by Kristen Hwang

More than 31,000 Kaiser Permanente health care workers remained on strike Monday as the open-ended walkout entered its fourth week, disrupting patient appointments, surgeries and treatments across California and Hawaii.

Bargaining teams for Kaiser and workers resumed negotiations after weeks of stalemate, but no agreement appears imminent. This is the latest of a number of major strikes to have roiled Kaiser in recent years, including a 10-week strike by mental health workers in 2022 and a 2023 dispute mediated by the then-U.S. Secretary of Labor.

The strike, which started Jan. 26, is an effort by one of the organization’s largest unions to improve wages and staffing conditions. Members of the United Nurses Associations of California/Union of Health Care Professionals have never before walked off the job. The union, which is an umbrella organization for multiple local chapters, represents nurses, physical therapists, midwives and other health professionals.

Workers accuse Kaiser of violating staffing agreements and worsening patient care — both of which the health care giant denies. They are demanding a 25 percent raise over four years, arguing the wage increase is needed to retain and recruit employees and account for the steep inflationary pressures of the past few years.

Kaiser contends its employees are on average the highest paid among other health care organizations. It has proposed a 21.5 percent increase over four years. In a statement, a Kaiser spokesperson said negotiations are happening while health care costs rise and millions of Americans are at risk of losing insurance.

“This underscores our responsibility to deliver fair, competitive pay for employees while protecting access and affordability for our members. We’re doing both,” the unsigned statement says.

According to the statement, Kaiser leadership believes it can afford the 21.5 percent wage increase without increasing member premiums, but it cannot make the same guarantee under the union’s proposal.

Union leaders have argued that Kaiser can afford across-the-board wage increases given its $66 billion in reserves. Kaiser posted a one-year loss of $4.5 billion in 2022. Since then, the health system has rebounded, posting net income of $12.9 billion in 2024 and $9.3 billion last year.

The company argues that it intends its reserves for long-term commitments and emergencies. In a statement the company said using reserves for payroll would be “financially irresponsible.” Kaiser’s wage proposal would cost about $2 billion, and the union’s would cost an additional $1 billion, according to the statement.

Inflation squeezes health workers

Joe Guzynski, executive director for the union, said its members last signed a contract with Kaiser in 2021 before inflation peaked around 8 percent in 2022. At the same time, some of the organization’s local units declined to bargain during the COVID-19 pandemic, believing it would be too disruptive, and refrained from seeking additional raises. The group’s latest contract expired in September last year.

Other major unions at Kaiser that signed contracts after 2022 received inflation-adjusted wage increases.

“What we’re asking for is the same deal. Everybody else got to deal with inflation,” Guzynski said. “It’s really about restoring fairness.”

The union is also speaking up for three groups of Northern California employees who recently formed unions and are bargaining for their first contracts: certified nurse midwives, certified registered nurse anesthetists and physician assistants.

Kaiser has proposed cutting retirement and medical benefits for these groups, freezing wages for current employees and cutting wages for new hires, said Brian Mason, lead negotiator for the nurse midwives. There are 157 nurse midwives in Northern California.

“The reality is we’re a few hundreds of thousands of dollars apart and that’s like being $10 apart for the common person,” Mason said of the nurse midwife contract. “It’s not a lot but they’re acting like we’re asking for billions and billions of dollars.”

Nurse midwives deliver 80 percent of vaginal births across Kaiser’s Northern California hospitals, said Emily Hardy, a certified nurse midwife at the Redwood City Medical Center. Their work results in fewer cesarean sections and maternal complications and improved patient satisfaction, she added. It’s also cheaper to use nurse midwives for low-risk births than it is to pay for doctors, who focus on complications and high-risk mothers.

Hardy, who has been a nurse for 15 years, said she has never gone on strike before and neither have many of her colleagues. Walking off the job was a “last resort” after two years of negotiations for the nurse midwives.

“It has felt very painful because you operated for so long under the assumption that your employer really valued your services and cared about the impacts you made for members,” Hardy said. “To hear ‘we want to lower retirement and keep wages stagnant’ does not tell me that you value (us).”

Patients report disruptions across the state

Patients on social media and in local news reports have described cancelled chemotherapy treatments, surgeries and other procedures. They’ve also posted images of pharmacy and laboratory lines snaking down hallways and out the door. Unionized nurses on strike, too, have reported getting recruitment texts from contractors seeking to backfill the staff positions.

Kaiser is the largest health provider in California, serving more than 9 million patients. It is also the largest private employer in the state. In a statement issued before the strike, the company said it had been “preparing contingency plans” for months to maintain access to care.

Cecilia Ochoa, 50, was unable to get a prescription filled at the Downey Medical Center last week. Ochoa, who had been recently hospitalized, said she was at home when she started to feel nauseous and weak several days ago. She went to the emergency room and received medication for nausea. Later, her lab results came back positive for a urinary tract infection.

Ochoa said she was vomiting and shaking when she tried to get antibiotics at the 24-hour pharmacy in Downey. The line was nearly 100 people long, she said, and almost reached the street. Ochoa tried another Kaiser pharmacy around the corner and waited an hour before a staff member came outside to tell everyone that the pharmacy would not fill any more prescriptions for the day. One man complained that he had been waiting in line for three hours just to check in.

“It was bad. It was so bad they were handing out snacks, water. People were there for so long,” Ochoa said.

She was born at Kaiser and has been a member her whole life, Ochoa said. Over the years it has gotten harder to see specialists and wait times for appointments are so long she has to schedule them months in advance. She’s supportive of the nurses and other workers striking, some of whom she has known for decades.

“I think somewhere they lost the whole thing. It’s not about the patient, it’s about the money,” Ochoa said. “I hope all of this ends as soon as possible for everybody.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.