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NELP|APRESCRIPTIONFORGOODJOBSINTHEINDUSTRIALMIDWEST|AUGUST2017 1

APrescriptionforGoodJobsintheIndustrialMidwest:LaborStandardsandUnionsintheBoomingHospitalIndustry

Introduction&Summary

Acrossthenation,Americansareworkingharderandproducingmorebutstillstrugglingtogetby.1Despitelowunemploymentrates,manyworkersincreasinglyfeelliketheeconomyisnotworkingforthem,withgrowinginequality,stagnantwages,andevendeclininglifeexpectancyfuelingeconomicanxiety.2Nowonderthatpolicymakersacrossthepoliticalspectrumseecreatingmoremanufacturingjobsasakeypolicygoal.Manufacturinghaslongbeenassociatedwithgoodjobs,inlargepartbecauseofitsstrongunionsandhistoricallyrobustlaborstandards.3ThishasbeenparticularlytrueintheIndustrialMidwest,4wherefordecadesqualitymanufacturingjobsenabledresidentstobuildsecuremiddle-classlives.Itisimportantthatthosevaluesbepreservedintoday’sgrowingindustrysectorssothattheregioncansustainitsstrongandvibrantcommunities.Healthcareisonesuchgrowingindustrysector—oneexpectedtoaddmorejobsthananyothersectoroverthenextdecade.5Withinhealthcare,thehospital

DATABRIEF|AUGUST2017


industryinparticularprovidesakeyexamplenotonlyoftheopportunitythatcomesfrombringingworkervoiceandimprovedlaborstandardstotheservicesector,butalsoofthescopeofchallengesahead.InmanymajorcitiesintheIndustrialMidwest,hospitals(orhealthcaresystems6)areamongthelargestprivate-sectoremployers.SeeAppendixA.Hospitalsareoftentheeconomicanchorsoftheircommunities,generatingmillionsofjobs,directlyorindirectly.7Asaresult,hospitalsandthewagestheypayhaveanoutsizedroleontheimpactoftheeconomichealthofcommunities.Buttoday,thevastmajorityofhospitalservicejobsarenotobjectively“goodjobs.”Foreveryhigh-paiddoctorinthehospitalindustryintheIndustrialMidwestandindeednationwide,therearemorethansixworkersprovidingvitalsupportiveservicesthatastronghealthcaresystemneeds:workerswhosterilizesurgicalinstruments,cleanhospitalrooms,maintainpatientfiles,prepareanddeliverfood,keeppatientscleanandcomfortable,andtransportpatientswithinthehospital.8Today,toomanyofthesejobsfailtopayalivingwage,tothedetrimentofthemorethan300,000workerswhoholdthesejobsintheIndustrialMidwestalone,manyofwhomarewomenandpeopleofcolor.Foreveryhighlypaiddoctorinthehospitalindustry,therearesixworkersprovidingessentialsupportiveservices.Wehavetheopportunityasanationtoimprovethesejobsbyapplyingkeyprinciplesfrommanufacturingjobs—specifically,byimprovinglaborstandardsandensuringthatworkershavevoiceintheworkplace.Raisingtheminimumwageto$15perhourandrespectinghospitalworkers’righttojoinaunionwouldsignificantlyimprovethejobsinthegrowinghospitalindustryandthehealthcaresectormorebroadly.ServiceSectorOffersOpportunitytoGrowGoodJobs

Formanydecades,theservicesectorhasdrivenbothemploymentandemploymentgrowthintheUnitedStates.Since1980,theprivateservicesectorhasaddedmorethan52millionjobs,andby2016itrepresented83percentofallprivateemployment.Incomparison,manufacturingoverthissameperiodhasshedsixmillionjobs—a34percentdropfrom1980—andnowrepresentsjust10percentofallprivate-sectoremployment.(SeeFigureA.)Healthcare—onesignificantcomponentoftheservicesector—hasexperiencedsharpincreasesinemploymentoverthelast25years,adding6.8millionjobs,anearly80percentincreaseoverthatperiod.9Giventhesetrends,healthcaretodayeclipsesnearlyallotherprivate-sectorindustrysectorsinemployment.Itissecondonlytoprofessionalandbusinessesservices,andhealthcareisprojectedtoovertakethatsectoraswellby2024.10


