In 1990, healthcare didn’t lead employment in any state. It wasn’t even close. By 2024, it became the top employer in 39 states. That’s not a passing trend. It’s a full-scale shift in how the American labor market operates. The country has tilted toward healthcare, and the numbers are locking it in.
July 2025 labor data shows healthcare and social assistance now make up 14.2% of all nonfarm employment. That’s over 22 million jobs. In Massachusetts, the figure is 18.6%. Hospitals, clinics, insurers, and home health agencies are absorbing workers faster than any other sector.
This is nuts.
In 1990 healthcare wasn’t the top employer in any state
In 2024 it’s the top employer in 39 states
We are the united states of healthcare pic.twitter.com/n72Py3YBaO
— Carnivore Aurelius ©🥩 ☀️🦙 (@AlpacaAurelius) July 11, 2025
CVS Health employs more than 300,000 people. UnitedHealth Group is past 400,000. These aren’t just companies. They’re employment engines. In states like Pennsylvania, Ohio, and Michigan, healthcare systems are the largest employers by a wide margin. UPMC, Cleveland Clinic, and Trinity Health are not just providers. They’re labor monopolies.
Federal policy is reinforcing the shift. The One Big Beautiful Bill Act, signed in July 2025, includes $500 billion in Medicare cuts and nearly $1 trillion in Medicaid reductions starting in 2026. Providers are preparing for reimbursement shortfalls. Employers are bracing for higher insurance costs. The impact will hit hiring, wages, and benefit structures.
The SHRM 2025 Benefits Survey shows 97% of employers offer general health coverage. Dental and vision coverage sit at 99% and 96%. Nearly one quarter of employers now cover GLP-1 drugs for diabetes and weight loss, despite monthly costs of $700 to $800. These drugs are popular. They’re also expensive. And they’re driving up pharmacy budgets across the board.
Healthcare’s labor footprint is expanding. But it’s not just about headcount. It’s about dependency. When 39 states rely on healthcare as their primary employment engine, the system becomes embedded in the economy. That’s not a side effect. That’s the structure.
Sources