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After a historic strike, health care giant Kaiser Permanente and the Coalition of Kaiser Permanente Unions announced Friday that they reached a tentative, four-year union contract agreement in the early hours of the morning.

The deal gives frontline health care workers the resources to do the job they love and keep patients safe, said Yvonne Esquivel, a pediatric medical assistant at Kaiser Permanente in Gilroy, Calif., in a statement issued by the coalition.

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The tentative agreement includes raising all wages by 21% over four years to increase worker retention, including establishing a new minimum wage of $25 per hour in California — in line with recently passed California legislation that phases in a $25 minimum wage for health care workers over the next several years — and $23 per hour for other states over the next three years. The contract also includes better opportunities for workers to make money through Kaiser’s Performance Sharing Plan, stipulations around subcontracting and outsourcing labor, and several initiatives around hiring and skill development.

The agreement was reached with the help of acting U.S. Labor Secretary Julie Su, who was also on hand for the failed last-minute set of negotiation talks before the unions went on strike last week. In a statement, Su praised the power of the collective bargaining process and the deal that they achieved.

The coalition expects to begin ratification of the agreement starting Oct. 18. The contract will have an effective date of Oct. 1, 2023.

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Seventy-five thousand members of the union, which spans seven of the states plus Washington, D.C., in Kaiser’s nationwide health care network, went on strike last week from Oct. 4 through the early hours of Oct. 7. The coalition largely represents ancillary health care workers, including call center staff, certified nursing assistants (CNAs), receptionists, surgical techs, imaging techs, respiratory therapists, emergency department technicians, physical therapy assistants, radiological techs, pharmacists, phlebotomists, dietary aides, housekeepers, janitors, food service workers, and security officers. The coalition also includes optometrists and registered nurses in Hawaii, southern California, and Washington state.

The coalition’s contract expired Sept. 30, and union leaders accused Kaiser officials of not bargaining in good faith, especially over the understaffing issues at the root of the strike. In a statement after the labor stoppage, the union said labor outsourcing in particular emerged as “a major sticking point” in negotiations, and Kaiser executives “have refused to agree to common sense limitations on subcontracting and outsourcing.”

The coalition earlier this week gave Kaiser notice of a second strike, which would have occurred from Nov. 1-8, once the contract for Kaiser health care workers in Seattle expired at the end of October. Kaiser Permanente said in a statement that the coalition unions have withdrawn their notices for another strike.

The Kaiser strike is only one of several health care strikes across the country in recent months. In September, nurses at St. Louis University Hospital went on a 24-hour strike over workplace violence, pay, and understaffing. At the end of September, dialysis workers at nearly two dozen Satellite Healthcare and Fresenius Kidney Care clinics in California went on a two-day strike over understaffing and wages.

On Friday, workers at four Prime Healthcare hospitals in southern California are wrapping up their five-day strike over short-staffing and unfair labor practices.

“Staffing has been so critically low that many caregivers have left. The remaining workers are stretched thin and rushed. We’re forced to take on more patients with less staff, which leaves much less time for quality one-on-one patient care,” said Bernie Espinoza, an Ultrasound Tech at Prime Garden Grove Hospital, in a statement, echoing the concerns of Kaiser Permanente workers.

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