FigureA:U.S.PrivateServiceSectorandManufacturing1980-2016

Source:AggregateddatafromtheU.S.PrivateServiceSectorandManufacturing1980-2016,CurrentEmploymentStatistics,BureauofLaborStatistics.TheIndustrialMidwestlargelymirrorsthenationaltrends,withmanufacturinglosing1.4millionjobsandhealthcaregaining1.3millionoverthelast16years.By2016,healthcareendedupwithanet780,000moreworkersinthisregionthanmanufacturing.11(SeeFigureB.)Withinhealthcare,hospitalsinparticularhavegrownby18percentsince2001.12

FigureB:IndustrialMidwestHealthcareandManufacturingEmployment2001-2016

Source:AggregateddatafromtheQuarterlyCensusofEmploymentandWages,BureauofLaborStatistics,forthe11IndustrialMidweststates,https://www.bls.gov/cew/.

0

50

100

150

200

250

U.S.Employment1980-2016Index1980=100

PrivateServiceProviding Manufacturing

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000

5,000,000

5,500,000

6,000,000

6,500,000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

HealthCare&SocialAssistance Manufacturing


HealthCareWillContinuetoDriveJobGrowthinServiceSector

AccordingtothelatestbiennialBureauofLaborStatistics(BLS)long-termemploymentprojections,healthcareiscurrentlythefastest-growingindustrysectorintermsofemployment,anditisexpectedtoaddthemostnewjobsnationwidefrom2014to2024.Thesectorisprojectedtogrow21percent,providing41percentoftotalemploymentgrowthoverthatsameperiod,whilemanufacturingemploymentisprojectedtodecrease7percent.BLShasalsoprojectedthatthehealthcareindustrywillhaveallfiveofthetopfivefastest-growingsectors(bydetailedindustry),andthreeofthetop10sectorsaddingthemostjobs,includingthehospitalsector,whichitselfisprojectedtoincreaseby394,900jobs.13(SeeFigureC.)

FigureC:BLSNationwideEmploymentProjections

Source:ProjectionsofIndustryEmployment2014-24,BureauofLaborStatistics,https://www.bls.gov/careeroutlook/2015/article/projections-industry.htm.


Moststatesproducetheirownprojectionsofjobgrowththatlargelyparallelthenationalpredictions.In10oftheIndustrialMidweststatesidentifiedabove(allbutKentucky),thehealthcaresectorinaggregateisprojectedtoaddmorethan650,000jobsinthedecadeendingin2024—a13percentincreasefrom2014—including120,000inhospitals.14Overthesameperiod,manufacturingintheregionisprojectedtoexperiencenetjobloss,includinginsevenofthe10statesthatmakeprojections.15SeventyPercentofServiceWorkersinHospitalsEarnLessThan$15anHour

Foreveryhigher-paiddoctorinhospitalsintheIndustrialMidwest,therearemorethansixserviceworkersinhospitalswhoperformavarietyofimportantfunctionsrelatedtoensuringthatpatientsgetpropermedicalcare.Thisworkincludestendingtopatients,transferringpatients,cleaning,stockingsuppliesandequipment,cooking,foodanddrinkpreparation,processingspecimens,completingandmanagingdrugorders,sterilizingsurgicalinstruments,andtransportingpatients,amongothercriticaltasks.Morethanonemillionofthenation’shospitalworkersareemployedinthethreebroadoccupationalcategoriesthatcapturethiswork—healthcaresupport,foodpreparationandservice,andbuildingandgroundscleaning.16Table1providesrepresentativeoccupationaltitlesundereachofthesegroups.

