California Healthcare Worker Strike
Author(s): Scott Douglas Jacobsen
Publication (Outlet/Website): The Good Men Project
Publication Date (yyyy/mm/dd): 2025/01/24
*Interview conducted December 26, 2024.*
The National Union of Healthcare Workers in the United States. They highlighted systemic issues during the October 2024 strike by Southern California’s mental health workers, including appointment delays, cancellations, and inadequate staffing. They criticized Kaiser’s insufficient contingency plan and its failure to meet state-mandated mental health care standards. They noted NUHW’s push for legislative reforms, such as SB 221 and SB 855, to enhance mental health care access. The union’s demands include equitable pay, restored pensions, and sufficient time for therapists to manage non-appointment tasks, addressing chronic understaffing and high turnover. They also emphasized the vital role of therapist-patient relationships and urged systemic changes to ensure parity between mental and physical health care services. NUHW’s efforts aim to hold Kaiser accountable and improve care for its 9.4 million California members.
Scott Douglas Jacobsen: How has Kaiser Permanente responded to the ongoing strike?
National Union of Healthcare Workers: Kaiser has responded to this strike similarly to how it responded to a strike by mental health therapists in Northern California, for which it was cited for illegally canceling 111,803 individual and group therapy appointments.
State law requires Kaiser to continue providing mental health care during a strike, just as it would be required to maintain medical care. But since the strike in Southern California began on Oct. 21, NUHW has filed complaints against Kaiser documenting instances of the HMO:
Forcing patients onto 30-day appointment waitlists; Cancelling psychotherapy groups for thousands of patients; Failing to adequately staff its hospice services; and Sending patients with severe conditions to an outside provider unequipped to care for them.
Kaiser’s state-mandated contingency plan for providing timely and appropriate mental health care during an ongoing strike by its behavioral health professionals was also woefully inadequate, without any detail for how the state’s largest HMO is providing critical mental health services for its 4.8 million members from San Diego to Bakersfield.
The 3-page document submitted to the California Department of Managed Health Care just prior to the start of the strike, provides no information about the volumes of replacement services Kaiser anticipates having to provide and no information about how many workers from outside of Kaiser can be relied on to provide it. The plan itself is barely over a page with a one-page introduction.
Jacobsen: What about the allegations of inadequate mental health care?
National Union of Healthcare Workers: Last week, four Kaiser patients spoke about their inadequate access to clinically appropriate mental health care in a recorded zoom press conference
More than 500 Kaiser mental health patients have submitted their stories to kaiserdontdeny.org since October 2024 and more than 3,000 have submitted since 2018.
Facing two state investigations, Kaiser agreed to a $200 million Settlement Agreement that included a $50 million fine for violating California mental health parity laws and agreed to pay an additional $150 million to support mental health initiatives throughout the state last year.
The giant HMO, which has 9.4 million members in California, had been previously fined for similar violations, but this time Kaiser acknowledged its mental health services were understaffed and that patients were suffering because of it.
Kaiser understaffed its clinics, which resulted in appointment wait times that exceeded the 10-business day standard set by NUHW’s landmark law SB 221. https://californiahealthline.org/news/article/california-law-aims-to-strengthen-access-to-mental-health-services/
Instead of abiding by the law, Kaiser has started programs to cut appointment times for some patients to less than 30 minutes, far shorter than clinical standards.
Jacobsen: What is the National Union of Healthcare Workers demanding to address the staffing and care issues?
National Union of Healthcare Workers: NUHW sponsored SB 221 and SB 855 to improve access to mental health care and has filed dozens of complaints with state agencies against Kaiser. Our strike in Northern California in 2022 contributed to Kaiser’s $200 million settlement agreement between Kaiser and the California Department of Managed Health Care, which included a record $50 million fine. In the current contract negotiations, we’re fighting to make Kaiser treat mental health care on par with its other services. Our demands are a prerequisite for Kaiser to satisfy the terms of its Settlement Agreement and “transform” its mental health delivery services.
