Jun 14, 2017

Under ACA, increased coverage paired with more jobs

The more a state's insured rate has increased since the passage of the Affordable Care Act, the more health care jobs that have been added in the state. That's the pattern we found when we compared the data on the growth of health care jobs with the health insurance gains in each state.

Note: Health care employment figures are taken from the Census Bureau's County Business Patterns dataset and include employed persons under the "Health care and social assistance" NAICS classification. Data: Census Bureau; Graphic: Chris Canipe / Axios

Why this matters: The House health care plan, which the Senate is currently editing, would cause an estimated 23 million people to lose insurance, according to the Congressional Budget Office. If that's true — and Republicans dispute the estimate — it stands to reason that this could lead to a slowdown in one of the fastest-growing job markets.

Those with the biggest growth in both coverage and health care jobs include a mix of red and blue states — so the impact would be widespread. "It would be hard to imagine it wouldn't have some negative impact on the growth in health jobs if you suddenly had 20 million more uninsured," said Ani Turner, a co-director at the Altarum Institute's Center for Sustainable Health Spending.

What to watch:

  • Coverage numbers alone won't determine the impact a new health law would have on jobs. Key questions include how hospitals and providers that see uninsured patients are compensated, and how that impacts their bottom line, Turner told me. An increase in the number of insured people likely created, at least temporarily, an increased demand for health care. It also decreased the number of people without coverage, who showed up at hospitals when they were sick but were unable to pay for their care.
  • The health care sector has been adding jobs steadily for a long time, including through the 2008 recession — which means the ACA's enhanced coverage is only partially responsible for the increase in jobs over the last few years. The Altarum Institute has a useful analysis of recent growth trends.
  • A slower growth in the number of health care jobs may not be a bad thing. "We should spend more on health care if we get health outcomes to justify it and less if we don't. We shouldn't subsidize an inefficient industry or starve an efficient one," David Cutler, a health economist at Harvard University, told me.
  • But a shrinking demand for health care workers could be more difficult for some parts of the country to deal with than others. "Bigger cities will find it easier -- lots of stuff to do," Cutler said. "Harder would be in coal country or small towns without much of a diversified employment base."

For context: Some in the industry see at least some stability in health care job growth, mostly because of the baby boomer effect. Younger workers will need to replace aging doctors, nurses and clinicians, as well as care for that aging population.

Go deeper