Table1:RepresentativeServiceWorkersinHospitals

MajorGroup

(OccupationCode)

HealthcareSupport(31-0000)

FoodPreparation

&Service(35-0000)

Building&

GroundsCleaning&Maintenance(37-0000)

RepresentativeOccupationalTitles

NursingAssistants;

Phlebotomists

Cooks;

Institution&CafeteriaFoodPreparationWorkers;

FoodServers,Nonrestaurant

Janitors&Cleaners;

Maids&HousekeepingCleaners

Thehospitalindustryisamajordriverofoureconomy.17In2015,thebroadersetofhealthcarespendingrepresented18percentoftheU.S.grossdomesticproduct;itisprojectedtoreach20percentby2025.18Hospitalsrepresentthesinglelargestcomponentofthehealthcaresectorandthesecond-largestsourceofprivate-sector


jobsoverall,employingmorethan5.4millionpeople,accordingtoindustryanalysis.19Oftenthelargestemployersintheircommunities,hospitalsthushaveboththeopportunityandresponsibilitynotonlytoprovidehigh-qualitycaretotheirpatients;theycanandmustincubategoodjobsintheircommunities,layingthefoundationforlong-termeconomicgrowthandcommunitystability.20Seventypercentofhospitalserviceworkersnationwide—and71percentintheIndustrialMidwest—arepaidlessthan$15anhour.ButouranalysisofgovernmentdatafindsthatAmerica’shospitalsarenotfulfillingthispromise.Acrossthecountry,70percentofhospitalserviceworkersarepaidlessthan$15anhour—anamountthatasingleadultlivinganywhereinAmericawouldneedtocoverthebasics,letaloneexpensesrelatedtoraisingchildrenorsupportingafamily.21IntheIndustrialMidwest,71percentofallhospitalserviceworkersarepaidlessthan$15anhour.22WomenandPeopleofColorHoldMajorityofHospitalServiceJobsinIndustrialMidwest

Womenandpeopleofcolordisproportionatelyholdservicejobsinhospitals,includingintheIndustrialMidwest.AccordingtoouranalysisofU.S.EqualEmploymentOpportunityCommissiondata,23inthe14metropolitanareaswithapopulationofmorethanonemillionintheIndustrialMidweststates,thevastmajorityofthehospitalserviceworkforceismadeupofwomen,andnearlyhalfoftheoverallworkforcearenon-white(Table2).Thismeansthathospitalsthatpaylowwagesamplifyandreinforcegenderedandracializedpatternsofincomeinequality,giventhatthemajorityofAfricanAmericansandLatinoworkers,andnearlyhalfofwomenworkers,makelessthan$15perhour.24Butthosehospitalsthattakeonthechallengetocreategoodjobshaveapowerfulopportunitytomakeadifferenceinaddressingstructuralinequalityinoureconomy.

Table2:DemographicsofHospitalServiceWorkersinLargeIndustrialMidwestMetroAreas(>1M)

Race&GenderIdentification

ShareofHospitalServiceWorkers

TotalNon-White 49%

Women 68%

Black 37%

BlackMen 13%

BlackWomen 24%

Hispanic 5%


ThePrescription:WorkerVoiceandStrongLaborStandards

Thesameone-twopunchthattransformedmanufacturingintothe20thcentury’sgood-jobsgeneratorcandrivecreationofgoodjobsinhospitalsandhealthcaremorebroadly.Thestartingpointsforthistransformationarehigherwagesandworkervoice.Higherminimumwageswouldimmediatelyraisethewagesofhospitalserviceworkersearninglessthan$15—amuch-neededeconomicboostforworkersintheIndustrialMidwestandthroughoutthecountry.Asoutlinedpreviously,atleast70percentofhospitalserviceworkers—and71percentofallhospitalserviceworkersintheIndustrialMidwest—wouldgetaraisewithsuchapolicy.Ensuringthatworkershaveavoiceinthetermsandconditionsoftheirworkdoesevenmoretocreategoodjobs.Toillustratetheroleofunionsinboostinghospitalserviceworkers,Table3capturesthestartinghourlywageforunionhospitalserviceworkersinSeattle,NewYork,andOakland,allofwhicharehigherthanthe$15mark.25

