The Brief

Nearly six months into their labor union dispute against Southern California Kaiser Permanente, eight mental health care workers banded together last week in an organized five-day hunger strike to highlight their cause.

“Kaiser’s trying to starve us out, that’s clear — so, give them what they want,” said Adriana Webb, a member of the National Union of Healthcare Workers who chose to subsist solely on water and electrolytes from Monday morning through Friday evening. “I feel hungry for equity. I feel hungry for change. How is this any different?”

Now engaged in the longest mental health strike in U.S. history, the Southern California workers have been seeking a new union contract that would include:

• more mandated time between therapy sessions for patient follow up
• restoration of pension benefits that were removed from new employee contracts in 2015
• cost-of-living wage adjustments

After a long list of Democratic members of the state Assembly and Senate wrote Kaiser in December urging it to accept the union’s “reasonable contract proposals” — and after Gov. Gavin Newsom’s Feb. 6 written request for both sides “to prioritize the common good that have allowed Californians to rise above our difficulties and resolve our differences” — state Health and Human Services Secretary Mark Ghaly and former Sacramento Mayor Darrell Steinberg have agreed to mediate.

Kaiser executives threw their hands up and walked out of mediation talks on March 11 when the union continued pressing its three major contract issues. Today bargaining talks are scheduled to resume.

Steinberg mediated a similar open-ended strike for Northern California Kaiser mental health care workers in 2022, which lasted 10 weeks and resulted in Kaiser meeting most of the union’s demands.

“We know Kaiser can provide all these things if they wanted to,” said Webb, a medical social worker in the infectious disease unit who stood on the picket line in front of Kaiser’s Los Angeles Medical Center on Sunset Boulevard. “They already provide it to our Northern California counterparts, and all we’re asking for is the same thing. Kaiser still can’t explain why we deserve less or our patients deserve less.”

In a written response to CalMatters questions, Kaiser Permanente spokesperson Terry Kanakri discussed Kaiser’s overall commitment to work with more than 40 unions that represent 80% of its employees.

“Every one of the 80 contracts is different, and each reflects the differences in operational needs, local market economics and wages, professional classifications of the employees in each local, and a host of other factors,” said Kanakri.

“Our goal is and has always been to reach an agreement that makes Kaiser Permanente the best place to give and receive care. We have made — and repeatedly improved — our proposals during bargaining in an effort to reach an agreement. However, in nearly nine months of bargaining, NUHW has made very little movement on the key bargaining issues.”

Although not aware of any specific details of the 2022 NorCal strike or the current SoCal strikes, University of Southern California professor of healthcare finances and economics Glenn Melnick gave his overview on today’s health care labor climate.

“Northern California has the highest wage index in the country,” he said. “I think it’s 20 points higher than L.A. — maybe 25%. So there’s economic reasons why there’s differences. An economist would say, ‘Mental health care worker, you want these benefits? Move to San Francisco.’

“And many employers are cutting back pension benefits these days. Ten or 15 years ago, pension benefits were much more generous across the board. Kaiser could easily afford to give them these benefits and not think twice, but it’s bigger than just these workers. It’s the ripple effect, right?”

Melnick also speculated that health care workers’ negotiating power has waned as the COVID pandemic, which drove demand for their services, has somewhat subsided.

From April 8 through 12, the hunger strikers spent eight-hour days alongside their picketing fellow union members and each night together fasting at a West Hollywood church. Sleeping in a community space barely big enough for eight air mattresses huddled beside the piano against a back wall, they shared a bathroom and took turns showering in a motel room next door.

Medically cleared beforehand, they received daily wellness checks from volunteer union nurses.

“Right now, I feel like I could go another month,” said Zhane Sandoval, propped up on an elbow from their mattress on the morning of April 11, day four of the hunger strike. “So test me, Kaiser!

“Kaiser says that it’s a union employer, but all we’re seeing is union busting. All we’re seeing is separation, trying to divide. But their efforts just lead us to unite.”

Union organizer Rachel Forgash, who stayed overnight with the hunger strikers at the church, expressed frustration over the protracted standoff.

“Kaiser has exceeded all of our expectations in their unwillingness to bargain in good faith and drag this out as long as possible,” she said. “In Southern California, they’re about to start bargaining with the Alliance, which is a huge group of unions at Kaiser, and I think they’re afraid that — when we win — it’s going to set a precedent for other unions to fight just as hard.”

