Even as the first few weeks of their strike against Kaiser Permanente last fall rolled by without movement on a new contract, mental health care professionals in Southern California remained guardedly optimistic.
Kaiser, after all, had already been through grueling labor negotiations with mental health care workers in Northern California and Hawaii in recent years, and in both cases the union-represented employees ultimately achieved substantial gains. Moreover, Kaiser has repeatedly been cited by California authorities for failing to adequately care for its mental health patients; it paid a record $50 million fine as part of a $200 million settlement with the state in 2023 that included promises to build out its lagging mental health care program.
Kaiser’s history of state reprimands on mental health care might suggest a more proactive approach to these negotiations. But this week, as the Southern California job action ground past its 100th day, there has been little progress. The union has said Kaiser has resisted movement on two key points: providing more preparation time for therapists, and providing them pensions.
And for many of the roughly 2,400 workers who initially went on strike, their initial optimism has given way to a darker reckoning: Their employer is trying to smoke them out.
“Of course that’s their strategy. They’re waiting for us to fold,” said Jade Rosado, a licensed clinical social worker at Kaiser’s Downey Medical Center and a member of the striking National Union of Healthcare Workers. “And it’s easier for them, right? They’re a multibillion-dollar organization, and we’re the labor. But we are united.”
Kaiser’s public comments about the negotiations have been strident and consistent. The health giant’s most recent update, emailed to Capital & Main by a spokesperson, reiterated long-established talking points that the union is exacerbating the problem by not accepting Kaiser’s terms.
“Our desire is to reach an agreement that provides fair wages and benefits to our valued NUHW-represented employees while protecting our members’ continued, timely access to high-quality and affordable mental health care,” Kaiser’s statement said. “Our strong offer, on the table since Oct. 25, 2024, does this and also provides protected time for activities such as planning, preparation, coordination, and administrative work.”
Kaiser is an absolute behemoth. The largest health care provider in California with 9.4 million members, the company has made billions in net revenue in recent years, and it has a cash reserve estimated at more than $50 billion.
Financially, at least, it can withstand an extended job action. Kaiser dragged out negotiations with Northern California mental health professionals for more than 10 weeks in 2022 before finally agreeing to substantial upgrades in wages, staffing and — critically — more time for therapists each week to work on patient issues outside of scheduled appointments.
The NUHW strike in Hawaii that same year went on for more than 170 days before a settlement was reached in 2023. Among the union workers’ achievements there was fighting off Kaiser’s attempt to eliminate pensions for new hires in mental health care.
Both of those issues, prep time and pensions, are at the heart of the Southern California stalemate. The union wants Kaiser to give its therapists the same seven hours per week outside of scheduled appointments that the company gave its Northern California workers — time that the workers say is crucial for them to update charts, answer patient questions and devise treatment plans, among other things.
The NUHW also wants Kaiser to provide pensions for mental health care workers. The company suspended that practice for such workers hired in Southern California after 2014, although it provides pensions for almost all other Kaiser employees.
Kaiser negotiators haven’t moved on the pension issue. As to prep time, one of the company’s proposals is to use creative accounting, suggesting that therapists can end each scheduled one-hour patient session at 50 minutes, which the company says meets standard of care practices, and use the extra 10 minutes for nonappointment duties. Kaiser says that could add five hours of time each week outside of therapy sessions.
“Before the strike, I would say that at most clinics, we were getting maybe four hours per week to do administrative tasks that were not patient-facing,” said Rosado, who has attended negotiating sessions. “But Kaiser was starting to encroach even on that time. Most people were down to two hours a week, which is ludicrous.”
There isn’t a clear path forward. Union representatives have already filed a number of complaints with the state, among them claims that Kaiser isn’t following its own plan for making sure mental health patients get the care they need during the strike. Kaiser, meanwhile, accuses the union of making misleading claims about patient access, adding, “Any member who needs an appointment is able to get one.”
State officials have said they’re watching Kaiser closely to be sure there’s no repeat of 2022, when the organization canceled more than 100,000 mental health care appointments during the Northern California strike. But the negotiations themselves, which were set to resume Thursday, will take as long as they take — and Kaiser, which has altered its offer only minimally since October, appears willing to wait.
“I’m still hopeful,” said Nancy Tomas, a medical social worker at a Kaiser clinic in Bellflower. “I’ve read the Northern California contract, and we’re not asking for anything new. But I’ve also been to the bargaining sessions and seen firsthand how Kaiser is acting. It’s not good.”