Table3:HourlyStartingWageforUnionWorkers

Occupation

Kaiser

Permanente,NorthernCalifornia

LeagueofVoluntaryHospitals&Homes

ofNewYork

SwedishMedicalCenter(Seattle)

CNA $25.58 $18.20

Cook $27.36 $23.26 $17.11

Dishwashers $18.05

FoodServer $24.38 $18.05 $16.11

HousekeepingCleaner $24.66 $18.05 $15.34

Laundry $18.05 $15.08

ParkingLotAttendant $24.49

PatientTransport $24.06 $15.34

ShuttleDriver $24.87 $18.83 $16.42

Workervoicedoesmorethanimprovethequalityofhospitalworkers’jobs:ithelpsensurethathospitalserviceworkersprovidethebestpossiblepatientcare.Forexample,ateamofeconomistsrecentlycompletedanempiricalanalysisofhospitalunionizationinCaliforniabetween1996and2005;theyfoundthathospitalswherekeycaregiverswereunionizedoutperformedhospitalsthatwerenotunionizedin12of13“nurse-sensitive”patientoutcomes,afteraccountingforhospital-specific


trends.26Theauthorsfoundthatafternurseswereunionized,hospitalshadsignificantdropsintheincidenceofeverythingfromsugarshockfromdiabetestodelusion,disorientation,anddepression.27Theysuggestnumerouspossibleexplanations,includingthathigherwagesmayresultin“increasing[employee]effort,reducedturnover,andpossiblyincreasingmorale.”28Thatrationalecouldsuggestsimilarbenefitsfromunionizinghospitalsupportworkersaswell.Conclusion

Oneofthekeylessonsofthe20thcenturyisthatsolidinvestmentinhigh-growthindustries,throughstronglaborstandardsandrobustworkerorganization,canconvertevendirtyanddangerousworkintogoodmiddle-classjobsthatnurtureandsustainworkingpeopleandtheirfamiliesandcommunities.Asimilarcommitmenttogoodhealthcarejobs,particularlyinlow-wagehospitalpositions,cantransformthe21stcentury’shigh-growthsectorsintoladdersoutofpovertyandintoathrivingmiddleclass.NotesonMethodology

Estimatingthenumberandshareofworkersmakinglessthan$15perhour:ThebulkofouranalysisinthisstudyusesdatafromtheCurrentPopulationSurvey(CPS),theprimarygovernmentsurveycontaininginformationonwagesandhours.TheCPSisamonthlynationalsurveyofapproximately60,000householdsthatisrepresentativeoftheU.S.non-institutionalpopulationaged16andolder.WeusedtheCurrentPopulationSurveyMergedOutgoingRotationGroups(CPSORG)filesmadepubliclyavailablebytheNationalBureauofEconomicResearch(NBER).WedefinedhospitalserviceworkerstoincludeworkersclassifiedintheCensusIndustrialClassificationas8190(Hospitals)inthesethreeoccupations:healthcaresupportoccupations;foodpreparationandserving-relatedoccupations;andbuildingandgroundscleaningandmaintenanceoccupations.Inordertohaveasamplesufficientlylargetoanalyzespecificoccupationsandindustries,ouranalysiscombinesdatafromthelastthreeconsecutiveyearsavailable(2014-2016).Weusewagevariablesinwhichallvalueshavebeenconvertedto2016dollars.Oursampleincludesprivate-andpublic-sector,hourlyandsalariedworkers.Weexcludeself-employedworkers.Fornon-hourlyworkers,hourlywagesarecalculatedusingreportedhoursworked.Thefigureswereportarecalculatedfromhourlyearningsthatdonotincludetips,overtime,andcommission.Notethatthereisatendencyforworkerstoreporthourlyearningsinroundnumbers,whichcausespercentilesofthedistributionto“clump”atwhole-dollarvalues.Ouranalysisdoesnot“smooth”wagestocorrectforthissourceofmeasurementerror.Forcalculationsinvolvingwages,weonlyincluderespondentsforwhomwagedataareavailable.