Aida Valvidia, a psychiatric social worker at Kaiser’s Sylmar facility, and Melissa Chavez, a medical social worker at Riverside, both started working for Kaiser before the 2015 contract negotiations reached a settlement, so they each have pension benefits that 70% of their fellow mental health care union members do not. Yet both chose to participate in the hunger strike.

“For the people who don’t have pensions, I think it’s unfair,” said Valvidia. “Why do I have a pension and you don’t? Because you started later? That makes no sense to me. We’re equals.”

Chavez and her husband have been on strike together since Oct. 21. “Kaiser members deserve equity and access to timely quality care,” she said. “Workers are experiencing high caseloads, inadequate and unsafe staffing, lack of time, lack of tools.”

The hunger strike week started with iconic labor leader and activist Dolores Huerta visiting the picketers on April 8, two days before her 95th birthday. “I know that you’re not just doing this on your own behalf,” said Huerta, surrounded by cheering union members in their red union T-shirts. “You’re actually doing this on behalf of all the patients at Kaiser that are not getting the mental health services that they deserve.”

The union cites a recent 88-page report from the state Department of Managed Health Care, which notes that Kaiser’s failures to remedy 19 of the 20 violations in 2022 led to $200 million in state fines. The union has also filed its own complaints alleging Kaiser mismanages patient triage and appointment scheduling, by hiring unlicensed clerical staff and using algorithmic programming.

“Despite the persistent efforts of NUHW to mislead the public, the Department of Managed Health Care (DMHC) has not identified new deficiencies in our mental health care,” said Kanakri’s statement. It went on to say that Kaiser met with the state department “last week in our first quarterly review and demonstrated the extraordinary progress we have made on all the deficiencies outlined in the Corrective Action Work Plan.”

“We’re in disbelief,” said hunger striker Nick Nunez, a therapist in Kaiser’s Virtual Medical Center, which lends support to any patients in need across Southern California. “They take out ads in the paper saying everything’s fine — that they’re providing adequate care to their patients and everything is top-notch. It’s so bizarre and unbelievable.”

Andrew Kane worked as an associate clinical social worker at the Los Angeles Medical Center he now pickets and fasted at. “It’s a little odd, a little surreal,” he said, noting that he happened to see a patient in the world outside of Kaiser. “Fortunately — or unfortunately — he didn’t notice me, so we didn’t have to have that interaction.”

Kane started in June 2024, so he’s been on strike longer than he’s received a Kaiser salary.

As the strike persisted without end in sight since October, many workers have returned to Kaiser due to financial concerns. But some communicate the problems they see internally while back at work.

“They’re actually the ones documenting all the things going wrong,” said hunger striker Kassaundra Gutierrez-Thompson, a psychiatric social worker in Kaiser’s ADAPT virtual online treatment program. “We have DMHC investigators talking to a lot of our returned back staff. Unfortunately, a lot of our managers are combatting them.

“And so, a lot of our members are kind of scared, having to advocate for our patients.They’re fighting a different kind of battle inside.”

Rage Against the Machine guitarist and political labor activist Tom Morello joined the Kaiser picketers on April 9 to perform a short acoustic set, and U.S. Rep. Sydney Kamlager-Dove and state Sen. Maria Elena Durazo visited the strikers April 11.

Hours later, they broke their fast with religious leaders passing around a ceremonial bread loaf.
“We can’t just be treated like numbers,” said hunger striker Ana Vargas Garcia, who also saw members remotely through the ADAPT program. “Patients can’t be treated like numbers. There’s real lives behind everyone that we see, behind every worker at Kaiser. That’s a big part of why we’re doing this.”

It's tick season, possibly the worst in a decade.

More and more Americans are being exposed to these parasites as climate change expands the range where they can survive. That means more people are also exposed to the bevy of health conditions they can cause, such as Rocky Mountain spotted fever, the alpha-gal-triggered red meat allergy and, most common of all, Lyme disease.

For Lyme disease, there may be some additional protection on the horizon. Pharmaceutical companies Pfizer and Valneva announced this spring that they plan to seek regulatory approval for a vaccine to protect against Lyme disease. A previous vaccine for Lyme became available in the late 1990s but was pulled only three years later due to lawsuits, public fear of side effects and a lack of interest.

It's unclear whether this latest stab at a Lyme disease vaccine will get a warmer reception if it's approved, especially in the post-COVID era of vaccine skepticism.

For a sense of how it might go over with rural populations at high risk of Lyme, KFF Health News spoke with a group of hunters.

