Workers at Kaiser Permanente began a strike authorization vote on Aug. 26, with the Coalition of Kaiser Permanente Unions (CKPU) calling on the company to address unfair labor practices and unsafe staffing levels that leadership has failed to sufficiently address in contract negotiations.
The CKPU represents about 40% of health care workers at Kaiser Permanente facilities. In April, the CKPU began its national bargaining process on the first new contract since the start of the COVID-19 pandemic. A particular point of contention for workers is chronic understaffing, which they say has resulted in increased workloads and poorer quality of care for patients. Employees are also calling for a base wage of $25 per hour. If health care employees go on strike, dozens of Kaiser hospitals and clinics across the country could shut down.
“What’s important to me is making sure that we have safe staffing, proper staffing so that we can provide care to our patients appropriately and also livable wages,” said Audrey Loera, a fees and benefits support specialist at the Kaiser Permanente Tanasbourne Dental Office in Hillsboro, Oregon. “We want to have all of [our patients] be able to be seen within a timely manner and get the care they need.”
In an Aug. 24 online statement, Kaiser Permanente said, “While Kaiser Permanente has experienced the same pressures, through diligent work and an unwavering commitment to our people, we have weathered these staffing challenges better than most health care organizations. Kaiser Permanente’s average employee turnover rate of 8.5%, as of June 2023, is significantly lower than the rate of 21.4% across the health care industry.”
A vote to authorize a strike does not mean a strike will necessarily take place, but it puts significant pressure on Kaiser to offer workers a better deal. CKPU announced on Thursday that failure to address bad-faith bargaining grievances and the growing care crisis in a timely manner is likely to result in a strike. While workers say understaffing was an issue even before the pandemic, burnout in the health care industry has been exacerbated by poor working conditions, stagnant wages, and the toll the work takes on employee mental health.
The new contract is an opportunity to make compensatory gains for the people who are working through the traumatic years of COVID-19 and fight for the recruitment and retention of staff. Workers are concerned that current levels of understaffing create a high-risk environment for dangerously long wait times, mistaken diagnosis, and neglect.
Patients bear the highest risk from current staffing levels. In a May survey of 33,000 health care workers by Service Employees International Union-United Healthcare Workers West (SEIU-UHW), 74% of health care workers reported always, frequently, or sometimes lacking proper time to care for patients. Sixty-five percent of workers said they’d seen care delayed or denied due to short staffing.
Loera said her dental office sees about 150-200 patients per day and has suffered significantly from understaffing in recent months. The office often has to reschedule or divert patients to other Kaiser locations for care, she said, a significant inconvenience, especially given that Kaiser insurance holders are significantly restricted from receiving non-emergency care from non-Kaiser hospitals and clinics. Appointment delays also result in minor dental issues growing to require expensive and cumbersome procedures.
“We see it a lot where someone might have come in with a cavity … and we couldn’t get them in for eight months,” Loera said. “And so eight months later, that cavity has grown, and now they need a root canal or a crown, or worse, they need to have that tooth extracted when, had we seen them within a week or two, or worst-case scenario a month out, they would still have that tooth and fewer expenses.”
Short staffing can also negatively impact patients’ finances. According to Loera, there have been times when patients have received unexpected bills because someone couldn’t review their benefits with them. Elderly patients on the Kaiser Permanente Senior Advantage plan have expressed frustration to her that they pay high premiums for coverage only to be unable to get recommended appointments scheduled and take full advantage of their benefits, which do not roll over to the next year.
Loera has also experienced the harm of understaffing from the patient perspective. In May, she found out that her child needed urgent surgery to address difficulty swallowing, a life-threatening issue in cases of choking. She has been unable to get that appointment, with schedulers telling her that due to the staff shortage, they may need to wait six-to-nine more months even to get scheduled.
“It’s very difficult because I’m watching my son change his whole lifestyle right now and wondering, today, am I going to have to take him to the emergency room?” Loera said. “And is there going to be staff to see him? Are they going to get him scheduled? How much longer?”
Kaiser has reported making more than $3 billion in profit over the last six months despite being a nonprofit organization and benefiting from tax-exempt status. According to CKPU, 49 executives at Kaiser are compensated at more than $1 million annually, and Kaiser’s CEO was paid more than $16 million in 2021. Yet Kaiser’s initial offer for workers was a $21 minimum wage starting in 2026.
“We had folks come up and share their stories about how many hours they had to commute to get into work, two hours many times in Los Angeles either direction, to then work an eight-, 10-, 12-hour shift, providing care to you all, to drive home for another two hours because they cannot afford to live where they work,” said Caroline Lucas, executive director of CKPU, during a press conference on Thursday. “Kaiser listened to that story, and they told us it touched their heart, and then they told us our members were overpaid.”
Workers say negotiations have been hampered by a series of unfair labor practices related to bargaining in bad faith. During Thursday’s press conference, Dave Regan, the president of SEIU-UHW, said Kaiser has not provided the CKPU coalition with regional operating margins it can use to evaluate the impact of bargaining proposals and has attempted to reduce the size of the coalition’s bargaining team. In response, several unions representing Kaiser Permanente workers have filed charges of unfair labor practices with the National Labor Relations Board. Kaiser Permanente disputes the charges. Regan also said that Kaiser Permanente is recruiting strike breakers and offering wages three times what the incumbent workforce receives.
“We need to fix the health care staffing crisis in America, and we’re not going to fix it by taking a low-road approach to negotiating with the workforce that has been there through the pandemic and will continue to be there going forward,” Regan said.
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