Appendix

CHICAGO

2ofthe3largestprivateemployersarehealthsystemso #1AdvocateHealthCare–18,930employeeso #3NorthwesternMemorialHealthcare–15,747employees

Source:Crain’sListChicago’sLargestEmployersasof12/31/2015MetroAreaHospitalEmployment&Projections

MetroArea2016HospitalEmployment

ProjectedNewHospitalJobs2014-24

Chicago(CookCounty) 130,504 4,163Chicago-Naperville-ArlingtonHeightsIL 155,608 8,130

Source:ILDepartmentofEmploymentSecurityhttps://illinois.virtuallmi.com/vosnet/dashboards/defaultana.aspx?menuid=MENU_START_PAGE_DASHBOARD_ANA&pu=1&plang=E

DemographicsofHospitalServiceWorkersValuesinPercentages

Chicago-Naperville-Elgin,IL-IN-WIRace/Ethnicity Men Women AllEmployees

ALLEMPLOYEES 31.36 68.64 100ASIANAMERICAN 2.72 3.78 6.5BLACK 11.35 25.34 36.69HISPANIC 6.68 12.63 19.31TOTALNONWHITE 21.29 42.75 64.04WHITE 10.07 25.89 35.96

Source:EEO-1data,https://www1.eeoc.gov/eeoc/statistics/employment/jobpat-eeo1/

HospitalMarketProfits–aggregatedMedicarecostreportdataforacutecare&children’shospitals

Chicago-Naperville-Elgin,IL-IN-WI

Chicago/CookCounty

Profits Hospitals Profits HospitalsFY2015 $1,311,974,147 73 $849,153,433 47

Source:CenterforMedicareandMedicaidServices,HealthCareCostReportInformationSystem(HCRIS)


CLEVELAND

Top2non-temporaryservicefirmemployersinClevelandarehealthsystemso #1ClevelandClinic–34,328employeeso #2UniversityHospitals–21,519

Source:Crain’sClevelandBusiness,CompanyData, December26,20164oftop10employersinthestateofOhioarehealthsystems

o #2ClevelandClinic–49,050employeeso #5MercyHealth–32.035o #7UniversityHospitalsHealthSystem–26,000o #8OhioHealth–22,340employees

Source:OhioMajorEmployers,OhioDevelopmentServicesAgency,April1,2017

MetroAreaHospitalEmployment&Projections



ClevelandMSA 69,000 4,800Source:OhioDepartmentofJobsandFamilyServices,http://ohiolmi.com/


Cleveland-Elyria,OHRace/Ethnicity Men Women AllEmployees




Cleveland Profits HospitalsFY2015 $985,892,275 24



DESMOINES

2oftop3employersinCentralIowaarehealthsystemso #2UnityPointHealth–8,026employeeso #3MercyMedicalCenter–7,055

Source:CentralIowa’sLargestEmployers,BusinessRecord2017BookofLists


MetroArea 2017Q1Hospital

Employment

ProjectedNewHospitalJobs

2014-24

NotesonProjectionGeography

DesMoines(PolkCounty)

11,663 610 WorkforceDevelopmentZone11(DesMoines

area)Source:IowaWorkforceDevelopment,https://www.iowaworkforcedevelopment.gov/labor-market-information-division


DesMoines-WestDesMoines,IARace/Ethnicity Men Women AllEmployees




DesMoines Profits HospitalsFY2015 $236,586,560 3



DETROIT

2of3largestprivateemployersinDetroit,or3of10largestarehealthsystems(excludingpublicuniversitiesandhealthsystems)

o #2DetroitMedicalCenter–9,184employeeso #3HenryFordHealthSystem–8,790employeeso #10AscensionHealth–3,159employees

