That's the whole point. Big institutions can decide that certain job roles shouldn't have access to benefits. Then, it's trivial to outsource those roles. This

That's the whole point. Big institutions can decide that certain job roles shouldn't have access to benefits. Then, it's trivial to outsource those roles. This commonly happens for low-status job roles like janitorial, facilities maintenance, groundskeepers, and building security. JH may be relatively unique in being a 100% employee shop, but it would definitely be a case of the exception proving the rule. *Edit -- it looks like JH has a history of fairly high-profile labor conflicts. If they are 100% employees, I would bet their history is a factor in why they are this way now.