Another major strike at Kaiser Permanente: What's at stake this time

About 31,000 Kaiser Permanente health care workers in California and Hawaii went on strike this week to protest deadlocked contract negotiations and what they said were unsafe staffing levels that put patients and staff at risk.

Their strike started at 7am on Tuesday and lasted until 7am on Sunday.

The striking workers are members of the United Nurses Association of California/Union of Healthcare Professionals (UNAC/UHCP). The union said it has been negotiating in good faith with Kaiser since May to try to address dangerous staffing levels and stagnant wages, but Kaiser has failed to provide adequate solutions.

Kaiser said it had been working with the union for months to reach a fair deal and called the strike “unnecessary and destructive.”

Dispute internal

Kaiser is one of the largest and most resourceful health systems in the United States. The company operates 40 hospitals and more than 600 medical offices in eight states and Washington, D.C., with more than 200,000 employees. It also operates a health plan with 12.6 million members.

Last year, the medical system had revenue of $115.8 billion and profits of nearly $13 billion. The company paid CEO Gregory Adams a salary of $15.6 million.

Kaiser's domestic and foreign investments total more than $100 billion, spanning fossil fuels, for-profit prisons, liquor companies, casinos and military weapons. In the past, union leaders have pointed to these investments as proof that Kaiser has ample resources to meet workers' needs but hasn't always chosen to prioritize those needs.

The health system is no stranger to labor divisions. Over the past five years it has faced multiple strikes organized by unions of nurses and other healthcare workers – mainly over staff shortages, working conditions and wages.

Kaiser is currently negotiating a contract with the Alliance of Healthcare Workers Union, a coalition of 23 unions representing approximately 60,000 Kaiser employees. UNAC/UHCP members are this week's strikers amid wider negotiations – other unions in the alliance are in various stages of negotiations and most are not yet on strike.

During those negotiations, Kaiser offered a 21.5 percent wage increase over four years, but UNAC/UHCP requested an “excessive wage increase” of 25 percent over the same period, the health system said.

“The seemingly small percentage difference between the two proposals is actually significant as it is multiplied across 60,000 employees and results in associated benefit increases over four years. The difference between the 21.5 percent and 25 percent increases adds approximately $300 million in annual wages at the end of the contract alone,” Kaiser said in a statement.

Kaiser currently pays $6.3 billion a year to employees of the Alliance of Health Care Unions. Its proposed raises would total $1.9 billion over four years, while UNAC/UHCP's request would add more than $2.2 billion.

The additional cost means further increases in rates for Kaiser members and patients, the health system said.

UNAC/UHCP has a different view than Kaiser.

“Kaiser's public messaging emphasizes '21.5 percent wage growth over four years,' but fails to mention years of wage freezes during record inflation, cuts to new union members, and the actual day-to-day impact of these conditions on patient care,” the group said in a statement.

The union also noted that Kaiser has raised insurance rates for years regardless of the status of its labor contracts, and argued that these increased rates were caused by underlying cost pressures within the health care system, such as skyrocketing drug prices and excessive denials of coverage.

Additionally, UNAC/UHCP highlighted the fact that Kaiser holds $66 billion in reserves, saying it “is competing for resources devoted to patient care, not Kaiser executives or corporate reserves.”

Union says it's not about money

UNAC/UHCP said it rejected Kaiser's false characterization of the dispute as one solely related to wages.

“Employers are spreading these messages – false narratives, lies – about why we are outside the hospital, outside the workplace, outside the clinic, when we should be inside. They're telling the public it's for the money, it's for the paycheck. That couldn't be further from the truth. It's about respect. It's about dignity. It's about ensuring high-quality patient care,” said Charmaine Morales, Kaiser nurse practitioner and president. UNAC/UHCP said Tuesday while speaking to a group of striking health care workers outside Kaiser Hospital in Baldwin Park, California.

She acknowledged that the strike was a personal sacrifice for employees and their families, given that Kaiser is not paying striking workers, but for her and others gathered outside the picket line, it was a necessary step to ensure a better future for health care workers.

