Kaiser health care workers launched the biggest such strike in US history earlier this month. Their contract agreement, announced late last week, shows the landmark strike secured big gains for workers and patients alike.

Striking Kaiser Permanente workers hold signs as they march in front of the Kaiser Permanente Vallejo Medical Center on October 6, 2023 in Vallejo, California. (Justin Sullivan / Getty Images)

Earlier this month the Coalition of Kaiser Permanente Unions staged a three-day unfair labor practice (ULP) strike in response to Kaiser’s unwillingness to seriously negotiate with the coalition in the months leading up to the contract’s expiration on September 30. The seventy-five-thousand-worker strike was the largest health care workers’ strike in US history, surpassing a strike of fifteen thousand Minnesota nurses in 2022.

By all accounts, the turnout for picket lines at Kaiser’s thirty-nine medical centers was very strong, and enthusiasm was high. Picket lines had DJs, people in costumes, drummers, and plentiful food, all of which contributed to a generally fun and energetic vibe that was only challenged by an early-fall heat wave. There were even other locals that struck in sympathy, such as Engineers and Scientists of California Local 20 members, who were very visible on the Kaiser picket lines last week despite having a contract expiration date later this month.

The coalition promised to strike again in November if progress wasn’t made in contract negotiations. Its show of force seems to have paid off. At 3:00 a.m. on Friday, October 13, the coalition reached an agreement with Kaiser that will have annual raises of 6 percent in the first year and 5 percent in the remaining three years of the four-year contract (resisting Kaiser’s goal of holding the coalition to the standard negotiated in other Kaiser contracts), a $1,500 ratification bonus, increased minimum wages for all Kaiser workers, preserved health care and other benefits (with improvements for retiree health care), and eliminated regional differences in wages (Kaiser wanted to increase regional differences).

Kaiser workers have lucrative performance bonuses that Kaiser wanted to reduce. The agreement preserves them. A portion of them will be tied to financial goals, but the union successfully tied a portion to aggregate patient outcomes — namely, lowering the blood pressure of Kaiser patients and vaccination rates. Dave Regan, the president of Service Employees International Union – United Healthcare Workers West (SEIU-UH), notes that the union is fine positioning itself in alignment with the common good as well as the good of coalition workers, in opposition to Kaiser’s emphasis on financial outcomes.

Importantly, Julie Su, the acting secretary of labor, flew to California for the final round of negotiations, which was agreed to after the coalition’s strike. Her role in achieving the settlement has been acknowledged by both the coalition and Kaiser. Coalition workers were very pleased that she came in talking about how she grew up as a Kaiser member in California and has a personal investment in the resolution of contract negotiations. Su played an active role, even in the all-night bargaining session that finally resulted in the agreement. One negotiating team member noted that “she was literally in the room with us, doing the work.”

The success of the strike appears to have caught Kaiser by surprise, prompting the company to quickly agree to a new round of contract negotiations. But Su’s presence, while perhaps not the decisive factor, was clearly appreciated by union members and leaders. It also suggests that Su, who began in her current role earlier this year, might be a better ally than the Biden administration was to the railroad workers in 2022.

As with the strikes that have hit Hollywood and the Big Three automakers (as well as the one that nearly hit UPS), inflation, the pandemic, and a tight labor market have all contributed to the circumstances around the Kaiser strike. The inequality that has been continuously growing through financial bubbles and waves of the pandemic is stressing workers, even those in relatively good jobs like unionized manufacturing and health care. Workers are clearly tired of bearing the brunt of bad managerial decisions, and of submitting to an institutional context that favors corporations and the wealthy over working people and their communities.

But all of these strikes also involve industry- and company-specific issues. Health care workers bore the brunt of the COVID-19 epidemic. Thousands died. Tens of thousands left the industry. Kaiser workers reported living in their garages or otherwise having to isolate for months from their families. The ones who remained have been stressed at work, due not just to the pandemic but also to widespread short staffing, which both undermines patient care and exhausts the workers who remain.