We’ve also connected with Kaiser patients directly via kaiserdontdeny.org to hear their stories of mental health care delays and denials and have shared their stories with regulators. We work hard to amplify the voices of the most impacted which are the workers and the patients.
Seeking Equity for Mental Health Care: to improve staffing levels and reduce turnover that disrupts patient care, Kaiser’s Southern California mental health professionals are seeking a contract that includes the same working conditions as their fellow Kaiser mental health providers in Northern California and comparable pay and benefits as their colleagues who don’t work in mental health. However, despite being under a state order to undertake “transformational change” of its mental health delivery services, Kaiser has so far rejected the workers’ three primary proposals.
Patient Care Time. Southern California workers are seeking the same amount of time (7 hours per week) to perform critical patient care duties that can’t be done during appointments as their counterparts working for Kaiser in Northern California. The lack of time to respond to patient calls and emails, prepare for appointments and devise treatment plans is a major reason why therapists leave Kaiser, contributing to the HMO’s chronic understaffing issues.
Fair Pay. Workers are seeking to close the gap between themselves and therapists that provide medical care at Kaiser, who make up to 40 percent higher salaries.
Restoration of pensions. Workers are seeking to restore pensions that nearly all Kaiser employees still receive, but were taken away from newly hired mental health professionals in Southern California starting a decade ago. More than 70 percent of Kaiser mental health professionals in Southern California do not have a pension, and Kaiser data shows that they are twice as likely to leave Kaiser.
Jacobsen: How does Kaiser’s mental health therapist-to-patient ratio compare to industry standards?
National Union of Healthcare Workers: Not an apples to apples comparison because Kaiser is fairly rare in having an in-house network directly employed by Kaiser itself. What we do know is that in comparing Kaiser’s two California regions, Kaiser staffs a significantly higher ratio of therapists in Northern California than in Southern California. That means more Northern California patients get the benefits of Kaiser’s integrated model of care instead of being sent outside the Kaiser system.
Jacobsen: What are the long-term effects of high turnover among mental health professionals at Kaiser?
National Union of Healthcare Workers: Mental health depends greatly on the relationship between the therapist and the patient. If Kaiser members are bounced from therapist to therapist, as indicated by many patients who’ve reached out with us to share their stories that relationship never forms, OR that relationship is severed because Kaiser can’t retain therapists, it makes it harder for patients to make progress.
Jacobsen: How does Kaiser’s refusal to restore pensions contribute to the ongoing staffing crisis?
National Union of Healthcare Workers: Kaiser eliminated pensions for mental health professionals in Southern California starting in 2015. Currently, more than 70 percent of mental health professionals at Kaiser in SoCal do not have pensions. Those workers were twice as likely to leave employment with Kaiser as their colleagues that still do have pensions according to Kaiser’s own employment data. That data is here in this fact sheet: https://nuhw.org/wp-content/uploads/Kaiser-Fact-Sheet.pdf
Jacobsen: What steps can be taken to ensure parity between mental health and physical health services within Kaiser Permanente?
National Union of Healthcare Workers: There are two tracks. When it comes to state enforcement, Kaiser is required to submit a state-approved Corrective Action Plan to address the deficiencies cited by the state investigations that led to the settlement agreement. Kaiser was supposed to have had this plan approved by the state early this year, but it still hasn’t received approval. Here is a fact sheet about the Settlement Agreement: https://nuhw.org/wp-content/uploads/Kaiser_PsychSocial_Strike_SettlementFAQ_Leaflet_1_20241021-2.pdf
The state needs to ensure that Kaiser produces a Corrective Action Plan that truly results in a systemic overhaul and improvement of its mental health delivery system and that Kaiser puts it into practice.
The other track is with workers. Kaiser’s Corrective Action Plan will never be worth the paper it’s printed on if it doesn’t finally start treating mental health care as equally important to its medical services. The contract provisions being sought by the striking workers are prerequisites for making that happen.
Jacobsen: Thank you for the opportunity and your time.
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