More than 75,000 healthcare workers in Virginia, California, and three other states began walking the picket line Wednesday morning in front of Kaiser Permanente hospitals over wages and staffing shortages. The strike marks the latest major labor unrest in the country.

It is the largest strike by healthcare workers in U.S. history, according to The Los Angeles Times. 

Kaiser Permanente, one of the nation’s largest insurers and healthcare system operators, has 39 hospitals and 622 medical facilities located across the country. The non-profit company, based in Oakland, California, provides health coverage for nearly 13 million people. 

Both sides were still negotiating right up until the strike began at 6:00 a.m. Pacific Time, according to KABC-TV. 

“Both Kaiser Permanente management and Coalition union representatives are still at the bargaining table, having worked through the night in an effort to reach an agreement,” Kaiser said in a statement before the strike began. “There has been a lot of progress, with agreements reached on several specific proposals late Tuesday.”

“We remain committed to reaching a new agreement that continues to provide our employees with market-leading wages, excellent benefits, generous retirement income plans, and valuable professional development opportunities,” the statement concluded. 

The Coalition of Kaiser Permanente Unions, representing about 85,000 of the health system’s employees nationally, approved a strike for three days in California, Colorado, Oregon, and Washington, and for one day in Virginia and Washington, D.C.

Striking union members include licensed vocational nurses, home health aides, and ultrasound sonographers, as well as technicians in radiology, X-ray, surgical, pharmacy, and emergency departments. Doctors are not participating in the strike. 

Kaiser said all of its hospitals, including emergency rooms will be open during the strike, manned by thousands of temporary workers. However, the strike could lead to delays in getting appointments and non-urgent procedures rescheduled. 

Unions representing Kaiser workers in August asked for a $25 hourly minimum wage as well as increases of 7% each year in the first two years and 6.25% each year in the two years afterward. Kaiser has countered with minimum hourly wages of between $21 and $23 next year depending on the location. 

In addition, the unions are asking for a 24.5% raise for members over the next four years, protections against outsourcing, the right to organize in any hospital system the company might acquire as well as a raise in employees’ performance sharing plan, and increased medical benefits, according to Fox Business. 

Kaiser’s latest offer this past weekend was 16% and 12.5% wage increases for union members over the life of the contract, depending on their location, the outlet reported. 

The workers’ last contract was negotiated in 2019, before the pandemic. It expired on Saturday. 

Union members say understaffing is boosting the hospital system’s profits but hurting patients, and executives have been bargaining in bad faith during negotiations.

“They’re not listening to the frontline health care workers,” Mikki Fletchall, a licensed vocational nurse based in a Kaiser medical office in Camarillo, California, told the Associated Press. “We’re striking because of our patients. We don’t want to have to do it, but we will do it.”

Kaiser Permanente reported $2.1 billion in net income for this year’s second quarter on more than $25 billion in operating revenue. But Kaiser executives said the company is still still dealing with high costs and challenges from inflation and labor shortages.

The company said its practices, compensation, and retention are better than its competitors with a 7% turnover compared to the industry standard of 21%, despite the effects of the pandemic.

“Across the country, there’s been a staffing crisis and we have not been immune to that,” Michelle Gaskill-Hames, president of Kaiser Permanente Health Plan and Hospitals of Southern California and Hawaii told the Los Angeles Times. “We’ve had the challenges, but we have been leaning in heavily to try to address them.”

She said at the bargaining table, “The discussions are down to wages.” 

Gaskill-Hames admitted to the AP that the COVID-19 pandemic was hard on healthcare workers. 

“I think coming out of the pandemic, healthcare workers have been completely burned out,” she said. “The trauma that was felt caring for so many COVID patients, and patients that died, was just difficult.”

Hospitals generally have struggled in recent years with high labor costs, staffing shortages, and rising levels of uncompensated care, according to Rick Gundling, a senior vice president with the Healthcare Financial Management Association, a nonprofit that works with healthcare finance executives.

Most of their revenue is fixed, coming from government-funded programs like Medicare and Medicaid, Gundling noted. He said that means revenue growth is “only possible by increasing volumes, which is difficult even under the best of circumstances.”

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