The contract addresses these issues in a number of ways. It increases shift differentials for the first time in thirty years, an outcome strongly desired by Kaiser workers that stabilizes the workforce. Kaiser has wanted to increase outsourcing and subcontracting to increase financial performance and deal with the staffing issues. In this round of negotiations they were targeting “revenue cycle” workers (people who deal with billing and reimbursement — a job that has become much more important and much more complicated). The coalition preserved the protections and expanded its own approach to dealing with staffing shortages: facilitating the training of new health care workers by funding tuition through Futuro Health and developing a readily available workforce through AlliedUP, a worker-owned and unionized staffing agency (which started in California but is now being expanded across Kaiser’s footprint). Funding for Futuro Health dropped by $20 million in this contract, but the last round of funding had not been fully spent anyway. Finally, the coalition agreed to limit some internal bidding rights that Kaiser felt were being abused and otherwise made organizing staffing more difficult than it needed to be.

Ethan Ruskin, who has been a health educator at Kaiser’s San Jose Medical Center for twenty-two years and who serves on UHW’s executive board, told Jacobin that Kaiser underestimated the coalition and its willingness to strike, something that seems pervasive in contract negotiations across industries this year. But for workers whose job is to help people, like teachers and health care workers, the decision is especially fraught. As Ruskin said, “People don’t go on strike for wage increases” — the stakes have to be much higher.

There has not been a major strike at Kaiser in decades, but that doesn’t mean workers have been content. Kaiser’s approach to the negotiations radically underestimated the degree of stress and anger that’s been intensifying among health care workers since the pandemic, as well as the level of organization achieved within the coalition.

In broader terms, financialization is having a big impact on health care delivery. Financial performance is more and more important to health care managers and executives. This process is impacting patient care, as health care operations are eyed more for their potential for financial extraction than whether they are meeting the needs of patients. Kaiser, a nonprofit health care provider with a distinctive integrated model that is organized to improve the overall health of its clients while keeping costs low, is consistently profitable. But increasingly those profits have been used to fund acquisitions outside of its footprint, venture capital investments, and a $56 billion unrestricted investment portfolio. The lauded labor-management partnership at Kaiser has been increasingly stressed, and Kaiser has been having difficulty sustaining its standing as one of the best health care employers in the country.

By resisting efforts to subcontract work, protecting small groups of workers that were targeted for outsourcing, and eliminating regional differences in pay, the new contract helps reestablish Kaiser as the leading health care employer. This will likely help to prevent other health systems from poaching Kaiser workers in moments of extreme short staffing, a drain that only makes remaining Kaiser workers’ jobs harder and increases incentives to leave.

Ruskin is most pleased that the coalition stood up against Kaiser’s efforts to divide the workforce, saying, “This matters because once again we stood for a small number of workers that were being targeted and didn’t trade them off for higher wages or something in negotiations.” Worker solidarity can be hard to maintain in moments of intense conflict with employers, but Kaiser workers stayed the course and stood up for that principle.

The Coalition of Kaiser Permanente Unions has now set the standard for Kaiser unions in contract negotiations — rivaled only by the California Nurses Association contract negotiated at the end of 2022 (though notably, nurses have considerably more power than any other bargaining unit in hospital labor relations). Given that Kaiser initially set out to hold the coalition to the standard of the contract negotiated by the other labor alliance, and specifically its wage increases of 3 percent in the first two years and 2 percent in the next two from 2021 to 2025, this was a significant victory that pushes back against the financialization of Kaiser and the deterioration of Kaiser labor relations since the heyday of the labor-management partnership.

The new contract is also a major victory for the union members who organized a successful strike across thirty-seven medical centers in several states. The organizing this required will be a resource that the coalition unions can continue to benefit from going forward. UHW members have since been on strike at Prime Healthcare as well, and have authorized a strike at Tenet’s California facilities, all while trying to negotiate several first contracts.

Ultimately, the financialization of health care will only be resisted by workers and patients. This strike and contract victory at one of the largest health care providers in the country can help point the way to better community well-being and a stronger labor movement.

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