How 35,000 Kaiser Workers Built the Largest Healthcare Strike in U.S. History

Over 35,000 Kaiser Permanente workers walked off the job in what unions are calling the largest healthcare strike in U.S. history—a carefully orchestrated two-wave action that began with nurses and expanded to pharmacy and lab workers, targeting the specific services that keep a massive health system running.

On January 26, 31,000 nurses and healthcare professionals across California and Hawaii launched an open-ended strike. Two weeks later, on February 9, another 4,000 pharmacy technicians, pharmacy assistants, and clinical laboratory scientists joined them on the picket lines.

This wasn’t a spontaneous eruption. It was a strategic campaign against one of America’s largest nonprofit health systems, designed to maximize pressure while building public momentum.

The Two-Wave Strategy

Rather than throwing everyone onto the picket lines at once, unions started with nurses and specialized health professionals. Registered nurses, nurse anesthetists, pharmacists, physician assistants, midwives, rehab therapists, and dietitians whose contracts expired September 30, 2024, walked out first.

Fifteen days later came the pharmacy and lab workers.

The initial wave set up picket lines, tested the company’s response capacity, and built media attention. Then came the second punch: shutting down pharmacy operations and laboratory testing across Southern California.

“We will not be silenced,” said Zhayne Serang, a clinical laboratory scientist at the Anaheim Medical Center. He framed the expansion as a response to the company’s “repeated unfair labor practices” and refusal to bargain in good faith.

The company told patients that “some outpatient laboratories are temporarily closed or have different operating hours.” Pharmacies “may be operating during adjusted hours, or experiencing long wait times.” The company encouraged members to use mail-order pharmacy delivery—which takes three to five days.

For a health system serving 4.9 million members in Southern California alone, those delays compound fast. Urgent and critical lab testing continued in hospitals and emergency departments, but outpatient facilities created diagnostic backlogs that would accumulate with each passing day.

Who Built This Coalition

Multiple unions coordinated through the Alliance of Health Care Unions, a coalition formed in 2018 that comprises 23 separate local unions representing over 60,000 employees across multiple states.

The United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP) leads the nursing and specialty professional component, representing roughly 40,000 staff members. UNAC/UHCP President Charmaine S. Morales became the primary public voice, framing the conflict around patient safety rather than economics.

“We’re not going on strike to make noise,” Morales said. “We’re striking because the company has committed serious unfair labor practices. We’re striking because management refuses to bargain in good faith over staffing that protects patients, workload standards that stop the emotional toll of being unable to provide adequate care, and the respect and dignity that caregivers have been denied for far too long.”

The United Food and Commercial Workers (UFCW) bring decades of retail and food service organizing now focused on the medical sector. UFCW Local 135 in San Diego and UFCW Local 770 in Los Angeles represent the pharmacy staff who organized as part of retail chains before shifting to the medical sector.

Todd Walters, President of UFCW Local 135, connected the pharmacy and lab action to the broader coalition: “Our members are standing shoulder to shoulder with our Alliance partners. Management’s refusal to return to the National Bargaining table is blocking progress on safe staffing, fair wages and the contract our members have earned as professionals.”

The Alliance framework prevents the company from negotiating separately with individual unions and locations—a common management tactic to weaken bargaining power. In 2015, when the coalition began operating, organizers knew that only by standing together could they address the structural issues that affect staff across the system.

The striking workforce reflects the demographics of the industry: predominantly women, spanning both long-tenured employees and recently unionized staff. In Northern California, Certified Nurse Midwives and Certified Registered Nurse Anesthetists had recently won union recognition, then faced proposed wage cuts in their first contract negotiations.

Geographic wage disparities added fuel. Southern California nurses earn less than their Northern California counterparts for identical work, despite facing comparable housing costs.

What They’re Fighting Over

The company offered what it characterized as “the strongest compensation package in Kaiser Permanente’s national bargaining history: a 21.5% wage increase over the life of the contract, with 16% within the first 2 years.” Including “step increases and local adjustments,” management claimed “the total average increase is approximately 30%.”

The unions demand 25% wage increases over four years. They argue that the company’s mathematics inflate the offer by including step increases and longevity adjustments already embedded in existing pay scales.

But the deeper conflict involves how negotiations are organized. Management wants to shift to local-only bargaining, which would break up the unified negotiating power that the Alliance spent years constructing. The unions filed formal complaints with the National Labor Relations Board in December 2024, arguing that the attempt to dismantle national bargaining violates federal labor law.

Under federal labor law, unfair labor practice strikers can’t be permanently replaced and possess stronger legal protection against retaliation. Economic strikers lack those protections.

Staffing levels represent the third battleground. Staff describe chronic understaffing that creates both patient safety risks and emotional harm for professionals unable to provide adequate care. The unions want system-wide staffing ratios. The company resists binding commitments, preferring local flexibility.

The company reported $66 billion in unrestricted reserves—a figure unions deploy as evidence that the company can afford higher wages and better staffing.

Operational Impact and Bargaining Leverage

Pharmacy and lab closures created friction for millions of members. But the company’s financial capacity to absorb disruption through contracted replacement staff proved substantial. Management reported that “more than 35% of striking employees have returned to work across striking locations, and as high as 55% at some locations.”

The company stated it had “onboarding up to 7,600 nurses, clinicians, and other staff to work during the strike, the majority of whom have worked at Kaiser before.” That’s significant backup staffing for a company facing a 35,000-worker walkout.

By early February, union officials announced that “limited bargaining at the local level is expected to resume this week,” yet the national bargaining table remained closed.