Few people spend more time in the woods exposed to ticks. At the same time, as a collective, hunters  skew conservative, rural and male, according to a survey from the Theodore Roosevelt Conservation Partnership. And these are identities associated with increased hesitancy about or resistance to vaccines, according to Ashley Kirzinger, associate director for Public Opinion and Survey Research at KFF, a health information nonprofit that includes KFF Health News.

Targets for ticks

Left untreated, Lyme can cause a variety of symptoms, from fevers, chills and headaches to arthritis, shooting pains and inflammation of the brain and spinal cord, according to the Centers for Disease Control and Prevention.

About 476,000 people in the U.S. may be diagnosed and treated for Lyme disease each year, the CDC says. That's at least in part because the range of places where cases have been reported has "expanded significantly" since 1995.

So would hunters get the Lyme vaccine if it became available?

"Given my proclivity for the outdoors, absolutely," said Jess Manganelli, one of seven hunters (and one hiker) who spoke with KFF Health News on a recent Saturday at the Busch Shooting Range in Weldon Spring, Mo., just outside of St. Louis.

Of the eight, Manganelli, who had been hunting turkeys the weekend before, was the most positive about the vaccine. Six others said they would consider it but would want more information about its safety and effectiveness, as well as their risk for contracting the disease.

But Manganelli was the only one who believed she may have previously contracted Lyme disease, although she was never formally diagnosed with it. Two years ago, she experienced muscle weakness, tiredness, fatigue, swelling and headaches after a tick bite, but when she went to urgent care, she was told they didn't test for Lyme.

Nearly all the hunters knew someone who had had Lyme disease — an old roommate, a family member, friends, a former student. Lyme can be difficult to diagnose and to treat and is often misdiagnosed at first. Many of the hunters witnessed their acquaintances navigating those challenges and struggling with sometimes debilitating symptoms.

An illness with lingering effects

That familiarity among the hunters in Missouri was unsurprising to author and conservationist Steven Rinella, host of the hunting show MeatEater.

"I'm a turkey hunter. In talking about turkey hunting, you talk about ticks as much as you talk about turkeys," Rinella said. "Just the nature of turkey hunting puts you into exposure. You're sitting for long periods of time, trying to use vegetation for concealment."

In fact, both Rinella and his older son contracted Lyme disease 13 years ago during a bluegill fishing trip in the Hudson Valley in New York. His son developed Bell's palsy, a sudden paralysis on one side of the face, but recovered quickly after a course of oral antibiotics. Steven Rinella's symptoms, on the other hand, lingered for months, leaving him unable to walk down stairs without a handrail or to ride a bike. He ended up receiving intravenous antibiotic treatments for a month.

"I thought my life had changed," Rinella said, "but I recovered, as far as I know."

That experience is one reason Rinella said he would absolutely consider getting a Lyme vaccine if it proved safe and provided considerable protection against the disease. Unlike with some other diseases, prior infection does not provide permanent immunity, so a person who has had Lyme could still benefit from a vaccine.

Knowledge of similar challenges influenced the thinking of the hunters in Missouri as well.

Jeremy Hollingshead said he may be less inclined to take a vaccine owing to his former roommate's experience with Lyme disease, which is not to say the experience was pleasant. In fact, Hollingshead said he thinks his old pal is still dealing with lingering effects of it 10 years later. But Hollingshead has spent his whole life in the woods, and of hundreds of people he knows who have done the same, he knows of only one of them contracting Lyme.

"I know it was a bad outcome for him," Hollingshead said, but he thinks the odds of getting Lyme himself seem pretty slim.

Meanwhile, Julian Barnes said seeing a relative struggle with Lyme makes him more open to a potential vaccine. It took a long time for doctors to come to that diagnosis, and finding a good treatment has been equally difficult.

"I would say I am vaccine-hesitant, generally speaking," Barnes said. "But Lyme, I've seen the way it affects people in my life. ... I would definitely have to really understand the vaccine, how it works."

An unclear path for a new vaccine

The new, four-dose vaccine candidate technically missed one of the bars set out in trials because not enough participants contracted Lyme. Still, the companies say it's about 75% effective in reducing cases, and they plan to submit it to regulators for approval. A Pfizer spokesperson said there were no updates on their regulatory efforts when contacted by KFF Health News in June.

Health and Human Services Secretary Robert F. Kennedy Jr. was a noted anti-vaccine activist before taking over as head the agency that oversees vaccine approvals, and he's remade it in ways that have prompted some vaccine makers to pull back on development.

But he's also been an advocate on Lyme disease. In May, he announced an initiative to combat Lyme disease. And during his Senate confirmation hearings, he said his family had been deeply affected by Lyme disease and that nobody would work harder than he would to find a vaccine or treatment.

