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Tens of thousands of Kaiser Permanente workers have voted to authorize a strike if no agreement is reached with their unions by the end of September, union officials announced Thursday.

SEIU United Healthcare Workers West said nearly 60,000 workers in California had approved a possible strike, teeing up what could be the biggest strike by healthcare workers in U.S. history. Its members include nursing assistants, housekeepers, phlebotomists and medical assistants.

Unions representing additional Kaiser workers in Colorado, Oregon and Washington have also announced the same decision, with some unionized workers at Kaiser facilities still voting through next Wednesday.

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No strike would occur before October, after the contract expires for more than 85,000 Kaiser Permanente workers whose unions have formed a coalition. Their absence would be significant: The Coalition of Kaiser Permanente Unions said it represents roughly 40% of the overall Kaiser Permanente workforce.

Union leaders have complained about understaffing, saying that it can lead to alarmingly long wait times for patients, said management proposals on wages and workforce development would only worsen the staffing crisis, and argued that the health system had not bargained with them in good faith.

SEIU-UHW President Dave Regan said that workers “have overwhelmingly voted to authorize a strike because we will not simply stand by as Kaiser violates the law and puts patients at risk.”

Kaiser Permanente said in a statement Thursday that it was confident that it would soon reach an agreement “that strengthens our position as a best place to work and ensures that the high-quality care our members expect from us remains affordable and easy to access.”

It called the vote to authorize a strike “a disappointing action considering our progress at the bargaining table” and disputed union claims about its proposals, saying that it was offering wage increases and has been aggressively recruiting to fill positions.

More bargaining sessions are scheduled for next week.

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