscientious objections to joining or financially supporting labor organizations" is exempt from any union dues obligations. But he or she may be required to pay the equivalent of union dues and fees to one of three non-religious charitable organizations listed in the collective-bargaining contract.

Section 19 does not supersede Section 701(j) of the Civil Rights Act of 1964, discussed in Part I (under which employers must "accommodate" their employees' religious practices, observances, and beliefs absent a showing that such accommodation would impose "undue hardship" on the conduct of the business). Employees are free to pursue their remedies under both statutes.85

It is important to note that the NLRA makes a distinction between being a member of a bone fide religion, body, or sect that holds conscientious objections to unions, in which case one can claim the religious exemption, and simply having sincere religious objections to joining or supporting unions.86