Update: After this post was published, Capital & Main learned that officials with Kaiser Permanente have agreed to mediation in their longstanding negotiation with the National Union of Healthcare Workers. The first session is scheduled for March 10.
Now in their fifth month off the job, striking mental health care workers from Los Angeles to San Diego appear to be little closer to a Southern California contract settlement with Kaiser Permanente than when they began.
After a fruitless Presidents’ Day negotiation, Kaiser officials refused to schedule a new bargaining session with the workers’ union until March 6, union negotiators say. Kaiser spokesperson Terry Kanakri, meanwhile, confirmed to Capital & Main that the health giant declined Gov. Gavin Newsom’s Feb. 6 request that the sides enter mediation — the same process that settled a much shorter, 10-week strike in 2022 by Kaiser’s mental health care workers in Northern California.
Kaiser appears dug in. Asked to clarify its positions and how Kaiser arrived at some of the figures it has presented publicly during the dispute, Kanakri emailed a statement laying the blame for stalled negotiations on the National Union of Healthcare Workers, which represents the nearly 2,400 mental health care workers who began their strike in October. (NUHW is a financial supporter of Capital & Main.)
“The union is not engaging productively at the bargaining table, and acting as though they’re not truly interested in constructive negotiations to reach an agreement that benefits our members and our mental health professionals,” Kaiser’s statement said. It added that after 26 bargaining sessions since July 2024, “the union’s demands remain essentially the same.”
Union leaders, meanwhile, say they’ve made and revised their offers numerous times, most recently including a concession over the amount of time outside of appointments that therapists have to do their jobs. But asking Kaiser to mediate the going-nowhere dispute led to Kaiser negotiators walking out of that Presidents’ Day session, according to NUHW President Sal Rosselli.
In some respects, this qualifies as a rather standard, if exceptionally drawn out, labor issue. But there’s a key difference: What lies in the balance is Kaiser providing mental health care to its patients in Southern California — and both prior and current evidence leads one to question whether that care is being delivered.
Kaiser’s documented history of providing mental health care to patients in California is clinically abysmal. The company has been cited multiple times for inadequate access to such care, paying a $4 million fine to the state in 2013, reaching a settlement in 2017 to avoid another payout, then agreeing to a $200 million settlement in 2023 with the state’s Department of Managed Health Care (DMHC) that included a $50 million fine, the largest ever levied by the agency.
The October 2023 settlement laid out in detail Kaiser’s repeated failures to provide adequate mental health care. The DMHC found that during the Northern California therapists’ strike, Kaiser canceled more than 110,000 appointments affecting nearly 64,000 patients, a direct violation of state law. The agency also concluded that Kaiser routinely failed to provide mental health care patients with timely access to appointments and follow-ups.
Kaiser, led by CEO and longtime company employee Greg Adams, agreed to provide an acceptable plan to correct its actions, and to then implement changes and have them monitored through October of this year. But the company and the DMHC didn’t even produce a final agreement on that plan until January, almost 15 months after their settlement. There are now only eight months remaining before Kaiser’s requirement to implement a monitored plan will expire.
In the meantime, the NUHW is claiming that Kaiser is again short-changing patients who need mental health care, this time in Southern California.
Union research director Fred Seavey has filed multiple complaints with the state since the strike began. Among them are allegations that Kaiser has cancelled psychotherapy groups for thousands of enrollees, placed patients on 30-day waitlists despite being required to provide follow-up appointments within 10 business days, and violated industry standards by referring some patients with severe conditions to an outside virtual provider meant to handle only mild to moderate mental health cases.
The DMHC has reached no formal findings of violations. After the current strike began last October, the department said it would monitor Kaiser to ensure that a repeat of 2022, with its mass cancellations of therapy appointments, did not occur.
That’s a concern echoed by California Senate President Pro tempore Mike McGuire, who reminded Kaiser’s Adams in December (in a letter replicated by Assembly Speaker Robert Rivas) that the 2023 settlement with the state “was intended to ensure that all of Kaiser’s California enrollees would maintain full access to the behavioral health services they are entitled to under California law, including in the event of a strike.”
The need for mental health care in California has continued to escalate. Newsom’s request for mediation came in the aftermath of the devastating Los Angeles wildfires, and in his letter to Kaiser and the NUHW, the governor cited “an unprecedented rise in the need for behavioral health support” over the past several years, dating to the COVID-19 pandemic in 2020.
Newsom also offered to help find a mutually agreeable mediator, as he did during the Northern California strike in 2022, when then-Sacramento Mayor Darrell Steinberg took on that role. In that case, Kaiser and the union reached a tentative contract agreement after three days of Steinberg-led mediation.
But Kaiser doesn’t negotiate as a monolith. Its Northern California and Southern California operations are distinct entities with their own bargaining units, and the company has stood firm on one major strike issue: Kaiser’s refusal since 2015 to extend a defined pension benefit (as opposed to a riskier 401k) to the NUHW therapists in Southern California, though it’s provided to almost all other Kaiser employees. The union’s offer to reduce its request from seven hours to six for therapists to care for patients outside of their scheduled appointments also has produced no movement.
Medical industry economists have noted that for most health companies, mental and behavioral care services produce a low return on investment. “As a result, those services have been underfunded for decades,” Jeff McCombs, a longtime professor and health economist at the University of Southern California, told Capital & Main in 2022.
That’s one reason, the economists say, that giants like Kaiser, with 9 million members in California, would rather pay state-sanctioned fines than spend what it would cost to actually build out their mental health care services. In this current labor dispute, the company claims that NUHW wants raises that would pay its therapists 31% more than their “peers” make in Southern California, but it hasn’t explained its math.
“We’ve been clear to the union and the governor that mediation takes a willing partner committed to engage in constructive negotiations. We have not yet seen that from NUHW,” Kaiser’s emailed statement said. More than four months in, this is a negotiation with no end in sight — and a need for mental health care services that is only growing more acute.
