Testimony of Bill Hammond
Senior Fellow for Health Policy, Empire Center for Public Policy
Before the Committees on Health, Mental Health, People with Disabilities, Higher Education, and Labor
December 19, 2023
As state lawmakers consider policy changes intended to bolster New York’s health-care workforce, they should beware of overreacting based on incomplete or outdated information.
While pandemic-related labor disruptions are still affecting some providers and some regions, the state’s overall health-care workforce is bigger and better paid than ever.
As of this fall it has exceeded 1.3 million people, or almost one in seven working New Yorkers. That’s a quarter-million more jobs than at the low point of the COVID crisis, and 81,000 more jobs than its pre-pandemic high point in the fall of 2019.
New York now employs more health-care workers per capita than any other state, having surpassed Minnesota and Massachusetts over the past four years.
The state’s health-care workers are also earning more. Average pay for professional and technical health jobs was up 19 percent from 2019 to 2022, 5 points above the inflation rate. For health-care support staff, it was up 17 percent, or 3 points above inflation.
To be sure, these trends – derived from Bureau of Labor Statistics data – have not applied equally to all health-care sectors in all places.
Nursing home staffing remains sharply lower than before the pandemic, while home care hiring has soared. Health-care jobs – as with jobs of all types – have generally bounced back more quickly downstate than upstate.
On the whole, however, New York’s health care workforce is thriving – and any ongoing labor shortages are exceptions to a pattern of abundance.
Given this context, policymakers should avoid heavy-handed, broad-brush interventions.
For example, large across-the-board increases in Medicaid payments, as proposed by some industry groups, are likely to be wasteful and counterproductive. Because Medicaid enrollment is concentrated in New York City, the bulk of such spending would tend to flow to the part of the state which has already experienced the strongest health-care job growth.
Lawmakers should also keep in mind that New York’s per capita Medicaid outlays are the highest in the U.S. – and that there is a multi-billion-dollar budget gap to close in the coming year, which limits the capacity for new spending.
From March to April 2020, as the coronavirus pandemic first took hold, the state’s total health workforce dropped 13 percent in a single month – an unprecedented blow for an industry accustomed to steadily rising job counts.
Due to state-imposed restrictions on non-essential care, reduced consumer demand and other issues, employment did not return to its pre-pandemic level until the fall of 2022. In the year since then, however, the workforce has increased by 6 percent.
Within that general upward trend there were stark disparities, with different employer types, occupation categories and geographic regions recovering at widely varying rates.
Among provider types, home health care saw the strongest growth, increasing its employment level by 21 percent since the fall of 2019. At the other end of the spectrum are nursing homes, where employment remains 19 percent lower than its pre-pandemic level and shows no clear sign of bouncing back. In between are hospitals, which on a statewide level have regained all their pre-pandemic jobs and added another 2 percent.
On a population-adjusted basis, New York’s hospital workforce is 21 percent larger than the U.S. average. Its nursing home workforce – despite losses over the past three years – remains 16 percent larger than average.
Among occupation categories, home health and personal care aides have returned to their pre-pandemic pattern of robust growth. They now account for one out of every 18 workers and outnumber retail clerks and fast-food counter workers combined.
Nationally, New York’s per capita home-care workforce is an outlier – 144 percent larger than the U.S. average and 29 percent above the No. 2 state, California. The larger category of health-care support workers (which includes home care aides) is up 9 percent since 2019.
The number of practitioners and technical health-care workers grew by a relatively modest 2 percent.
The category of registered nurses – which has been a focus of public concern in recent years – has grown by 12,000 jobs or 7 percent from their pre-pandemic level.
Across all these categories, health care hiring has been relatively robust in the New York City area and relatively weak upstate. Hospital employment, for example, was up 9 percent in New York City but down 7 percent for the rest of the state.
Region- and industry-specific shortfalls notwithstanding, New York’s overall health care workforce is proportionally the largest in the U.S. and growing faster than the national norm. Given those facts, lawmakers should react cautiously to claims of sweeping or pervasive shortages – and limit their interventions, if any, to areas of true need.