Source:Crain’sDetroitListasofJune2016employees4oftop10largestprivateemployersinDetroitRegionarehealthsystems(excludingpublicuniversitiesandhealthsystems)

o #5BeaumontHealth–22,225employeeso #6HenryFordHealthSystem–17,332employeeso #8TrinityHealth–14,231employeeso #10AscensionHealth–11,303employees

Source:DetroitRegionalChamberofCommerce,LargestEmployersDetroitRegion2016MetroAreaHospitalEmployment&Projections

MetroArea 2016HospitalEmployment


NotesonProjectionGeography

DetroitMSA 97,700 6,000 DetroitProsperityRegion-Macomb,Wayne,OaklandCounties

Source:MichiganDepartmentofTechnology,ManagementandBudget,http://milmi.org/DemographicsofHospitalServiceWorkersValuesinPercentages

Detroit-Warren-Dearborn,MIRace/Ethnicity Men Women AllEmployees


Source:EEO-1data,https://www1.eeoc.gov/eeoc/statistics/employment/jobpat-eeo1/HospitalMarketProfits–aggregatedMedicarecostreportdataforacutecare&children’shospitals

Detroit Profits HospitalsFY2015 $519,069,155 37



MILWAUKEE

• Top3privateemployersinMilwaukeeareaarehealthsystemso #1AuroraHealthCare–26,462employeeso #2AscensionWisconsin–12,000o #3FroedtertHealth–10,913employees

Source:MilwaukeeBusinessJournal,LargestMilwaukee-areaPrivateEmployers,July21,2017


MetroArea2016HospitalEmployment ProjectedNewHospitalJobs2014-24

MilwaukeeMSA 39,400 N/ASource:WisconsinDepartmentofWorkforceDevelopment,http://worknet.wisconsin.gov/worknet/


Milwaukee-Waukesha-WestAllis,WIRace/Ethnicity Men Women AllEmployees




Milwaukee Profits HospitalsFY2015 $584,565,300 19



PITTSBURGH

• Top2privateemployersinPittsburghareaarehealthsystemso #1UPMC–46,480employeeso #2HighmarkHealth(includesAlleghenyHealthNetwork)–20,497

Source:PittsburghBusinessJournal,LargestPittsburgh-areaEmployers,July7,2017




PittsburghMSA 59,292 N/ASource:PennsylvaniaCenterforWorkforceInformationandAnalysis,http://www.workstats.dli.pa.gov/Pages/default.aspxDemographicsofHospitalServiceWorkersValuesinPercentages

