Economic Vulnerability Among US Female Health Care Workers: Potential Impact of a $15-per-hour Minimum Wage

Kathryn E. W. Himmelstein, MD, MSEd; Atheendar S. Venkataramani, MD, PhD


Am J Public Health. 2019;109(2):198-205. 

In This Article

Abstract and Introduction


Objectives: To investigate racial/ethnic and gender inequities in the compensation and benefits of US health care workers and assess the potential impact of a $15-per-hour minimum wage on their economic well-being.

Methods: Using the 2017 Annual Social and Economic Supplement to the Current Population Survey, we compared earnings, insurance coverage, public benefits usage, and occupational distribution of male and female health care workers of different races/ethnicities. We modeled the impact of raising the minimum wage to $15 per hour with different scenarios for labor demand.

Results: Of female health care workers, 34.9% of earned less than $15 per hour. Nearly half of Black and Latina female health care workers earned less than $15 per hour, and more than 10% lacked health insurance. A total of 1.7 million female health care workers and their children lived in poverty. Raising the minimum wage to $15 per hour would reduce poverty rates among female health care workers by 27.1% to 50.3%.

Conclusions: Many US female health care workers, particularly women of color, suffer economic privation and lack health insurance. Achieving economic, gender, and racial/ethnic justice will require significant changes to the compensation structure of health care.


Women constitute the vast majority of health care workers in the United States. Although most US physicians are male, women occupy more than 85% of positions as nurses and as nursing, home health, and personal care aides.[1] Nearly 20% of women in the US workforce are employed in health care, and this share is likely to grow in coming years given projected growth in women-dominated health care fields.[2] The US Bureau of Labor Statistics anticipates that health care employment will increase nearly twice as fast as the population, and 5 of the 10 occupations projected to have the greatest employment growth through 2026 are in health care, with "home health care services"—an occupation whose workforce is 88% female—leading the projections.[3,4]

The wages and benefits of health care workers thus have significant implications for women's economic well-being and, consequently, their health. This is of particular importance given that many health care jobs in which women represent the majority of workers are low paying—and even within the same jobs, women tend to be paid less than their male counterparts.[5] There is also significant evidence that workers of color across all industries receive lower compensation than do their White colleagues, with women of color particularly disadvantaged.[6] Within health care, Black women were the only group of women who experienced a decline in median wages between 2005 and 2015, from $16.06 to $15.71 per hour.[7]

Existing literature has briefly described the experiences of specific demographic groups and health care professions, as well as the health insurance coverage of health care workers before the passage of the Affordable Care Act.[7–17] However, a systematic analysis of the gender and racial/ethnic distribution of wages among workers across the health care industry—and the prevalence of poverty, uninsurance, and poor health among low-wage female workers of different races—has not been conducted. Moreover, the possible effects of labor market policies on socioeconomic and health outcomes among female health care workers are not known.

This study addresses this critical gap in the literature with nationally representative US data from 2017. We first examined wage distributions for male and female workers in the US health care system, as well as racial/ethnic subgroups of female workers, quantifying the share of workers of each demographic group currently earning less than $15 per hour. We then examined rates of poverty, insurance coverage, public benefit utilization, and poor self-reported health among female and male health care workers, and among women of different races/ethnicities. Finally, we assessed potential consequences of raising the minimum wage to $15 per hour, a popular policy proposal recently adopted by 6 major US cities and by several large private hospital systems and health insurance firms.[18–20]