Eric Ruark's picture


  by  Eric Ruark

An article ran in Politico last week touting the need for more home health care aides as the Baby Boom generation ages.

Says Politico:

Demand for home health aides is expected to outstrip the growth for nearly all other jobs in coming decades, with the Bureau of Labor Statistics projecting the number of home health aide positions will increase 38 percent by 2024. That puts it among the top five fastest-growing U.S. occupations….So who’ going to do it?

This being Politico, of course the answer is that the United States needs many more immigrants to fill these jobs. According to Ted Hesson, the article’s writer, “The current move to curb immigration threatens to cut off the main supply of potential new workers to care for aging Americans.”

The BLS does indeed project that home health aides will be one of the occupations with the most job growth over the next decade, an estimated 425,600 more jobs in that field by 2026, but it does not at all follow that the United States needs to bring in hundreds of thousands of new immigrants to fill these jobs.

The best argument that Americans will do these jobs is made unwittingly by Hesson himself who says:

Right now, immigrant workers fill a significant share of the formal and informal caretaker workforce. In health care overall, immigrants (both legal and undocumented) make up roughly 17 percent of workers, on par with their representation in the broader labor force. When it comes to home health care, however, that figure is considerably higher: about 24 percent, according to the nonpartisan Migration Policy Institute….In theory, native-born Americans could take some of those jobs, but there are reasons to assume they won’t.

The claim that the Migration Policy Institute (MPI) found 24 percent of “home health care” workers are immigrants is not accurate. That figure refers to a broader category under the Bureau of Labor Statistics classification, “nursing, psychiatric, and home health care aides”
(# 31-1010), often referred to as direct-care occupations. It is true that the proportion of immigrants in this category is larger than the share of immigrants in the overall workforce, as it is true the overwhelming number of those same jobs are being done right now by U.S.-born workers. If 76 percent of jobs in that occupational category are filled by American workers, the argument that it’s difficult to find Americans willing to do those jobs is fallacious.

Hesson’s explanation for why so many immigrants are in home health care is that these jobs are readily available and generally do not require a college degree. These are valid points, but it only tells half the story. While the foreign-born are less likely than the native-born to have a college degree there are plenty of Americans without a college degree, well over 15 million, available for work, and those with an associate degree, or even a bachelor’s, might be attracted to direct-care occupations if employers offered greater incentives. Whether in health care or agriculture, too many employers prefer to hire new immigrants over potential workers who are already in the United States because these recent arrivals cost the employers less money. Current immigration policy allows for a continual supply of lower-wage labor, undercutting salaries and undermining working conditions in certain fields

The average annual wage for a home health aide is $23,300, according 2015 census data analyzed by the University of Washington Center for Health Workforce Studies. The average salary for personal and home care aides (a lesser-skilled position) is even lower, just $15,800 per year….The benefits – or the lack thereof – could also discourage U.S.-born workers from taking these jobs. For instance, many home health aides don’t have health insurance themselves — about 13 percent of full-time home health aides don’t have insurance, and the proportion is even higher for part-time workers. Other low-wage workplaces (McDonald’s, for instance) offer much better benefits, even tuition reimbursement, a perk that’s not common for home health work, according to [Bianca] Frogner [associate professor at the University of Washington School of Medicine].

Hesson contends “The strange thing about home health care work is that immigrants don’t appear to drive down wages, as happens in some other fields.” Kudos to him for acknowledging that immigration puts downward pressure on wages, which makes all the more curious his assertion that immigrants "tend to push wages higher" in direct-care occupations. Hesson cites as proof a study by the University of Washington Center for Health Workforce Studies that found “Naturalized citizens who worked as nursing, psychiatric and home health aides earned 22 percent more than their U.S.-born counterparts.” He doesn’t link to the study or even give its title (I couldn’t find it online), but even taken at face value, it doesn’t prove Hesson’s claim.

Without having looked at the study it is impossible to put that finding in context. It may tell us something about the education or skill level of the naturalized citizens, but it most certainly is not proof that immigration raises wages in the direct-care field. It doesn't tell us anything at all about overall wages for those occupations, or wage trends.

Something is driving down wages for direct-care workers, and Hesson makes a compelling case that something is immigration.

…if you cut off the supply of immigrant workers to the home health care sector, the cost of the service would increase — which in theory would lead to wage hikes and draw more people to those jobs. “You have people that are coming in and providing low-skilled labor, then that drives down the prices,” said Anupam Jena, an associate professor of health care policy at Harvard Medical School. “How much would it drive up the prices? That’s hard to know.”

Bringing in tens of millions more immigrants, who will demand far more from the system than they will ever pay in, is not a plausible solution to anything, even in the short-term. Yet, that’s the only solution that’s ever been proffered for the last half-century by our political elite, no matter the President and no matter the socioeconomic conditions; and that’s the solution Hesson, too, suggests

Hesson doesn’t consider the alternatives, at least not seriously. The article reads like, and has the appearance of, an advertisement for the corporate healthcare industry, which may have something to do with it being part of a series on “the future of health, presented by UnitedHealth Group.” For those not familiar with UnitedHealth Group, it is a managed health care company ranked sixth on the Fortune 500 with over $7 billion in profits last year.

Perhaps UnitedHealth Group could boost its profits in the coming decade if more U.S.-born workers in the direct-care health industry were replaced by immigrants. Perhaps.

ERIC RUARK is the Director of Research for NumbersUSA

Vulnerable Americans
Low-skilled Americans

Updated: Sat, Nov 11th 2017 @ 1:35pm EST

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