Pittsburgh,PARace/Ethnicity Men Women AllEmployees




Pittsburgh Profits HospitalsFY2015 $446,605,310 29



Endnotes

1Productivitygainshaveplateauedinrecentyears.SeeMitchellHartman,“WhatKilledU.S.Productivity?,”Marketplace,January10,2017,accessedAugust16,2017,https://www.marketplace.org/2017/01/10/world/what-killed-us-productivity.Buttotalproductivitycontinuesinchingup—1.2%fromthesecondquarterof2016tothesecondquarterof2017,duetoacombinationofincreasesinoutput(2.7%)andhoursworked(1.5%).“SecondQuarter2017ProductivityandCostsReport,”BureauofLaborStatistics,accessedAugust16,2017,https://www.bls.gov/news.release/prod2.nr0.htm.2Thenationalunemploymentratehasdippedto4.3%,whichisthelowestrateinadecade.“LaborForceStatisticsfromtheCurrentPopulationSurvey,”BureauofLaborStatistics,accessedAugust16,2017,https://data.bls.gov/timeseries/LNS14000000.Butworkersacrossthecountrystillfeelacuteeconomicanxiety,whichhasanumberofdrivers.See,e.g.,KeithPayne,TheBrokenLadder:HowInequalityAffectstheWayWeThink,Live,andDie(NewYork:Viking,2017)(inequality);Bivens,Josh,and&LawrenceMishel,“UnderstandingtheHistoryDivergenceBetweenProductivityandaTypicalWorker’sPay:WhyItMattersandWhyIt’sReal,”EconomicPolicyInstitute,September2,2015,http://www.epi.org/publication/understanding-the-historic-divergence-between-productivity-and-a-typical-workers-pay-why-it-matters-and-why-its-real/;GinaKolata,DeathRatesRisingforMiddle-AgedWhiteAmericans,StudyFinds,https://www.nytimes.com/2015/11/03/health/death-rates-rising-for-middle-aged-white-americans-study-finds.html?_r=0(lifeexpectancy).3See,e.g.,BenCasselman,“AmericansDon’tMissManufacturing—TheyMissUnions,”FiveThirtyEight(2016),https://fivethirtyeight.com/features/americans-dont-miss-manufacturing-they-miss-unions/.4Seeibid.5“EmploymentProjections:2014-24Summary,”accessedAugust17,2017,https://www.bls.gov/news.release/ecopro.nr0.htm.6Hospitalsareoftenreferredtoashealthsystemstodescribethebreadthofinpatientandoutpatientservicestheyprovide.7AmericanHospitalAssociation(AHA),“HospitalsareEconomicAnchorsintheirCommunities,”accessedAugust17,2017,http://www.aha.org/content/17/17econcontribution.pdf.AccordingtheAHA,“…theimportanceofhospitalstotheircommunitiesextendsfarbeyondhealthcare,”toutingthemillionsofworkershospitalsemploybothdirectlyandindirectlythroughtheireconomicactivity.Ibid.8AggregateddatafromtheOccupationalEmploymentStatistics,BureauofLaborStatistics,fortheelevenIndustrialMidweststates,https://www.bls.gov/oes/.9CurrentEmploymentStatistics1980-2016,https://www.bls.gov/ces/.10“EmploymentbyMajorIndustrySector,”BureauofLaborStatistics,accessedAugust17,2017,https://www.bls.gov/emp/ep_table_201.htm.11AggregateddatafromtheQuarterlyCensusofEmploymentandWages,BLS,fortheelevenIndustrialMidweststates,https://www.bls.gov/cew/.12Ibid.13BureauofLaborStatistics,“ProjectionsofIndustryEmployment,2014–24,”accessedAugust17,2017,https://www.bls.gov/careeroutlook/2015/article/projections-industry.htm.14See“IllinoisEmploymentProjections,”IllinoisDepartmentofEmploymentSecurity,accessedAugust17,2017,http://www.ides.illinois.gov/LMI/Pages/Employment_Projections.aspx;“IndianaIndustryProjections,”HoosiersbytheNumbers,”accessedAugust17,2017,http://www.hoosierdata.in.gov/dpage.asp?id=57&page_path=Industry%20Data&path_id=7&menu_level=smenu1&panel_number=2;“IowaIndustryProjections,”IowaWorkforceDevelopment,accessedAugust17,2017,https://www.iowaworkforcedevelopment.gov/industry-projections;“MichiganDataSearch,”MichiganDepartmentofTechnology,ManagementandBudget,accessedAugust17,2017,http://milmi.org/datasearch/projections-excel);“MinnesotaEmploymentOutlook,”MinnesotaEmploymentandEconomicDevelopment,accessedAugust17,2017,https://apps.deed.state.mn.us/lmi/projections/EmploymentOutlook.aspx;“MissouriIndustryEmploymentProjections,”MissouriEconomicResearchandInformationCenter,accessedAugust17,2017,https://www.missourieconomy.org/industry/indprj/?naics=611300&prj=lt;“OhioEmploymentProjections,”OhioDepartmentofJobandFamilyServices,accessedAugust17,2017,http://ohiolmi.com/proj/projections.htm;“PennsylvaniaIndustryEmployment2014-2024Long-TermProjections,”PennsylvaniaCenterforWorkforceInformationandAnalysis,accessedAugust17,2017,http://www.workstats.dli.pa.gov/Documents/Projections/Industrial/PA/PA_LTIP.pdf;“WestVirginiaIndustryProjections,”WorkforceWestVirginia,accessedAugust17,2017,http://lmi.workforcewv.org/LTprojections/LTIndustryProjections.html;and“WisconsinLongTermIndustryEmploymentProjections,2014-2024,”Wisconsin’sWorknet,accessedAugust17,2017,http://worknet.wisconsin.gov/worknet_info/downloads/INDPRJ/lt_ind_2014.xlsx.Kentuckydoesnotprovidestateprojectiondata.15Ibid.