Media coverage expanded with the February 9 pharmacy and lab escalation. Healthcare Dive, Los Angeles Times, and regional Southern California newspapers provided detailed coverage. The striking staff’s emphasis on staffing and patient safety rather than wages alone proved effective in shaping coverage.

During October 2025’s five-day action preceding the current one, California elected officials including State Treasurer Fiona Ma, State Controller Malia Cohen, Lieutenant Governor Eleni Kounalakis, and Congressman Gil Cisneros joined staff on picket lines.

The action’s sustainability depends on staff ability to maintain financial commitment during an indefinite work stoppage. The UFCW benefit structure provided $350 per day for laboratory staff and $200 per day for pharmacy staff—figures that offset but don’t fully replace lost wages.

Historical Context

In October 2023, 75,000 Kaiser workers struck for three days across four states and Washington, D.C.—a larger number than the current 35,000.

What makes this one “largest”? The open-ended duration rather than predetermined three-day limit. The specific targeting of pharmacy and laboratory operations. The geographic concentration in California and Hawaii rather than dispersed national action.

The National Labor Relations Act imposes stricter requirements on medical sector work stoppages: 10 days’ notice to employers and notification to federal mediation services.

Research on medical work stoppage impacts found that strikes don’t lead to increased patient mortality. Hospitals maintain emergency capacity through management reassignment and contracted staff.

The October 2023 action resulted in tentative agreement providing “21% wage increases over four years, investments in workforce hiring, and patient safety improvements”—establishing a baseline that shaped expectations for 2026 negotiations.

If the company settled favorably in 2023, why the breakdown in 2026?

The answer involves the Labor-Management Partnership (LMP) established between the company and unions in 1997. The partnership was designed to avoid work stoppages through formal systems for working together and joint problem-solving.

By 2026, both sides accused each other of violating partnership principles. Unions alleged that the company “abandoned its labor roots” through escalating anti-union tactics. Management argued that the national bargaining process had become “gridlocked” and local bargaining would be “the most effective and timely path.”

Options for Escalation

Hospital Occupations and Sit-Down Components

The 1936-37 Flint sit-down actions against General Motors demonstrated that staff occupying production facilities created different pressure than traditional picket lines. A modified approach could involve striking staff occupying administrative offices or board meeting locations to demand management’s return to national bargaining.

This would generate heightened media attention and make it politically embarrassing for management. Challenges include potential legal liability, staff safety during overnight occupations, and employer use of injunctions.

National Labor Solidarity Action

The unions could coordinate with AFL-CIO leadership to call for a national solidarity day, with staff across multiple systems participating in rolling actions or partial work stoppages. This would change the dispute from one company’s problem to a crisis affecting all medical professionals.

Challenges include coordination complexity across competing unions and maintaining staff commitment across different contract timelines.

Pension Fund and Investment Pressure

The company “turned its employer-controlled pension investment funds to questionable areas that include foreign companies, ICE detention centers, and predatory lending.” Unions could coordinate with socially responsible investment organizations to file shareholder resolutions challenging these practices.

Staff could organize family members who hold company stock through retirement accounts to demand divestment from controversial investments pending settlement of labor demands.

Patient and Community Mobilization

Rather than positioning the action as disrupting patient care, unions could reframe it as patients’ and staff’s joint struggle for adequate care delivery. Community health advocates could document how understaffing—the underlying issue driving the action—already constrains patient access even without the work stoppage.

Regulatory and Legislative Escalation

Unions could file formal complaints with the California Department of Public Health documenting violations of nurse-to-patient ratios and understaffing-related patient safety concerns. Allied legislators could introduce bills establishing mandatory minimum staffing levels and restrictions on executive compensation.

California’s AB 394 establishing nurse-to-patient ratios emerged from sustained union advocacy and legislative campaigns.

Cross-Industry Alliance

The unions could coordinate with unions representing staff at competitor systems—Cedars-Sinai, Providence Health, UC system—to establish standard expectations for wages and conditions across the industry. If multiple systems commit simultaneously to minimum staffing ratios and wage increases matching the settlement, the regional labor market shifts.

Challenges include coordinating across competing union leadership and managing timing across different contract expirations.

What Happens Next

Union officials indicated that local-level bargaining would resume during the second week of February, though national bargaining on major economic and staffing issues remained stalled. The UFCW authorization stated that the action would continue “until an agreement is reached”—establishing open-ended commitment without predetermined termination date.

Past medical sector actions rarely exceed four to six weeks as financial pressure on striking staff compounds rapidly.

The company’s response involves three potential tracks. First, demonstrate indefinite operational viability through contracted replacement staff, gambling that financial constraints will force settlement on terms favorable to management. Second, move strategically on selected issues while holding firm on national bargaining structure—offering local wage increases and localized staffing improvements while refusing system-wide commitments. Third, pursue federal mediation or arbitration.

Federal mediation involvement appears likely as the action extends beyond two weeks. The Federal Mediation and Conciliation Service is required by law to maintain awareness of medical labor disputes.

UFCW could expand the action to include additional classifications—dietary, environmental services, patient transport. Alternatively, unions could coordinate with health advocacy groups to pressure major corporate accounts and public sector entities to demand resolution as a condition of continued service contracts.

The Alliance structure could potentially mobilize 60,000-plus staff, creating maximum pressure if management refuses to budge.

Whether 35,000 staff can force one of America’s largest health systems to restore national bargaining and commit to binding staffing ratios remains the central question. The answer will shape labor relations for years—either demonstrating that coordinated coalition actions can overcome employer resistance, or revealing the limits of even the largest work stoppage in U.S. history.

This article analyzes protest and activism tactics for educational purposes. We aim to contribute to effective and ethical efforts across the political spectrum, and we present diverse viewpoints and ideas without endorsement.