If the vaccine is ultimately approved by the FDA, an endorsement from Kennedy would go a long way, according to KFF's Kirzinger, particularly among supporters of his Make America Healthy Again movement, who tend to be more vaccine-skeptical.

"They trust him as much as they trust their own doctors to tell them what to do with their health and for health information," Kirzinger said. "If he comes out as a strong proponent of this vaccine and says, 'Look what my administration did, and we made this available,' I would imagine there would be less vaccine resistance among that group."

Only one of the hunters who spoke with KFF Health News said they definitely would not be interested in a Lyme vaccine if it became available.

"I kind of hand it off to God and the body he gave me. I'm pretty durable," JP Cummings said. But even though he's not interested in it for himself, he's curious to see what his fellow hunters do as more information comes out.

"Hunters care about the wildlife; hunters care about health," Cummings said. "They love the wildlife, they love their deer, and they love their fellow hunters."

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.

Far more people than previously known have dropped Affordable Care Act health insurance for 2026, according to data released Friday.

Five million fewer people are currently enrolled in ACA marketplace plans compared to the record high reached last year. More than 1 million fewer people picked a plan for 2026, and then 4 million more either disenrolled or failed to pay their premiums and, therefore, dropped coverage.

Prices in the market skyrocketed after President Donald Trump and Republicans in Congress failed to extend extra financial help for enrollees last year. The Department of Health and Human Services published a report about the data on its website Friday.

The report says 19.2 million people are currently enrolled in ACA insurance now.

At its high, 24.2 million people were in the ACA marketplace in 2025, according to government figures.

The steep drop in enrollment reflects what insurers, administrators and other health policy experts expected earlier this year. After initial sign ups were lower than last year, they predicted the picture would get worse as time went on and people found they could not afford to pay their premiums.

"The main takeaway is that enrollment is down 13% from last year," explains Cynthia Cox, director of KFF's Program on the ACA. "While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced double- or even triple-digit increases in their premium payments with the expiration of enhanced tax credits."

The idea that the growth in enrollment was due to massive fraud is a theory advanced by the Paragon Health Institute, a conservative think tank influential in the Trump administration.

Many health policy experts are skeptical. They say the increase in enrollment during the pandemic is not suspicious. It was a predictable consequence of Congress's investment of billions of federal dollars in making premiums more affordable — the enhanced premium tax credits.

"The marketplace doubled in size during the period when there were enhanced subsidies because the coverage was much more affordable and much more appealing to people," Cox says.

This year's drop in enrollment is also predictable, given that premium costs doubled, on average, from 2025 to 2026. The costs went up after Republican lawmakers let the enhanced premium tax credits expire; Democrats shut down the government in October 2025 trying to negotiate an extension of the credits that would have kept prices low.

"When their costs went up, many of them dropped their coverage," Cox says.

She adds that while fraud is a real problem in the ACA marketplaces, as it is in all insurance markets, she thinks it does not account for all of the drop in enrollment.

Stacey Pogue, senior research fellow at the Georgetown Center on Health Insurance Reforms, agrees.

"I don't see data that point to that conclusion that a 5 million-person drop can be explained by allegations of fraud," she says. "There's lots of evidence pointing to people making decisions based on what they can pay each month."

The higher health insurance costs are tough for consumers in an economy still plagued by overall inflation. As congress let the prices go up, people made tough decisions about family budgets, where to work, whom to marry and more.

It's also a problem for insurance companies, several of which have announced they will not be participating in ACA markets next year, including Cigna.

"If there are fewer customers, then that makes the market less appealing to insurance companies," Cox says.

That's especially true because the people dropping their coverage tend to be healthier people. If too many healthy people drop out of the markets, there's a danger that the markets could enter a "death spiral."

Cox says she's not worried about a death spiral at this point.

"I think there are still enough people buying ACA marketplace coverage and that's going to keep these markets working," she says. "At this point, we don't see any parts of the country that are at risk of having no insurance company. If that were to happen, that would be what a death spiral might look like."

Even so, the premiums for these plans are on track to keep rising, which could continue to pummel consumers navigating high health care costs. Enrollment in the marketplaces may continue to shrink too. According to a recent analysis from Pogue at Georgetown, early insurance rate filings for 2027 show that rates will be going up again next year.

Topline:

Details: The person was hospitalized with neuroinvasive illness and is currently recovering at home, Long Beach said in a statement.

Symptoms: WNV is transmitted through the bite of an infected Culex mosquito. Most people infected have no symptoms.