16Author’sAnalysisofCurrentPopulationSurveyMergedOutgoingRotationGroup2014-2016.17“HospitalsAreEconomicAnchorsinTheirCommunities,”AmericanHospitalAssociation,accessedAugust17,2017,http://www.aha.org/content/17/17econcontribution.pdf;“HospitalsasEmployers,”AmericanHospitalAssociation,accessedAugust17,2017,http://www.aha.org/content/11/110909-employer.pdf.18“NationalHealthExpenditureProjections2016-2025,”CentersforMedicareandMedicaidServices,accessedAugust17,2017,https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/proj2016.pdf.19“CutsThreatenHospitals’AbilitytoCureandCare,”AmericanHospitalAssociation,accessedAugust17,2017,http://www.aha.org/content/11/110909-employer.pdf.20Harkavy,IraandHarmonZuckerman,“EdsandMeds:CitiesHiddenAssets,”accessedAugust17,2017,http://staging.community-wealth.org/sites/clone.community-wealth.org/files/downloads/report-harkavy.pdf21Author’sAnalysisofCurrentPopulationSurveyMergedOutgoingRotationGroup2014-2016.Seealso“OurNationsWorkersNeedaFederalMinimumWageTheyCanRelyOn,”NationalEmploymentLawProject,accessedAugust17,2017,http://www.nelp.org/news-releases/our-nations-workers-need-a-federal-minimum-wage-they-can-live-on/.22Ibid.Forworkersinthethreebroadoccupationalcategoriesthatcapturehospitalservicework—healthcaresupport,foodpreparationandservice,andbuildingandgroundscleaning—theshareearninglessthan$15is71%intheIndustrialMidwest.23AllprivatehospitalsfileanEEO-1surveyannuallywiththeU.S.EqualEmploymentOpportunityCommission(EEOC)whichrequirescompanyemploymentdatatobecategorizedbyrace/ethnicity,genderandjobcategory.“JobPatternsForMinoritiesAndWomenInPrivateIndustry:AGlossary,”EEOC,accessedAugust17,2017,https://www.eeoc.gov/eeoc/statistics/employment/jobpat-eeo1/glossary.cfm.Althoughthedataareconfidential,theEEOCdoesmakecertaindataavailableinanaggregatedformatformajorgeographicareasandbyindustrygroup.24Huizar,LauraandTsedeyeGebreselassie,“Whata$15MinimumWageMeansforWomenandWorkersofColor,”accessedAugust17,2017,http://www.nelp.org/content/uploads/Policy-Brief-15-Minimum-Wage-Women-Workers-of-Color.pdf.25Author’sanalysisofrelevantcollectivebargainingagreements.26Dube,Arindrajit,EthanKaplan,andOwenThompson,“NurseUnionsandPatientOutcomes,”accessedAugust17,2017,http://econweb.umd.edu/~kaplan/NurseUnions.pdfp.817.27Ibid.at816.28Ibid.at827.©2017NationalEmploymentLawProject.ThisreportiscoveredbytheCreativeCommons“Attribution-NonCommercial-NoDerivs”licensefee(seehttp://creativecommons.org/licenses).Forfurtherinquiries,pleasecontactNELP([email protected]).