Another employee, Cameron Cook, a nurse anesthetist at Kaiser Hospital in Redwood City, Calif., said he and other nurses in his department can no longer tolerate the stress chronic understaffing puts on themselves and their patients.

“We lost about 25% of our colleagues from the Kaiser system to other systems in the Bay Area. We are now seeing greater workloads and longer patient wait times. Two years ago, we formed the union to raise our voices in hopes of forcing Kaiser to address these issues. In response, they have been at the bargaining table for the past 18 months — stalling, stalling, essentially retaliating against us for organizing,” Cook said in a phone interview Wednesday morning. Wire.

He added that while the strike may disrupt patient care in the short term, it serves as a reminder to the public that patient care is already compromised and could worsen if staffing shortages are not addressed.

In his view, the strike was intended to push Kaiser to formally acknowledge staffing and patient care issues in its contract rather than make informal commitments.

“When there are gaps in care, patients suffer,” Cook said. “Maybe we leave a little more time to fix it, or maybe we'll come in extra tomorrow to help our colleagues. Kaiser took advantage of our compassion. They took advantage of our vigilance, and we just realized over the past two years that we couldn't continue to do more to get Kaiser public so that they could continue to hand out multimillion-dollar bonuses to executives.”

Post-pandemic labor tensions are worse than this

Gerald Friedman, a union expert and economics professor at the University of Massachusetts, noted that the strike fits into a broader trend of labor unrest among health care workers after the pandemic, driven largely by understaffing, burnout and unpaid administrative work.

Nurses and doctors face heavier workloads than ever before due to increasingly complex administrative requirements and a lack of staff, yet their wages have not kept pace with inflation. In the process, health system and payer executives are getting higher and higher salaries. All of this, Friedman explains, is a sure recipe for the labor movement.

He also noted that Kaiser's strike will have a slight direct financial impact on the health system.

“Healthcare generally has to be done in a timely manner. For building cars or something, before a strike, you need to stockpile, and after a strike, you speed things up and maybe work a little overtime. But in health care, if you don't take patients, they either don't get care or they go somewhere else,” Friedman said.

However, he noted that the financial impact would not be significant as the strike would only last five days. Friedman said short-term strikes like these won't hurt employers much, but they do show the severity of labor needs.

In his view, strikes like the one at Kaiser Permanente this week will continue to have ripple effects throughout the U.S. health care system.

“There’s a lot of turmoil bubbling beneath the surface,” he declared.

a signal, not a shutdown

To one former health system executive, the strike's brief duration suggested the union may be close to resolving the issue but hopes to show how serious it is about its demands from Kaiser and its members.

“What does that tell you when a union announces a five-day strike? I think it tells you that they're probably very close to solving the problem,” said Chris Olivia, a retired former executive at health systems including Bon Secours Mercy Health and Allegheny Health System.

Throughout his career, he has been on both sides of health care labor disputes—as a health system C-suite leader, physician, and former union member. He believes a new contract will be agreed upon within the next week or so.

Olivia noted that while short-term strikes like this week's tend to disrupt elective surgeries as resources are diverted to critically ill patients, hospitals can generally manage these operational impacts.

Kaiser has kept hospitals and medical offices open during the strike, though the company is moving some appointments to virtual care and rescheduling certain elective visits. The health system said it would recruit up to 7,600 temporary staff to work during the strike, most of whom had previously worked at Kaiser.

Olivia’s number one piece of advice for health system leaders entering into contract negotiations with workers is to be honest.

“One of the tactics I use is to be honest with union leadership about your financial situation. If you have the ability to increase wages, ultimately you want to show that you are a good trustee and steward of the hospital's assets. As a hospital leader, you ultimately have to take care of your employees,” he commented.

He stressed the importance of transparency and working with unions, including incorporating union input into some of the health system's leadership decisions, to maintain trust and achieve more equitable outcomes.

Overall, Olivia sees this week's strike at Kaiser as a cautious move designed to send a signal — one that reflects the larger struggle facing the entire U.S. health care system to retain employees and ensure safe, quality care.

Photo: UNAC/UHCP