Less than 1% of infected patients develop neuroinvasive disease, which typically manifests as meningitis, encephalitis or acute flaccid myelitis, according to the Centers for Disease Control and Prevention.

People over 50 or who have chronic health conditions are at higher risk. Those with severe symptoms should seek immediate medical care.

There is no vaccine or treatment for WNV.

Why now: The risk of West Nile increases during hot weather, typically between June and October. While mosquitoes have tested positive for West Nile virus in California, this is the first symptomatic case in the state this year. Long Beach said it has not detected any WNV-positive mosquitoes in the city.

How to protect yourself:

The risk of WNV and other mosquito-borne diseases increases during hot weather. Health officials recommend taking these precautions:

• Prevent mosquito bites by applying insect repellent with EPA-registered active ingredients DEET, picaridin, IR3535 or lemon eucalyptus before going outside.
• Wear long-sleeved shirts and long pants if spending time outside during dawn and dusk. WNV-carrying mosquitoes are most active during those times.
• Install or repair door and window screens.
• Dump and drain standing water around home.
• Report dead birds online or call 877-WNV-BIRD (968-2473)

Twice a month, a popular night spot in Koreatown is transformed into a makeshift boot camp for a cadre of gamers to achieve mastery of old-school arcade games.

Their recent goal: training to take home the prize at the EVO esport championship in Las Vegas this weekend – where the main attraction is the latest edition of the ‘80s franchise, Street Fighter 6 – and to put SoCal on the map.

The Down Back Club (DBC) meets every other Tuesday at Mama Lion on Western Avenue, the longstanding Koreatown bar.

Down Back Club at Mama Lion in Koreatown.

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Ezra Silkin

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The dimly lit cocktail lounge near the Wiltern is typically more of a setting for a first date or a casual business meet-up. But gathered under its chandeliers earlier this month was a group of about 100 people, staring into screens big and small, fingers deftly working a controller stick, as they practice the “down-back” – one of the foundational maneuvers in Street Fighter where a player pushes the down and back buttons together, sending their character into a crouched blocking position.

And yes, the club is named after said move.

From arcade to the living room ...

When Street Fighter debuted in 1987, players played side by side in the arcade, then later, via home consoles in living rooms.

“You were playing IRL,” says Daniel Collette, 30, co-founder of DBC. “Because the core concept of the genre is that you are competing against the person sitting next to you.”

Inevitably, gaming moved online, making for a more isolating experience. Collette, a longtime gamer who’s worked in the gaming industry as a producer and writer, wanted to bring back that human interaction.

Down Back Club.

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Ezra Silkin

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Gamers gather at Down Back Club to get better at Street Fighter 6.

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... to now a Koreatown bar

The Down Back Club started in 2023 primarily for hardcore gamers at a small brewery in downtown L.A.’s Arts District. The club moved to Mama Lion last year, as participants expanded to include all levels of play.

One player training at DBC with high hopes for EVO this weekend is Gregory Wells, 26, a local high school field and track coach. He says people in the club lift each other up, but camaraderie isn’t the only reason why he goes.

“Once I started going, I've learned so much more from playing people in person, being able to get instant feedback.”

While personal connection is the goal, the night is structured around tournaments where players pay $20 to compete. First place comes with about $100 in cash prize, Collette says, depending on the bracket size. Spectator attend for free. Besides Street Fighter 6, other standard games at DBC include Tekken 8, 2XKO, Guilty Gear Strive.

While large cash prizes and big prestige are on the line tournaments like EVO, regulars say it’s also about upping the profile of L.A. players in the international scene.

Bragging rights

Gamers at Down Back Club.

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Ezra Silkin

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LAist

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“The goal is that everybody gets really good. So when we all go to a tournament, SoCal f**ks everybody up,” says Paul DeCuir, 42, a kitchen worker and Street Fighter veteran who plays as DeeJay — the happy-go-lucky Jamaican kickboxer.

Historically, Japanese players have dominated. A main reason, DeCuir says, is because videogames occupy a higher cultural perch in Japan than in the U.S.

The idea of someone pouring hours into upskilling at a single videogame may seem baffling to most folks outside the community, but for some players, that discipline has seeped into other areas of life.

Like Daniel Chong, 34, another veteran player and a chef who worked at Nobu and other noted restaurants.

“You need to go! You need to just trust yourself, and any hesitation will get you killed,” he says, kind of like working in a busy and high-stress kitchen. “So it's very in the moment. Nothing else matters – that's kind of what it feels like playing in a tournament.”