More than 80,000 Kaiser Permanente workers are poised to walk out of work in October because of grievances over a new contract with the giant California-based health system, in what could be one of the nation’s largest strikes in the last 20 years. 

Not all the unions in the coalition have voted to authorize the October strike yet, but given outcomes elsewhere, the umbrella organization representing Kaiser workers in various unions in several states expects the strike to gain support. Roughly 60,000 of the 80,000 workers, mostly non-clinical workers, have already cast their ballots in a vote over whether to authorize an October strike. The others will vote in the coming month. 

As the threat of the strike looms, Kaiser has agreed to sit down with the Coalition for a bargaining session on Sept. 16 as the two work toward a new contract. The last one expired nearly a year ago, Sean Wherley, a spokesman for the coalition, told Healthcare Dive.   ​ 

At issue are traditional concerns about protecting middle class jobs, staffing and patient care. But the Coalition of Kaiser Permanente Unions is also alleging the health system has departed from its mission and is focused more on profits than patients. 

Kaiser has said the coalition’s demands are unfair to its members and communities the system serves. 

"Coalition-represented employees are already compensated 23% above market rates — we pay well, and we have markets where our wage rates are challenging our ability to be affordable," John Nelson, vice president of Kaiser Permanente said in early August in response to the strike vote. 

Kaiser has proposed 3% wage increases across the board, each year through 2022, among other items.

Wherley would not say what type of increase the coalition is seeking. 

"It's not a simple a wage discussion. It's much larger than that, Wherley said, citing concerns over Kaiser outsourcing jobs.

Wages and benefits are set by the national contract while other provisions are addressed in the individual union agreements, Wherley said.   

"We reject what Kaiser has become, and instead urge the corporation to join us in the fight to provide quality patient care and protect good, middle-class jobs that America needs," Isis Acevedo, a schedule maintenance clerk at Kaiser Permanente in South San Francisco, said in a statement announcing a symbolic walkout on Labor Day. 

Nonprofit health systems have come under increased scrutiny over profits and executive compensation as critics question whether the community benefits nonprofits systems provide justify the tax-exempt status they enjoy. 

Earlier this year, Pennsylvania's Attorney General Josh Shapiro filed a lawsuit against UPMC after the system failed to agree to terms with its rival Highmark, putting in-network access for a number of patients at risk. As part of the suit, Shapiro called out the system's "corporate greed" and said it was flouting its responsibilities as a nonprofit. 

And 2018 marked a year of increased labor disputes broadly, according to the Bureau of Labor Statistics. Of those, education and healthcare industries accounted for almost all them. 

"The number of major work stoppages beginning in 2018 was the highest since 2007 (21 major work stoppages)," according to the BLS. And the number of workers involved in 2018 was the highest since 1986 when 533,000 were involved in a work stoppage. BLS defines major work stoppages as those involving more than 1,000 workers.

But, according to some experts, it’s too early to tell whether an uptick in disputes is the beginning of a new trend. Generally, the number of strikes have been declining for many years, Paul Clark, director of Penn State University’s School of Labor and Employment Relations, told Healthcare Dive.

Still, "there is something meaningful going on," Heidi Shierholz, former chief economist for the U.S. Department of Labor under former President Barack Obama, told Healthcare Dive. And it's starting to show up in the data, she said, referring to the BLS' figures.

Workers are recognizing the current economy isn't working for them but for a very slim slice of people at the top and they’re taking action, she said.

Yet she cautioned the number of unionized workers continues to fall, extending a decades-long trend. There are about 16.38 million unionized workers in America, down slightly from 16.44 million the year prior, according to the BLS.  

"The share of workers covered by a collective bargaining agreement dropped from 27% to 11.7% between 1979 and 2018, meaning the union coverage rate is now less than half where it was 40 years ago," Shierholz said in a blog post she wrote as part of a series on Labor Day for the Economic Policy Institute.

In the healthcare industry, those that walked out in 2018 included workers from University of California Medical Centers, University of Vermont Medical Center, Rhode Island and Hasbro Children’s Hospital and Kaiser Permanente. 

Interestingly, Kaiser workers have experienced at least 18 work stoppages since 1993, while workers at Sutter Hospitals have recorded 18 strikes since 2004. The two were involved in the most strikes than at any other healthcare organization, according to statistics with the Bureau of Labor Statistics that date back to 1993. 

The last time workers from Kaiser Permanente went on strike was in December when the National Union of Healthcare Workers took to picketing over staffing issues, among other concerns.

Not every union is under the umbrella of the Coalition of Kaiser Permanente Unions. Some, like the National Union of Healthcare Workers, represent some Kaiser workers, but are not part of the umbrella group.